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Objectives: Several international guidelines for the pharmacological treatment of posttraumatic stress disorder (PTSD) have been published. However, it is unclear whether clinicians use these procedures in their daily practice. We compared the psychopharmacological prescription patterns in a Swiss adult psychiatric center with international clinical guidelines at admission and discharge., Methods: Retrospective chart review study between 2005 and 2015 of adult patients with PTSD and no other documented psychiatric comorbidity., Results: Fifty-two outpatients and 21 inpatients were included; 47% had at least one psychopharmacological treatment at admission. Among them, 47% had one or several antidepressants, mainly escitalopram (31%, n=5) or citalopram. At discharge, 68% had at least one psychopharmacological treatment. Among them, 76% had at least one antidepressant, mainly escitalopram (34%, n=13) or mirtazapine (21%, n=8). They were compared to the guidelines of the Department of Veterans Affairs and Department of Defense (VA/DoD), showing 19% of the patients treated with antidepressants at admission were in agreement with the guidelines (sertraline, fluoxetine, paroxetine, venlafaxine), and 26% at discharge. In addition, we found prescriptions of benzodiazepines (62% at admission and 50% at discharge), antipsychotics (12% and 22%), Z-drugs (zolpidem, zopiclone: 15 and 40%) and a few pregabalin prescriptions (n=4)., Conclusions: Clinicians in this study frequently prescribed antidepressants to treat PTSD, as recommended. However, most of the antidepressants used were not recommended in the VA/DoD guidelines. Benzodiazepines and Z-drugs remained widely used, although they are not recommended., (Copyright © 2022 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

The physician's perspective on clinical assessment skills by nurses in psychiatry: A case study Abstract: People with a mental and physical illness receive less good somatic care compared to the general population. Patients in psychiatry receive better medical care when nurses have in-depth medical expertise. Therefore, in a psychiatric institution in Switzerland in 2017, the Clinical Assessment and Decision Making (CADM) by nurses was implemented. Background: People with a mental and physical illness receive less good somatic care compared to the general population. Patients in psychiatry receive better medical care when nurses have in-depth medical expertise. Therefore, in a psychiatric institution in Switzerland in 2017, the Clinical Assessment and Decision Making (CADM) by nurses was implemented. Aim: An embedded single case study was used, and the data analysis was based on grounded theory strategies by Charmaz. Semi-structured expert interviews (n = 11) and open unstructured observations were conducted in a psychiatric institution in Switzerland. Methods: An embedded single case study was used, and the data analysis was based on grounded theory strategies by Charmaz. Semi-structured expert interviews (n = 11) and open unstructured observations were conducted in a psychiatric institution in Switzerland. Results: The results showed nine relevant aspects regarding collaboration and CADM by nurses: "Strengths", "Weaknesses", "Risks", "Opportunities", "Expectations", "Challenges", "Benefits", "Competencies of CADM nurses" and "Wishes for the future". Conclusions: The physicians and senior psychologists considered the CADM by nurses as an added value for the interprofessional team and for the patients. Lack of clarity regarding the scope of responsibilities, role definitions and possible applications made the implementation of CADM difficult.

A 75 years old widower suffered since 26 years of many episodes of recurrent depressions. A compensated diabetes and a chronic, slowly progressive sensory-motor Neuropathy are relevant somatic comorbidities. Because of anxiety attacks complicating his progressively severe depression he could not be cared adequately in the old people home he lived in and was hospitalised. The anxiety responded well to Benzodiazepines, but the severe depression persisted despite a pharmacotherapy with Lithium, Mianserin and Citalopran. He was therefore transferred into a nursing home.There he demanded - supported by his son - an assisted suicide. 2 psychiatrists judged his wish to die as independent to his actual depression, a gerontopsychiatrist judged his suicidal ideas as a typical symptom of depression. Therefore the demanded assisted suicide was not allowed in the nursing home according to communal legal rules not allowing assisted suicide of persons with psychiatric illness in communal institutions. A hospitalisation against his own and his son's will was however not done and the assisted suicide was executed in privacy. This in Switzerland is legal even in cases of severe chronic psychiatric illness without a terminal disease. [ABSTRACT FROM AUTHOR]

Entrustable Professional Activities in Graduate Medical Education in Psychiatry: A Promising Concept Abstract. Entrustable Professional Activities (EPAs) are competency-based learning goals derived from observable clinical activities. In undergraduate medical education, they have now been adopted throughout Switzerland as part of the so-called PROFILES catalog (Principal Relevant Objectives and Framework for Integrated Learning and Education in Switzerland). The nine core EPAs to be mastered in undergraduate medical education can serve as a basis for introducing EPAs in graduate medical education as well. We will discuss this approach in the context of graduate medical education in psychiatry and psychotherapy from the perspective of different training contexts and a pilot example. In this position paper, we describe a promising opportunity to improve graduate medical training through the implementation of EPAs, both in terms of the quality of training and thus of patient care, as well as in terms of the attractiveness of the specialty for future residents.

The practice of special observation in adults in the German-speaking part of Switzerland - a descriptive cross-sectional study Abstract., Introduction: Psychiatric Special Observation (PSO) is an intervention often used by nurses to prevent service users of harming themselves or to protect others. The intervention ranges between control and therapy and is resource intensive. Despite the widespread use of PSO, there is still no data on the practice of the intervention in Switzerland., Aim: What is the current practice of PSO in adults in psychiatric hospitals in the German-speaking part of Switzerland?, Method: Descriptive cross-sectional study. Nurses from inpatient psychiatric services in the German-speaking part of Switzerland completed a questionnaire based on a concept analysis of PSO., Results: 538 questionnaires were analysed. PSO was more often conducted intermittent than as constant observation. In more than one out of four cases, suicidality reasoned as a cause for prescription. Nurses generally used standardized instruments to assess the risk of harming oneself or others. The duration of PSO lasted eight hours or more in three out of four cases. In every fifth case, there was no validation of the need of the intervention taking place during one shift. Nurses have a neutral attitude towards the intervention and are experiencing no or weak negative feelings during performance of PSO., Conclusions: The results suggest that there is an inconsistent performance of PSO in Switzerland as well as in other countries. The validation of the need of the intervention is insufficient. To facilitate PSO as a justified performance, the preparation of an interprofessional guideline is recommended.

Background: Patient safety in mental healthcare has not attracted great attention yet, although the burden and the prevalence of mental diseases are high. The risk of errors with potential for harm of patients, such as aggression against self and others or non-drug treatment errors is particularly high in this vulnerable group. Aim: To develop priority topics and strategies for action to foster patient safety in mental healthcare. Method: The Swiss patient safety foundation together with experts conducted round table discussions and a Delphi questionnaire to define topics along the treatment pathway, and to prioritise these topics. Finally, fields of action were developed. Results: An action plan was developed including the definition and prioritization of 9 topics where errors may occur. A global rating task revealed errors concerning diagnostics and structural errors as most important. This led to the development of 4 fields of action (awareness raising, research, implementation, and education and training) including practice-oriented potential starting points to enhance patient safety. Conclusions: The action plan highlights issues of high concern for patient safety in mental healthcare. It serves as a starting point for the development of strategies for action as well as of concrete activities.