Psychiatric services : a journal of the American Psychiatric Association
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Suicidal ideation frequently prompts visits to psychiatric emergency departments, and more information is needed about factors that mediate clinicians' decisions to hospitalize or discharge patients with suicidal ideation. ⋯ Psychosis, past suicide attempts, and the presence of a suicide plan robustly predicted the decision to hospitalize suicidal persons seen in psychiatric emergency services. Diagnosis, pharmacotherapy, having a psychiatrist, and insurance subtype were unrelated to hospitalization decisions, suggesting that psychiatric emergency department staff perceive few alternatives to hospitalization when psychosis and suicide plans accompany suicidal ideation.
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This study examined the number of days that prisoners spent in a special disciplinary housing unit in New York State prison before a suicide occurred. ⋯ Because most suicides in a special housing unit occurred within eight weeks of placement, enhanced observation of special housing inmates is warranted in that period at a minimum.
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The aim of this study was to ascertain trends from 1995 to 2002 in general hospital discharges among adults in the United States with serious mental illness. ⋯ The increasing trend in general hospital discharges involving serious mental illness has continued into recent years. Further investigations are needed to understand how patient- and system-level factors have contributed to the increasing trend in general hospital discharges involving an episode of serious mental illness.
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A significant proportion of patients of assertive community treatment (ACT) teams will adamantly refuse medication. Whether the team should continue to encourage medication or put a hold on advocating for medication is a clinical and ethical dilemma. On the basis of their clinical experiences, the authors propose best-practices criteria that ACT teams can consider in deciding whether medications may be temporarily discontinued when a patient refuses them. The authors suggest that in some circumstances stopping medications in such a case may help in the development or repair of a therapeutic alliance over the long term.
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Although antipsychotic polypharmacy is being prescribed with increasing frequency, few studies have described patient characteristics and treatment patterns associated with long-term use of this treatment strategy. ⋯ Long-term antipsychotic polypharmacy appears to be reserved for more severely ill patients with psychotic symptoms rather than mood symptoms. These patients may experience increased adverse effects as a result of excess antipsychotic exposure.