title: Measuring observed mental state in acute psychiatric inpatients.
abstract: BACKGROUND
  Relationships within acute psychiatric units between patient-level experiences and events and fluctuations in mental state have rarely been examined.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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, alpha=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.
authors: Centre for Brain and Mental Health Research, Hunter New England Mental Health, University of Newcastle, P.O. Box 833, Newcastle, NSW, 2300, Australia.
authors: Ketrina A
authors: KA
authors: Sly
authors: Terry J
authors: TJ
authors: Lewin
authors: Vaughan J
authors: VJ
authors: Carr
authors: Agatha M
authors: AM
authors: Conrad
authors: Martin
authors: M
authors: Cohen
authors: Srinivasan
authors: S
authors: Tirupati
authors: Philip B
authors: PB
authors: Ward
authors: Tim
authors: T
authors: Coombs
mesh_terms: D000208:Acute Disease; D000328:Adult; D000374:Aggression; D005260:Female; D006306:Health Surveys; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D008603:Mental Health / Q000706:statistics & numerical data*; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011595:Psychomotor Agitation / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D015203:Reproducibility of Results; D012559:Schizophrenia / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology