Want an example of past excess in psychiatry? Read how Freud and Wilhelm Fliess, his associate, almost killed a patient by operating repeated on her nose because they believe she masturbated excessively. And it’s not that long ago that tragedies in these hospitals were tossed off as “treatments” that didn’t work. I’ve heard tales from elderly workers who were there during those unbelievably cruel times.

I’ve seen the paint-chipped walls that were sealed off to hide the ugly truth of the chains on the walls, the tubs, and the fire hoses. And I’ve seen the result of four-year-old children being shuttled away forever to live their lives in these institutions.

One woman had never had a birthday card, a gift, or a visitor and didn’t know how to open a car door or that everything in a supermarket wasn’t free for the taking. Her diagnosis? Of course, it was schizophrenia at age 4, when she had a seizure disorder and diabetes and learned to talk like a patient.

“My feet,” she said to a mental health worker, “are talking to me.” How would you hear that? Actually, she had painfully distorted feet and large bunions, but she said the pain was “talk’” and they labeled her psychotic. How many children were raised in these institutions? Yes, raised. Once they reached 18, they were transferred to an adult facility. Do you know how sad it is to see seesaws at a psychiatric hospital?

I was taken to one in an East Coast state, and it was a forlorn horror worthy of something out of a Wes Craven film. The lights in the halls were from 25-watt bulbs, and the road leading to it was a mire of mud next to a filthy pond.

Today, I read that an impressive advocate for the mentally ill had died in October 2021 with little notice. How cavalierly we toss our heroes aside when it doesn’t suit us. Her name was Darby Penney. In addition to patient advocacy, she wrote The Lives They Left Behind, an examination of the wrenching contents of suitcases in a psychiatric hospital attic and the people who never left.

Those who died in these institutions were often buried in graves marked, if at all, with numbers. There, their remains lay in overgrown fields, forgotten by many, unbelievably, that these cemeteries existed at all. I knew a group that had set out to give all of them back their names in a tireless effort reading crumbled hospital notes left behind in abandoned buildings. They are heroes. The dead do speak to us if we listen.

Mental Health Progress

How far have we come from those dark days of whippings, rapes (a form of therapy by one of the medical directors), and starvation? The perspective and the research would seem to point to incredible advances supported by millions in grants. Much of the result has been to provide newer medications. But some researchers continue on a path that harks back to the age of mechanical interventions.

Do we truly understand the neurobiology of mental illness and, if not, what is to be done? Should we be seeking to bombard the scalp with light or yet more versions of electrical stimulation? When we still don’t know the precise mechanism, how can we know what to do to help bring the patients’ minds into some manner of normalcy? How much can artificial intelligence help in this effort? Are we using it sufficiently?

We seem to be taking a singular approach to a more complex problem similar to dear old Dr. Walter Freeman and his golden icepick. Even a Kennedy sister was one of his patients.

Perhaps the question should be directed first at diagnosis rather than treatment. Has the American Psychiatric Association’s DSM gone too far? It gives behavioral indicators only for diagnosing a mental disorder. How can that be adequate when we know there’s much more here than behavior?

Freud believed masturbation in women was a problem. How many know what was fact and what was fiction in his writings? Was Jeffrey Masson too close to the truth, and that’s why Anna Freud didn’t give him the care of Freud’s archive?

I suspect Freud was too full of himself not to see his own limitations and biases. When did he come up with the construct of Thanatos? When he was dying of mouth cancer from smoking too many cigars. Did he smoke cigars because of “oral fixation?”

The questions beg answers, and we are often footslogging without intense, lengthy questioning. Of course, you can see me as jaded, misguided, or too full of myself. That is your prerogative. I ask only that you ask. And that we never forget the forgotten lost in the mire of mental illness.

Thank you, Darby Penney, for reminding me that we need reminding.

The post The Forgotten in Mental Health Facilities Do Have a Few Advocates appeared first on Medika Life.

The study, entitled Trends in Patient Characteristics and COVID-19 In-Hospital Mortality in the United States During the COVID-19 Pandemic, sought to answer the following question: What factors were associated with observed trends in the in-hospital mortality rates in the United States during the first 9 months of the COVID-19 pandemic?

In-hospital mortality rates from COVID-19 were high but appeared to be decreasing for selected locations in the United States during 2020. The authors sought to identify the following;

• If changes in the characteristics of patients being admitted could account for the decreases
• If changes in treatment protocols could account for the reduction in deaths

According to the authors, they arrived at the following conclusion;

In this cohort study of 20 736 patients, in-hospital mortality rates decreased in the US between March and November 2020, even after accounting for the changing mix in patient age, sex, comorbidities, and disease severity at the time of admission. Hospital and intensive care unit length of stay and use of mechanical ventilation decreased over time, whereas the use of glucocorticoids and remdesivir increased.

In March and April, the overall in-hospital mortality rate was 19.1 percent. This figure fell to 11.9 percent in May and June, before tapering off at 10.8 percent from September through November.

While there were small changes in the patient population over the study period — including a slight decrease in age and a higher proportion of women — mortality rates decreased even after researchers adjusted for factors including age, sex, comorbidities, and COVID-19 disease severity.

According to lead author Gregory Roth, an associate professor of medicine at the University of Washington’s Institute for Health Metrics and Evaluation in Seattle,

“Our findings suggest that the decline in mortality could be due to overloaded hospitals and changes in treatment, Further analysis is needed to understand the drivers more precisely, but it speaks to a crucial need for information-sharing and identifying hospital best practices that can prevent mortality rates from increasing again, particularly during possible future waves of COVID-19 infections.”

The study identified various obstacles in its collection of data. Surveillance proved particularly challenging. In the United States, where no single registry tracks all COVID-19 cases. The American Heart Association’s (AHA) COVID-19 Cardiovascular Disease (CVD) Registry powered by Get With The Guidelines was deployed in April 2020 to address this gap and as a means of tracking hospital-based outcomes and improving national surveillance of all patients with COVID-19 admitted to a hospital

Study Cohort and Patient Characteristics

Their analysis included 20 736 patients admitted between March and November 2020 at 107 hospitals in 31 states, with 11 901 patients admitted in March or April, 4116 patients in May or June 2709 in July or August, and 2010 patients in September through November.

The mean (SD) age was 61.2 (17.9) years, and 9524 (45.9%) were women. Hypertension was the most common preexisting condition recorded, present in more than half of patients, followed by diabetes in just over a third of patients. Pulmonary disease (including chronic obstructive pulmonary disease) was present in almost one-fifth of patients. Cancer was present in 2560 patients (12.3%), chronic kidney disease in 2628 patients (12.7%), and heart failure in 2343 patients (11.3%).

At the time of admission to the hospital, the mean (SD) BMI was in the obese range (ie, 30.8 [8.5]), and approximately a quarter of patients were receiving supplemental oxygen.

To view the full study, click here.

The post New Analysis of COVID-19 Mortality Rates at 107 US Hospitals appeared first on Medika Life.