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Measuring observed mental state in acute psychiatric inpatients

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Abstract

Background

Relationships within acute psychiatric units between patient-level experiences and events and fluctuations in mental state have rarely been examined.

Aim

Data from a multi-centre service evaluation (11 units, 5,546 admissions) were used to examine mental state patterns and associations with clinical characteristics, events and adverse incidents.

Method

During the 12-month evaluation period, nursing staff completed shift-level ratings using a new rating scale, the observed mental state (OMS) scale, which assessed active psychopathology (emotional distress, disinhibition, psychosis, cognitive impairment) and withdrawal (45,885 sets of day/afternoon shift ratings).

Results

The OMS scale performed satisfactorily and is worth considering elsewhere (e.g., active psychopathology: internal consistency, α = 0.72; short-term stability, r = 0.72; sensitivity to change, adjusted standardised difference, ASD = 0.71). Levels of active psychopathology were much higher on shifts in which reportable (ASD = 1.47) and less serious aggression occurred (ASD = 1.44), compared with other shifts in which pro re nata medications were also administered (ASD = 0.76), suggesting that medication usage often followed these events, and possibly that agitation and distress levels either rose rapidly or went initially unnoticed on these shifts. Although mental state improved steadily across the admission, one-fifth of the patients with schizophrenia received OMS psychosis ratings in the moderate to severe range during the days prior to discharge.

Conclusions

Observed mental state ratings were strongly linked with diagnosis and reflected key events and incidents. Routine recording using the OMS scale may assist clinical decision-making and evaluation in acute psychiatric units.

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Acknowledgments

This project was sponsored by the Centre for Mental Health (NSW Department of Health and Aged Care, Sydney) and received considerable ongoing support from the three participating health services (Hunter, Illawarra, and South Western Sydney). We would like to formally acknowledge the assistance received from the nursing, medical, allied health and administrative staff within those services. Additional acknowledgments have been provided previously [9].

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Authors and Affiliations

  1. Centre for Brain and Mental Health Research Hunter New England Mental Health, University of Newcastle, P.O. Box 833, Newcastle, NSW, 2300, Australia

    Ketrina A. Sly, Terry J. Lewin, Vaughan J. Carr, Agatha M. Conrad, Martin Cohen & Srinivasan Tirupati

  2. Schizophrenia Research Institute, Darlinghurst, Sydney, NSW, Australia

    Terry J. Lewin, Vaughan J. Carr, Martin Cohen, Srinivasan Tirupati & Philip B. Ward

  3. Schizophrenia Research Unit, School of Psychiatry, University of NSW (Liverpool Hospital), Liverpool, NSW, Australia

    Philip B. Ward

  4. Australian Mental Health Outcomes and Classification Network, NSW Institute of Psychiatry, Parramatta BC, NSW, Australia

    Tim Coombs

Authors
  1. Ketrina A. Sly
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  2. Terry J. Lewin
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  3. Vaughan J. Carr
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  4. Agatha M. Conrad
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  5. Martin Cohen
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  6. Srinivasan Tirupati
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  7. Philip B. Ward
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  8. Tim Coombs
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Corresponding author

Correspondence to Terry J. Lewin.

Appendix: Observed mental state scale

Appendix: Observed mental state scale

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Sly, K.A., Lewin, T.J., Carr, V.J. et al. Measuring observed mental state in acute psychiatric inpatients. Soc Psychiat Epidemiol 44, 151–161 (2009). https://doi.org/10.1007/s00127-008-0427-9

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  • DOI: https://doi.org/10.1007/s00127-008-0427-9

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