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Cappon L, Heyndrickx M, Rowaert S, Grootaert N, de Decker A, Tremmery S, Vandevelde S, De Varé J. Systematic Aggression Registration in Forensic Psychiatric Care: A Qualitative Study on Preconditions for Successful Implementation. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2024; 68:657-676. [PMID: 35674230 DOI: 10.1177/0306624x221102850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Available research emphasizes the importance of getting a systematic overview of inpatient aggression in forensic psychiatric care. However, the same research does not focus on how systematic aggression registration should be introduced in clinical practice. To facilitate the use of systematic aggression registration instruments, it is very relevant to gain insight into the perspective of staff members on the introduction of these instruments in daily clinical practice. Additionally, preconditions for achieving a successful implementation can be considered. Therefore, this study aims to gain insight into the perspective of the staff members on the implementation of a systematic aggression registration instrument-that is, the MOAS-in a forensic psychiatric unit. Interviews (n = 8) and a focus group with staff members were carried out. Three main themes: (1) creating the most appropriate context for introduction, (2) choice for the MOAS as relevant instrument, and (3) perpetuating the use of the MOAS in clinical practice are scrutinized. The mentioned preconditions can be used as guidelines when implementing systematic aggression registration in clinical practice. We hope that this paper can inspire other forensic psychiatric facilities to introduce systematic registration of aggressive incidents.
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Affiliation(s)
| | | | | | | | - An de Decker
- UPC KU Leuven (Campus Kortenberg), Belgium
- University College Leuven-Limburg, Diepenbeek, Belgium
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Lengvenyte A, Giner L, Jardon V, Olié E, Perez V, Saiz P, Gonzalez Pinto A, Courtet P. Assessment and management of individuals consulting for a suicidal crisis: A European Delphi method-based consensus guidelines. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2023:S2950-2853(23)00113-8. [PMID: 38158127 DOI: 10.1016/j.sjpmh.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/12/2023] [Accepted: 12/20/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Managing patient with suicidal thoughts and behaviours presents significant challenges due to the scarcity of robust evidence and clear guidance. This study sought to develop a comprehensive set of practical guidelines for the assessment and management of suicidal crises. MATERIALS AND METHODS Utilizing the Delphi methodology, 80 suicide clinician and research experts agreed on a series of recommendations. The process involved two iterative rounds of surveys to assess agreement with drafted recommendations, inviting panellists to comment and vote, culminating in 43 consensus recommendations approved with at least 67% agreement. These consensus recommendations fall into three main categories: clinical assessment, immediate care, and long-term approaches. RESULTS The panel formulated 43 recommendations spanning suicidal crisis recognition to continuous long-term care. These guidelines underscore systematic proactive suicide risk screening, in-depth medical and toxicological assessment, and suicide risk appraisal considering personal, clinical factors and collateral information from family. The immediate care directives emphasize a secure environment, continuous risk surveillance, collaborative decision-making, including potential hospitalization, sensible pharmacological management, safety planning, and lethal means restriction counselling. Every discharge should be accompanied by prompt follow-up care incorporating proactive case management and multi-modal approach involving crisis lines, brief contact, and psychotherapeutic and pharmacological interventions. CONCLUSIONS This study generated comprehensive guidelines addressing care for individuals in suicidal crises, covering pre- to post-discharge care. These practical recommendations can guide clinicians in managing patients with suicidal thoughts and behaviours, improve patient safety, and ultimately contribute to the prevention of future suicidal crises.
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Affiliation(s)
- Aiste Lengvenyte
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, France; IGF, University of Montpellier, CNRS, INSERM, Montpellier, France; Clinic of Psychiatry, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | - Lucas Giner
- Department of Psychiatry, Universidad de Sevilla, Seville, Spain
| | - Vincent Jardon
- CHU Lille, Hôpital Fontan, Service de Psychiatrie Adulte, Lille, France
| | - Emilie Olié
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, France; IGF, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Victor Perez
- Institute of Neuropsychiatry and Addiction (Institut de Neuropisiquiatria i Addiccions), Parc de Salut Mar, Barcelona, Spain; CIBERSAM (Mental Health Networking Biomedical Research Centre), Spain
| | - Pilar Saiz
- CIBERSAM (Mental Health Networking Biomedical Research Centre), Spain; Department of Psychiatry, University of Oviedo, Oviedo, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Ana Gonzalez Pinto
- CIBERSAM (Mental Health Networking Biomedical Research Centre), Spain; Department of Psychiatry, BIOARABA, Araba University Hospital, University of the Basque Country, Vitoria, Spain; Faculty of Medicine, Department of Neurosciences, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Philippe Courtet
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, France; IGF, University of Montpellier, CNRS, INSERM, Montpellier, France
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Hennissen V, Van Nieuwenhove K, Meganck R, Dulsster D, Krivzov J, Desmet M. The self-critical patient in clinical supervision: a qualitative study of therapists’ alliance struggles and emotional reactions in short-term psychodynamic psychotherapy for depression. COUNSELLING PSYCHOLOGY QUARTERLY 2022. [DOI: 10.1080/09515070.2022.2050676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Vicky Hennissen
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | | | - Reitske Meganck
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Dries Dulsster
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Juri Krivzov
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Mattias Desmet
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
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Pallagrosi M, Picardi A, Fonzi L, Biondi M. Origin and Development of the Assessment of Clinician’s Subjective Experience (ACSE). THE CLINICIAN IN THE PSYCHIATRIC DIAGNOSTIC PROCESS 2022:95-114. [DOI: 10.1007/978-3-030-90431-9_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Dazzi F, Fonzi L, Pallagrosi M, Duro M, Biondi M, Picardi A. Relationship Between Gender and Clinician’s Subjective Experience during the Interaction with Psychiatric Patients. Clin Pract Epidemiol Ment Health 2021; 17:190-197. [PMID: 35173787 PMCID: PMC8728565 DOI: 10.2174/1745017902117010190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 05/27/2021] [Accepted: 10/12/2021] [Indexed: 11/22/2022]
Abstract
Introduction: The clinician’s subjective experience can be a valuable element for diagnosis and treatment. A few factors have been recognized that affect it, such as the patient’s personality, the severity of psychopathology, and diagnosis. Other factors, such as patient’s and clinician’s gender, have not been specifically investigated. The aim of this study is to explore the impact of gender differences on the clinician’s subjective experience in a large sample of psychiatric patients. Methods: The study involved 61 psychiatrists and 960 patients attending several inpatient and outpatient psychiatric settings. The clinicians completed the Assessment of Clinician's Subjective Experience (ACSE) questionnaire after observing each patient for the first time. Results: In multivariate analysis, higher scores on the Difficulty in Attunement (p < 0.001), Engagement (p<0.05), and Impotence (p<0.01) scales were significantly associated with female clinician gender, whereas higher scores on the Tension and Disconfirmation scales were significantly associated with male clinician gender. The scores on all ACSE dimensions were also associated with the severity of psychopathology. Conclusion: The findings suggest that clinician’s gender might affect a clinician’s emotional response toward patients. Specific attention to this issue might be useful in clinical situations, not only in terms of promoting gender-balanced teams but also in terms of enhancing self-observation in clinicians evaluating patients for the first time.
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El-Abidi K, Moreno-Poyato AR, Toll Privat A, Corcoles Martinez D, Aceña-Domínguez R, Pérez-Solà V, Mané A. Determinants of mechanical restraint in an acute psychiatric care unit. World J Psychiatry 2021; 11:854-863. [PMID: 34733647 PMCID: PMC8546761 DOI: 10.5498/wjp.v11.i10.854] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/28/2021] [Accepted: 09/03/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Despite numerous attempts to reduce the use of mechanical restraint (MR), this technique continues to be widely applied in many acute psychiatric care settings. In order to reduce MR, a better understanding of the variables associated with its use and duration in different clinical environments is essential.
AIM To determine the proportion of patients subjected to MR and the duration thereof in two acute care psychiatric units; and to identify the variables associated with the use and duration of MR.
METHODS Descriptive study of all patients admitted to the acute psychiatric units at the Parc de Salut Mar (Barcelona, Spain) in the year 2018. The number and percentage of patients subjected to MR, as well as the duration of each episode were assessed. The following data were also registered: sociodemographic characteristics, psychiatric diagnosis, and presence of cultural and/or language barriers. Multivariate analyses were performed to assess determinants of MR and its duration.
RESULTS Of the 464 patients, 119 (25.6%) required MR, with a median of 16.4 h per MR. Two factors - a diagnosis of psychotic disorder [Odds ratios (OR) = 0.22; 95%CI: 0.06-0.62; P = 0.005] and the presence of a language barrier (OR = 2.13; 95%CI: 1.2-3.7; P = 0.007) - were associated with a significantly higher risk of MR. Male sex was associated with a longer duration of MR (B = -19.03; 95%CI: -38.06-0.008; P = 0.05).
CONCLUSION The presence of a language barrier and a psychotic disorder diagnosis are associated with a significantly higher risk of MR. Furthermore, male sex is associated with a longer duration of MR. Individualized restraint protocols that include the required tools are necessary to ultimately limit the use of mechanical restraint.
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Affiliation(s)
- Khadija El-Abidi
- Department of Psychiatry, Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona 08003, Spain
| | - Antonio R Moreno-Poyato
- Public Health, Mental and Maternal and Child Health, School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona 08907, Spain
- Biomedical Research, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona 08003, Spain
| | - Alba Toll Privat
- Department of Psychiatry, Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona 08003, Spain
- Biomedical Research, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona 08003, Spain
- Biomedical Research, Center for Biomedical Research in Mental Health Network, Barcelona 08003, Spain
| | - David Corcoles Martinez
- Department of Psychiatry, Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona 08003, Spain
- Biomedical Research, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona 08003, Spain
- Biomedical Research, Center for Biomedical Research in Mental Health Network, Barcelona 08003, Spain
| | - Rosa Aceña-Domínguez
- Department of Psychiatry, Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona 08003, Spain
| | - Victor Pérez-Solà
- Department of Psychiatry, Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona 08003, Spain
- Biomedical Research, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona 08003, Spain
- Biomedical Research, Center for Biomedical Research in Mental Health Network, Barcelona 08003, Spain
| | - Anna Mané
- Biomedical Research, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona 08003, Spain
- Biomedical Research, Center for Biomedical Research in Mental Health Network, Barcelona 08003, Spain
- Department of Psychiatry, Institut de Neuropsiquiatria i Addiccions, Centre Fòrum, Barcelona 08019, Spain
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Klein Tuente S, Bogaerts S, Veling W. Mapping aggressive behavior of forensic psychiatric inpatients with self-report and structured staff-monitoring. Psychiatry Res 2021; 301:113983. [PMID: 34000510 DOI: 10.1016/j.psychres.2021.113983] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
Structured assessment of aggressive behavior in forensic psychiatry is needed. This study investigated staff-observed and self-reported measures to map prevalence and characteristics of aggressive behavior in forensic inpatients and aimed to identify early signs of aggressive outbursts. In this longitudinal study, 120 forensic psychiatric inpatients with a history of aggression were included. Staff monitored aggressive behavior for 30 weeks using the Social Dysfunction and Aggression Scale (SDAS). Patients completed baseline self-report measures on aggression, anger, and impulsivity. Staff monitoring showed that most inpatients displayed moderate (86%) or severe (65%) aggressive behavior at least once, and 37.5% showed physical aggression. Inpatients with a least one physical aggression incident differed from others in self-reported anger, (reactive) aggression, non-planning impulsivity, and sociodemographic and clinical characteristics (e.g., higher prevalence of cluster B personality disorders, and lower intelligence). Two-thirds of the physical aggression incidents were preceded by observations of increased non-physical aggression (SDAS). In forensic psychiatric inpatients with a history of aggression, more than a third of the patients demonstrated at least one occasion of physical aggression during 30 weeks of observation.
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Affiliation(s)
- Stéphanie Klein Tuente
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; Forensic Psychiatric Center (FPC) Dr. S. van Mesdag, Helperlinie 2, 9722 AZ Groningen, The Netherlands..
| | - Stefan Bogaerts
- Tilburg University, Department of Developmental Psychology, Prof Cobbenhagenlaan 225, PO Box 90153, 5000 LE Tilburg, The Netherlands; Fivoor, Fivoor Science & Treatment Innovation, Kijvelandsekade 1, 3172 AB Poortugaal, The Netherlands
| | - Wim Veling
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
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Michaud L, Greenway KT, Corbeil S, Bourquin C, Richard-Devantoy S. Countertransference towards suicidal patients: a systematic review. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01424-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AbstractCountertransference towards suicidal patients may blur healthcare professionals’ clinical judgment and lead to suboptimal decision-making. We conducted a systematic review of the quantitative studies on this topic. Following PRISMA guidelines, various databases were searched for studies measuring countertransference in healthcare professionals treating suicidal patients. Two authors independently performed screening and the quality of included studies was formally assessed. Ten studies were identified (3/5/2 of low/intermediate/high quality, respectively). Cross-sectional studies showed evidence for specific and adverse countertransference (e.g., disinterest, anxiety, overwhelming, rejection, helplessness or distress) towards suicidal patients. Furthermore, countertransference was prospectively associated with suicidal behavior and ideation in studies that explored this issue, but the meaning of this association remains to be clarified. Healthcare professionals’ characteristics (e.g. professional background, gender, personality traits) influenced countertransference. Suicidal patients elicit adverse countertransference, which should be addressed in clinical practice and through dedicated training.
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De Page L, Boulanger M, De Villers B, Di Virgilio P, Pham T, Saloppé X, Thiry B. Countertransference in Forensic Inpatient Settings: An Empirical Examination of Therapist Responses to Patients With Psychotic Disorders. JOURNAL OF FORENSIC NURSING 2021; 17:52-60. [PMID: 33122579 DOI: 10.1097/jfn.0000000000000308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Countertransference in forensic inpatient settings has received little empirical attention despite frequent emotional reactions in staff members, such as anger, disgust, or fear. In this exploratory study, we investigated countertransference in two forensic medium-secure units for patients with psychotic disorders. METHOD We measured countertransference using the Therapist Response Questionnaire and measured staff personality using the Ten-Item Personality Inventory. Our design allowed all staff members to participate anonymously. RESULTS One hundred thirty-four Therapist Response Questionnaire forms, along with data on patient and staff characteristics, were collected. Staff characteristics such as profession, experience, and personality were associated with different countertransference reactions. Psychologists and psychiatrists tended to report more countertransference feelings than nursing staff. Patient and staff variables (such as patient having committed violent offenses or a diagnosis of personality disorder and staff experience or gender) were associated with more negative countertransference feelings and subscale scores as well as less positive countertransference feelings such as parental, protective, and satisfying countertransference feelings. Some patient and staff variables (such as patient cooperativeness, staff personality trait agreeableness) had the inverse effect on countertransference feelings. CONCLUSION We discussed several conceptual problems inherent to measuring countertransference (in forensic inpatient settings) and the clinical implications of our findings.
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Affiliation(s)
| | | | | | | | - Thierry Pham
- Centre de Recherche en Défense Sociale, Université de Mons
| | - Xavier Saloppé
- Centre de Recherche en Défense Sociale, Université de Mons
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The indistinguishables: determining appropriate environments for justice involved individuals. CNS Spectr 2020; 25:122-127. [PMID: 31599217 DOI: 10.1017/s1092852919001391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Criminalizing those with mental illness is a controversial topic with a long and complex history in the United States. The problem has traditionally been dichotomized between criminals (i.e., "bad") in need of placement in jails and prisons and the mentally ill (i.e., "mad") who are need of treatment in psychiatric facilities. Recent trends demonstrate significant increases in the rates of mental illness in jails and prisons, as well as increased rates of violence within psychiatric hospitals. This would suggest that there are a group of justice involved individuals who are "indistinguishable" within the traditional dichotomous categories of dangerousness and mental illness. The authors argue for a more nuanced model that dimensionally conceptualizes dangerousness and mental illness; increased attention to situational factors that create facilities appropriate for those who are dangerous and mentally ill and more diversion programs for those inappropriate for incarceration or hospitalization.
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Michaud L, Ligier F, Bourquin C, Corbeil S, Saraga M, Stiefel F, Séguin M, Turecki G, Richard-Devantoy S. Differences and similarities in instant countertransference towards patients with suicidal ideation and personality disorders. J Affect Disord 2020; 265:669-678. [PMID: 32090784 DOI: 10.1016/j.jad.2019.11.115] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 11/21/2019] [Accepted: 11/28/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Previous findings showed that suicidal patients elicit mostly negative countertransference such as distress, hopelessness, feelings of inadequacy, and apprehension, and that a concurrent personality disorder is associated with more feelings of entrapment and mistreatment, among other adverse reactions. No studies were however conducted on instant countertransference (iCT), i.e., after a single encounter, for example in an emergency setting. We aimed to evaluate the impact of suicidal ideations, self-harm and presence of personality disorders on instant Countertransference (iCT). METHODS Caregivers rated their iCT with two validated and standardized questionnaires after a first emergency or outpatient consultation. Suicidal ideation, self-harm and personality disorders were tested as predictors for iCT in a multivariate and multilevel analysis. RESULTS Thirty caregivers rated their iCT towards 321 patients. Personality disorders and suicidal ideation, but neither recent nor past history of self-harm, predicted iCT. Common iCT included tension, lack of self-confidence and feeling of being tied. iCT specifically associated with suicidal ideation included distress, lack of hope, confusion, and sense that the patient's life had little worth. In contrast, iCT towards patients with personality disorders suggested tension in the therapeutic relationship (low affiliation with patient, anger, disappointment, devaluation). LIMITATIONS Caregiver's characteristics were not considered in the analysis. Furthermore, while countertransference also includes unconscious phenomena, only conscious iCT was assessed. CONCLUSIONS Patients with suicidal ideation and personality disorders elicit common but also specific negative iCT. Mental health institutions need to devote specific resources (such as clinical supervision and training) to help caregivers manage their iCT.
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Affiliation(s)
- Laurent Michaud
- McGill University, Department of Psychiatry & Douglas Mental Health University Institute, McGill Group for Suicide Studies, Montréal (Québec), Canada; Psychiatric Liaison Service, Lausanne University Hospital, 23, 1011, Beaumont, Lausanne, Switzerland.
| | - Fabienne Ligier
- McGill University, Department of Psychiatry & Douglas Mental Health University Institute, McGill Group for Suicide Studies, Montréal (Québec), Canada; Pôle Universitaire de Psychiatrie de l'enfant et de l'adolescent - Centre Psychothérapique de Nancy, Laxou, France
| | - Céline Bourquin
- Psychiatric Liaison Service, Lausanne University Hospital, 23, 1011, Beaumont, Lausanne, Switzerland
| | - Sylvie Corbeil
- McGill University, Department of Psychiatry & Douglas Mental Health University Institute, McGill Group for Suicide Studies, Montréal (Québec), Canada
| | - Michael Saraga
- Psychiatric Liaison Service, Lausanne University Hospital, 23, 1011, Beaumont, Lausanne, Switzerland
| | - Friedrich Stiefel
- Psychiatric Liaison Service, Lausanne University Hospital, 23, 1011, Beaumont, Lausanne, Switzerland
| | - Monique Séguin
- McGill University, Department of Psychiatry & Douglas Mental Health University Institute, McGill Group for Suicide Studies, Montréal (Québec), Canada; Département de psychoéducation et de psychologie, Université du Québec en Outaouais, Canada
| | - Gustavo Turecki
- McGill University, Department of Psychiatry & Douglas Mental Health University Institute, McGill Group for Suicide Studies, Montréal (Québec), Canada
| | - Stéphane Richard-Devantoy
- McGill University, Department of Psychiatry & Douglas Mental Health University Institute, McGill Group for Suicide Studies, Montréal (Québec), Canada
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Reitan SK, Helvik AS, Iversen V. Use of mechanical and pharmacological restraint over an eight-year period and its relation to clinical factors. Nord J Psychiatry 2018; 72:24-30. [PMID: 28875773 DOI: 10.1080/08039488.2017.1373854] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Use of restraint and finding the balance between security and ethics is a continuous dilemma in clinical psychiatry. In daily clinic and in planning health-care service, knowledge on the characteristics of restraint situations is necessary to optimize its use and avoid abuse. METHODS We describe characteristics in the use of pharmacological and mechanical restraint in psychiatric acute wards in a hospital in Middle Norway over an eight-year period. Data on all cases of mechanical and pharmacological restraint from 2004 to 2011 were retrospectively collected from hand-written protocols. Complementary information on the patients was obtained from the hospital patient administrative system. RESULTS Restraint in acute wards was used on 13 persons per 100,000 inhabitants annually. The percentage of admitted patients exposed to restraint was 1.7%, with a mean of 4.5 cases per exposed patient. Frequency per 100 admitted patients varied from 3.7 (in 2007) to 10 (in 2009). The majority of restraint cases concerned male patients under 50 years and with substance-abuse, psychotic, or affective disorders. Significantly more coercive means were used during daytime compared to night and morning. There was a significant increase in pharmacological coercion during spring and mechanical coercion during summer. CONCLUSIONS Restraint was used on 1.7% of admitted patients, representing 13 per 100,000 inhabitants per year. Use of restraint was higher during certain periods of the day and was associated with the patient's diagnosis, age, gender, and legal status of hospitalization. There was a marked variation over the years.
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Affiliation(s)
- Solveig Klæbo Reitan
- a Department of Mental Health , St. Olav University Hospital HF , Trondheim , Norway.,b Faculty of Medicine and Health Science , Norwegian University of Science and Technology , Trondheim , Norway
| | - Anne-Sofie Helvik
- a Department of Mental Health , St. Olav University Hospital HF , Trondheim , Norway.,c Department of Public Health and Nursing, Faculty of Medicine and Health Care , Norwegian University of Science and Technology (NTNU) , Trondheim , Norway.,d Norwegian National Advisory Unit on Ageing and Health , Vestfold Hospital Trust , Tønsberg , Norway
| | - Valentina Iversen
- a Department of Mental Health , St. Olav University Hospital HF , Trondheim , Norway.,b Faculty of Medicine and Health Science , Norwegian University of Science and Technology , Trondheim , Norway
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Haugvaldstad MJ, Husum TL. Influence of staff's emotional reactions on the escalation of patient aggression in mental health care. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2016; 49:130-137. [PMID: 27633374 DOI: 10.1016/j.ijlp.2016.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Patient aggression is universally recognized as an important challenge in mental health care (MHC). Based upon a pragmatic exploration of the professional literature, we seek here to determine how negative emotional reactions of staff-including those conveyed in terms of fear, anger, and insult-may serve to exacerbate this serious impediment to safe and effective MHC. This is done using biological and evolutionary paradigms. Studies of patient aggression have tended to focus more on patient characteristics and behavior than on those of their caregivers. The authors suggest that patient aggression may be viewed as a response to "normal" interaction processes. The results of this investigation imply that the emotional reactions of staff may escalate the aggressive interaction by increasing the patient's perception of threat, and also, increase the probability of new incidents by creating a patient-staff relationship characterized by unsafety and mistrust. Mindfulness-based interventions are suggested as useful strategies to expand the staff's emotional awareness and increase emotional control.
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Zaalberg A, Wielders J, Bulten E, van der Staak C, Wouters A, Nijman H. Relationships of diet-related blood parameters and blood lead levels with psychopathology and aggression in forensic psychiatric inpatients. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2016; 26:196-211. [PMID: 25827608 DOI: 10.1002/cbm.1954] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 10/28/2014] [Accepted: 01/20/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Earlier studies have suggested associations between diet-related blood parameters and both aggression and psychopathological symptoms, but little is known about this in forensic psychiatric inpatients. AIM This article aims to explore the levels of diet-related blood parameters and their relationship to aggressive behaviour and/or psychopathology among Dutch forensic psychiatric inpatients. METHODS Minerals, vitamins, lead and fatty acid levels were measured in blood samples from 51 inpatients, well enough to consent and participate in the study, from a possible total of 99. Levels of aggression and psychopathology were assessed using questionnaires, observation instruments and clinical data. Associations between blood parameters and behavioural measures were calculated. RESULTS Low average levels of vitamin D3 and omega (ω)-3 fatty acids were found, with nearly two-thirds of the patients having below recommended levels of D3 , while vitamin B6 levels were high. Magnesium, iron, zinc, copper and lead were overall within reference values, but copper/zinc ratios were high. Several significant associations between levels of fatty acid measures and both aggression and psychopathology were observed. CONCLUSION In our sample of forensic psychiatric inpatients, fatty acids - but not mineral or vitamin levels - were associated with aggression and psychopathology. A potentially causal link between fatty acids and aggression could be tested in a randomised, placebo-controlled trial of fish oil supplements. General health of such patients might be improved by better vitamin D status (increased sun exposure and/or supplement use) and better ω-3 fatty acid status (oily fish or fish oil consumption), but discouraging unnecessary self-prescription of B vitamins where necessary. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Ap Zaalberg
- Research and Documentation Centre (WODC), Ministry of Security and Justice, PO Box 20301, 2500 EH, The Hague, The Netherlands
| | - Jos Wielders
- Meander Medical Centre, Amersfoort, The Netherlands
| | - Erik Bulten
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Forensic Psychiatric Centre "Pompekliniek", Nijmegen, The Netherlands
| | - Cees van der Staak
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Anouk Wouters
- Division of Ortho- and Forensic Psychiatry, "Altrecht" Mental Health Institute, Den Dolder, The Netherlands
| | - Henk Nijman
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Division of Ortho- and Forensic Psychiatry, "Altrecht" Mental Health Institute, Den Dolder, The Netherlands
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15
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Zun L. Care of Psychiatric Patients: The Challenge to Emergency Physicians. West J Emerg Med 2016; 17:173-6. [PMID: 26973743 PMCID: PMC4786237 DOI: 10.5811/westjem.2016.1.29648] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Accepted: 01/07/2016] [Indexed: 11/16/2022] Open
Affiliation(s)
- Leslie Zun
- Mount Sinai Hospital, Department of Emergency Medicine, Chicago, Illinois
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16
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Baby M, Glue P, Carlyle D. 'Violence is not part of our job': a thematic analysis of psychiatric mental health nurses' experiences of patient assaults from a New Zealand perspective. Issues Ment Health Nurs 2014; 35:647-55. [PMID: 25162186 DOI: 10.3109/01612840.2014.892552] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This paper describes psychiatric mental health nurses' (PMHN) experiences of patient assaults within mental healthcare settings using a thematic analytical approach. The aim of the study was to explore and describe psychiatric mental health nurses' experiences of patient assaults. The major findings of the study related to the nature and impact of assaults and supportive strategies associated with violence perpetrated by patients against psychiatric mental health nurses. Perpetrator risk factors for patients include mental health disorders, alcohol and drug use and the inability to deal with situational crises. The injuries sustained by nurses in the context of the study include lacerations, head injuries, dislocations and bruises. Psychological harm has also occurred, including quite severe mental health problems, such as post-traumatic stress disorder. Protective strategies for combating negative consequences of workplace violence include practice of self-defence, social support and a supportive and consultative workplace culture with access to counselling services and assistance in all aspects, including finances. The paper concludes that while healthcare employers need to provide better support services to the healthcare professionals who are assaulted, the legal system also needs to acknowledge that assaults against nurses are a violation of human rights and violence should not to be tolerated as part of working in mental healthcare settings.
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Affiliation(s)
- Maria Baby
- University of Otago, Department of Psychological Medicine, Dunedin, New Zealand
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17
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Jacobowitz W. PTSD in psychiatric nurses and other mental health providers: a review of the literature. Issues Ment Health Nurs 2013; 34:787-95. [PMID: 24131410 DOI: 10.3109/01612840.2013.824053] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Psychiatric nurses are subject to a high rate of assault by patients. The stress of exposure to assault and the potential for assault appear to impact nurses' emotional states in the form of post-traumatic stress and post-traumatic stress disorder (PTSD). Most studies report a prevalence rate of PTSD in this population of between 9-10%. Training in the management of aggressive patients, participating in Critical Incident Debriefing, and having routine structured debriefing meetings may play a role in facilitating the development of resilience in nurses with respect to the risk of PTSD. Knowledge about the state of the science regarding aggression and PTSD is necessary for clinicians and researchers to develop and test effective strategies. This article presents a review of the current literature on this topic.
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18
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Kobes MHBM, Nijman HHLI, Bulten EBH. Assessing aggressive behavior in forensic psychiatric patients: validity and clinical utility of combining two instruments. Arch Psychiatr Nurs 2012; 26:487-94. [PMID: 23164405 DOI: 10.1016/j.apnu.2012.04.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 04/24/2012] [Accepted: 04/25/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Accurate observation of aggressive behavior among forensic psychiatric patients requires valid instruments. This study examines the validity and clinical utility of combining the social dysfunction and aggression scale (SDAS) and staff observation aggression scale revised (SOAS-R). METHODS Nurses weekly obtained SDAS scores of 127 patients, resulting in 6.124 assessments. Aggressive incidents were documented by the SOAS-R. Internal consistency, subscale structure, interobserver reliability of the SDAS, and convergent validity with SOAS-R were analyzed. CONCLUSION A three-factor solution was found. Interobserver reliability was moderate, and good convergent validity was found. The SDAS, in conjunction with the SOAS-R, monitors changes in aggressiveness and may contribute to the prevention of aggressive behavior.
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Affiliation(s)
- Marjolein H B M Kobes
- Forensic Psychiatric Hospital Pompe Foundation, Division Diagnostics Research and Education, Nijmegen, The Netherlands.
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19
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Zun LS. Pitfalls in the care of the psychiatric patient in the emergency department. J Emerg Med 2012; 43:829-35. [PMID: 22698827 DOI: 10.1016/j.jemermed.2012.01.064] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 09/26/2011] [Accepted: 01/16/2012] [Indexed: 01/22/2023]
Abstract
BACKGROUND Care of the psychiatric patient in the Emergency Department (ED) is evolving. As with other disease states, there are a number of pitfalls that complicate the care of the psychiatric patient. OBJECTIVE The purpose of this article is to update Emergency Physicians concerning the pitfalls in caring for the psychiatric patient, and possible solutions to deal with these pitfalls. DISCUSSION The article will address the burden of the psychiatric patient, staff attitudes, medical clearance process, treatment of the agitated patient, suicidal patients, and admission decisions. CONCLUSIONS Alternative care resources, collaboration with Psychiatry, staff education, improvement in the medical clearance process, proper use of restraint and seclusion, and appropriate choice of medication for agitated patients can help avoid some of the top pitfalls in the care of the psychiatric patient in the ED.
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Affiliation(s)
- Leslie S Zun
- Department of Emergency Medicine, Mount Sinai Hospital and Chicago Medical School, Chicago, Illinois 60608, USA
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20
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Diguer L, Gamache D, Laverdière O. Development and initial validity of the Object Relations Rating Scale. Psychother Res 2012; 22:402-16. [PMID: 22417116 DOI: 10.1080/10503307.2012.662606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
The aim of this study was to report on the development and the initial validation of the Object Relations Rating Scale (ORRS), which is a measure of in-session enactments of object relations that draws on a psychodynamic conceptualization of personality organization. Forty participants were included in the study, distributed among neurotic, borderline and psychotic personality organizations (PO). Results showed that the interrater reliability of this new measure is good. Two tests of criterion validity support the validity of the measure: the ORRS discriminates well between the three PO groups and it correlates in expected ways with five PO dimensions. Finally, ORRS scales that pertain to the degree of in-session object relation enactments correlated with a measure of transference intensity (convergent validity), and correlations with therapists experience were low as expected (discriminant validity).
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Affiliation(s)
- Louis Diguer
- École de Psychologie, Université Laval, Pav. Félix-Antoine Savard, Québec, Canada.
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21
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Dahl HSJ, Røssberg JI, Bøgwald KP, Gabbard GO, Høglend PA. Countertransference feelings in one year of individual therapy: An evaluation of the factor structure in the Feeling Word Checklist-58. Psychother Res 2012; 22:12-25. [DOI: 10.1080/10503307.2011.622312] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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22
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Keski-Valkama A, Sailas E, Eronen M, Koivisto AM, Lönnqvist J, Kaltiala-Heino R. The reasons for using restraint and seclusion in psychiatric inpatient care: A nationwide 15-year study. Nord J Psychiatry 2010; 64:136-44. [PMID: 19883195 DOI: 10.3109/08039480903274449] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The containment or the prevention of actual violence is the primary justification for the use of restraint and seclusion in psychiatry. The aim of the present study was to determine the grounds for using restraint and seclusion in clinical practice in Finland, and whether these reasons have changed over a 15-year period as a result of legislative changes. METHOD A structured postal survey concerning the reasons for restraint and seclusion was completed in all the Finnish psychiatric hospitals during a predetermined week in 1990, 1991, 1994, 1998 and 2004. The duration of the episode as well as demographic and clinical information on the restrained and secluded patient were also reported. RESULTS Agitation/disorientation was the most frequent reason for the use of restraint and seclusion. The duration of the restraint and seclusion episodes was not determined by the reason for using these measures. Some differences in the reasons were found among subgroups of patients. CONCLUSION Clinical practice deviates from the theoretical and legal grounds established for restraint and seclusion, and is too open to subjective assessment and interpretations.
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23
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Abstract
Nursing is a demanding and stressful occupation. Nursing staff is required and expected to develop an interpersonal style that conveys concern for mentally ill patients. This study is aimed at investigating whether staff attitudes and behaviours are related to assaults on nurses in psychiatric settings. One hundred, sixty-two nurses working in psychiatric hospitals participated in this descriptive and analytical study. The data were gathered with an Interview Form and The Interpersonal Style Inventory. The statistical analysis shows that nurses who are less social and less tolerant are more exposed to physical assaults from patients, however nurses who are more help-seeking are more exposed to verbal assaults and have a concern of being assaulted. The findings of this research suggest that nurses' interpersonal styles may contribute to aggressive behaviours of patients/relatives.
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Affiliation(s)
- Hülya Bilgin
- Florence Nightingale School of Nursing, Istanbul University, Istanbul, Turkey.
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24
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Abstract
The main aim of this study was to examine the relationship between patients' self-reported personality characteristics, treatment outcome and therapists' countertransference reactions. Eleven therapists filled in the Feeling Word Checklist 58 (FWC-58) for each patient admitted to a day treatment program. The patients completed the Circumplex of Interpersonal Problems (CIP) at admission and discharge. Outcome measures were assessed at the end of treatment. At the start of treatment, therapists reported fewer feelings of rejection and being on guard in response to patients who reported high avoidant, exploitable, overly nurturing and intrusive CIP subscale traits. At the end of the treatment, the CIP subscales of being domineering, vindictive and cold correlated with fewer positive and more negative countertransference feelings. The study revealed a strong relationship between improvement and countertransference feelings. This study confirms clinical narratives on relationships between the therapists' countertransference reactions and patients' reported interpersonal problems and outcome.
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25
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Thylstrup B, Hesse M. Substance abusers' personality disorders and staff members' emotional reactions. BMC Psychiatry 2008; 8:21. [PMID: 18402658 PMCID: PMC2322971 DOI: 10.1186/1471-244x-8-21] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2007] [Accepted: 04/10/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous research has indicated that aggressive behaviour and DSM-IV cluster B personality disorders (PD) may be associated with professionals' emotional reactions to clients, and that cluster C PD may be associated with positive emotional reactions. METHODS Staff members recruited from workshops completed a self-report inventory of emotional reactions to patients, the Feeling Word Checklist-58, and substance abusers completed a self-report of DSM-IV personality disorder, the DSM-IV and ICD-10 Personality Disorder Questionnaire. Correlational analysis and multiple regression analysis was used to assess the associations between personality disorders and emotional reations. RESULTS Cluster B disorder features were associated with feeling distance to patients, and cluster C disorder features were associated with feeling helpful towards patients. Cluster A disorders had no significant impact on emotional reactions. CONCLUSION The findings confirm clinical experiences that personality disorder features in patients with substance abuse have an impact on staff members reactions to them. These reactions should be considered in supervision of staff, and in treatment models for patients with co-morbid personality disorders and substance abuse.
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Affiliation(s)
- Birgitte Thylstrup
- Aarhus University, Centre for Alcohol and Drug Research, Købmagergade 26E, 1150 Copenhagen C, Denmark.
| | - Morten Hesse
- Aarhus University, Centre for Alcohol and Drug Research, Købmagergade 26E, 1150 Copenhagen C, Denmark
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26
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Bjørngaard JH, Ruud T, Friis S. The impact of mental illness on patient satisfaction with the therapeutic relationship: a multilevel analysis. Soc Psychiatry Psychiatr Epidemiol 2007; 42:803-9. [PMID: 17622476 DOI: 10.1007/s00127-007-0229-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Accepted: 06/11/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND The relationship between patients and their clinicians is an essential factor in psychiatric treatment. The purpose of this study was to analyze the influence of psychopathology on patient satisfaction with the therapeutic relationship. METHODS Data from 969 patients from 40 different treatment teams collected from eight Norwegian community mental health centres were analyzed. Patient satisfaction with the therapeutic relationship was assessed with a six-item scale: sufficient time for contact/dialogue, clinicians' ability to listen and understand, follow-up of planned interventions, respect for patients' views/opinions, cooperation among clinicians, and patients' influence on treatment. Mental illness was assessed using the Health of the Nation Outcome Scales (HoNOS) and Global Assessment of Functioning (GAF) scale. Diagnoses were established using the International Statistical Classification of Diseases and Related Health Problems -- 10th revision (ICD-10). Treatment outcomes were clinically assessed retrospectively by rating changes from start of treatment on seven items. Multilevel regression analysis was used for a simultaneous analysis of the contribution of patient and team variables. RESULTS Satisfaction was associated with treatment outcome, better health as assessed using HoNOS, being female, of older age and having less psychiatric team severity indicated by the teams' mean GAF score. Patients with a schizophrenia spectrum disorder were more satisfied when treated as in- and day patients, compared with outpatient treatment. Patients in other diagnostic categories were less satisfied with day treatment. CONCLUSIONS Patients' perceptions of the therapeutic relationship may be influenced by psychopathology. Teams comprising many patients with severe mental illness may constrain the therapeutic relationship. Hence, resources and organizational measures should be carefully considered in such care units.
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27
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Pompili M, Amador XF, Girardi P, Harkavy-Friedman J, Harrow M, Kaplan K, Krausz M, Lester D, Meltzer HY, Modestin J, Montross LP, Bo Mortensen P, Munk-Jørgensen P, Nielsen J, Nordentoft M, Saarinen PI, Zisook S, Wilson ST, Tatarelli R. Suicide risk in schizophrenia: learning from the past to change the future. Ann Gen Psychiatry 2007; 6:10. [PMID: 17367524 PMCID: PMC1845151 DOI: 10.1186/1744-859x-6-10] [Citation(s) in RCA: 216] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2006] [Accepted: 03/16/2007] [Indexed: 12/18/2022] Open
Abstract
Suicide is a major cause of death among patients with schizophrenia. Research indicates that at least 5-13% of schizophrenic patients die by suicide, and it is likely that the higher end of range is the most accurate estimate. There is almost total agreement that the schizophrenic patient who is more likely to commit suicide is young, male, white and never married, with good premorbid function, post-psychotic depression and a history of substance abuse and suicide attempts. Hopelessness, social isolation, hospitalization, deteriorating health after a high level of premorbid functioning, recent loss or rejection, limited external support, and family stress or instability are risk factors for suicide in patients with schizophrenia. Suicidal schizophrenics usually fear further mental deterioration, and they experience either excessive treatment dependence or loss of faith in treatment. Awareness of illness has been reported as a major issue among suicidal schizophrenic patients, yet some researchers argue that insight into the illness does not increase suicide risk. Protective factors play also an important role in assessing suicide risk and should also be carefully evaluated. The neurobiological perspective offers a new approach for understanding self-destructive behavior among patients with schizophrenia and may improve the accuracy of screening schizophrenics for suicide. Although, there is general consensus on the risk factors, accurate knowledge as well as early recognition of patients at risk is still lacking in everyday clinical practice. Better knowledge may help clinicians and caretakers to implement preventive measures. This review paper is the result of a joint effort between researchers in the field of suicide in schizophrenia. Each expert provided a brief essay on one specific aspect of the problem. This is the first attempt to present a consensus report as well as the development of a set of guidelines for reducing suicide risk among schizophrenia patients.
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Affiliation(s)
- Maurizio Pompili
- Department of Psychiatry, Sant'Andrea Hospital, "Sapienza" University of Rome, Italy
- McLean Hospital – Harvard Medical School, USA
| | - Xavier F Amador
- Department of Psychiatry, Columbia University, New York, USA
| | - Paolo Girardi
- Department of Psychiatry, Sant'Andrea Hospital, "Sapienza" University of Rome, Italy
| | | | - Martin Harrow
- Department of Psychology, University of Illinois College of Medicine, Chicago, USA
| | - Kalman Kaplan
- Department of Psychology, University of Illinois College of Medicine, Chicago, USA
| | - Michael Krausz
- Psychiatric Clinic, University Hospital Eppendorf, Hamburg, Germany
| | | | - Herbert Y Meltzer
- Department of Psychiatry Vanderbilt University School of Medicine, USA
| | - Jiri Modestin
- Deptartment of Psychiatry (Burghölzli Hospital), University of Zurich, Switzerland
| | - Lori P Montross
- Department of Psychiatry, Division of Geriatric Psychiatry, University of California San Diego, USA
| | - Preben Bo Mortensen
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Povl Munk-Jørgensen
- Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aarhus University Hospital, Aalborg, Denmark
| | - Jimmi Nielsen
- Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aarhus University Hospital, Aalborg, Denmark
| | - Merete Nordentoft
- Department of Psychiatry Copenhagen University, Bispebjerg Hospital, Copenhagen, Denmark
| | | | - Sidney Zisook
- Department of Psychiatry, Division of Geriatric Psychiatry, University of California San Diego, USA
| | - Scott T Wilson
- Department of Psychiatry, Columbia University, New York, USA
| | - Roberto Tatarelli
- Department of Psychiatry, Sant'Andrea Hospital, "Sapienza" University of Rome, Italy
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Valtonen H, Suominen K, Partonen T, Ostamo A, Lönnqvist J. Time patterns of attempted suicide. J Affect Disord 2006; 90:201-7. [PMID: 16412521 DOI: 10.1016/j.jad.2005.12.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2005] [Revised: 12/05/2005] [Accepted: 12/05/2005] [Indexed: 11/26/2022]
Abstract
BACKGROUND The association of mental disorders with time patterns of attempted suicide is poorly understood. METHODS The study material consisted of all consecutive suicide attempts admitted to health care in Helsinki during a one-year period from 15 January 1997 to 14 January 1998. Clinical diagnosis was made according to ICD-10. RESULTS Overall, the rate of suicide attempts varied markedly during the study period, peaking in autumn and being lowest during winter. Substance use disorders best explained suicide attempts occurring at weekends. There was considerable temporal variation among patients with mood disorders, compared to only slight variation among patients with schizophrenia spectrum disorders. Study subjects tended to contact health services in the late evening and around midnight. Those contacting health services outside normal hours received psychiatric consultation less frequently than others and were referred to aftercare less often. LIMITATIONS Structured Clinical Interviews for DSM-IV Axis I and II Disorders were not used. CONCLUSIONS There were marked time patterns of attempted suicide, especially among patients with mood disorders and substance use disorders. This contrasted with the limited fluctuation among patients with schizophrenia spectrum disorders. Contacts with the health care system occurred most often in the late evening and around midnight. The findings question the adequacy of staff numbers for psychiatric consultations and of time to plan aftercare.
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Affiliation(s)
- Hanna Valtonen
- Department of Mental Health and Alcohol Research, National Public Health Institute, Mannerheimintie 166, FI-00300 Helsinki, Finland
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Kristiansen L, Dahl A, Asplund K, Hellzén O. The impact of nurses' opinion of client behaviour and level of social functioning on the amount of time they spend with clients. J Psychiatr Ment Health Nurs 2005; 12:719-27. [PMID: 16336597 DOI: 10.1111/j.1365-2850.2005.00912.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The impact of nurses' opinion of client behaviour and level of social functioning on the amount of time they spend with clients For people afflicted with different kinds of psychiatric disorder, suffering is a common denominator. The time the nurses spend with psychiatric clients may mirror their attitudes towards and feelings for these clients. The aim of this study was to investigate the connections between the time spent together and the nurses' opinion of client behaviour and social functioning in community-based psychiatry. In this quantitative study, 29 clients were assessed by 30 nurses, who answered the Global Assessment of Functioning Scale (GAF) and the Positive and Negative Syndrome Scale (PANSS). At the same time, 11,200 non-participant observations of clients were registered using the Patient Activity Classification (PAC) to investigate how they spent their time at two psychiatric group dwellings. The PAC instrument revealed that clients spent an average of 60.8% of time alone, while only 20% of their daily time was spent with the nurses. Based on a factor analysis, indices were made by setting cut-off points for the PANSS and the GAF scores, and four small groups of clients were generated: a relatively high level of social functioning and a low degree of psychiatric symptoms (A); a relatively high level of social functioning and a high degree of psychiatric symptoms (B); a low level of social functioning and a low degree of psychiatric symptoms (C); and, finally, a low level of social functioning and a high degree of psychiatric symptoms (D). The clients judged as having a low level of social functioning in combination with high degrees of psychiatric symptoms, that is, the most vulnerable and dependent individuals, receive less staff attention (18%) and are the clients who spend the most time alone (71.4%). It might be possible to interpret the results of this study in the light of a process of dehumanization.
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Affiliation(s)
- L Kristiansen
- Department of Health Sciences, Mid-Sweden University, Sundsvall, Karolinska Institutet, Stockholm, Sweden.
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Karver MS, Handelsman JB, Fields S, Bickman L. A theoretical model of common process factors in youth and family therapy. ACTA ACUST UNITED AC 2005; 7:35-51. [PMID: 15832692 DOI: 10.1007/s11020-005-1964-4] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Recently there has been an increasing emphasis in the youth and family mental health treatment literature on the use of empirically supported treatments (ESTs). In contrast there has been scant attention paid to more universal aspects of the therapy process that may have even greater impact upon therapy outcomes. It is likely that the success of the techniques proposed by ESTs may depend on the presence of common process factors. In this article, the authors explore the status of common process factors research in the youth and family therapy literature, and propose a theoretical model linking specific therapeutic relationship variables and treatment outcomes for children and adolescents. This model is intended to guide synthesis of the empirical evidence for common process factors in youth and family treatment and to stimulate future research on common process factors.
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Affiliation(s)
- Marc S Karver
- Department of Psychology, University of South Florida, Tampa, Florida 33620, USA.
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McCarthy JF, Blow FC, Kales HC. Disruptive Behaviors in Veterans Affairs Nursing Home Residents: How Different Are Residents with Serious Mental Illness? J Am Geriatr Soc 2004; 52:2031-8. [PMID: 15571538 DOI: 10.1111/j.1532-5415.2004.52559.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine the prevalence and correlates of behavior problems of residents of Veterans Affairs (VA) nursing homes and to compare residents with serious mental illness (SMI) with other resident groups. DESIGN This study combined cross-sectional resident assessments with administrative data for all residents in VA nursing homes. Multivariate ordinal logistic regression was used to evaluate associations between resident characteristics and problem behaviors. SETTING Nursing home care units in the VA healthcare system. PARTICIPANTS A total of 9,618 nursing home residents assessed as part of the VA's April 2001 national resident census. MEASUREMENTS The Patient Assessment Instrument assessed each resident's verbally disruptive, physically aggressive, and socially inappropriate behaviors in the prior 4 weeks. Functional limitations in eating, mobility, toileting, and transfer were assessed. Diagnoses were evaluated for the stay and up to 6 months before assessment. RESULTS Almost one-fifth (17.9%) of residents received a diagnosis of SMI. Residents with SMI or dementia had greater behavior problems than residents with neither condition. Residents with SMI (and without dementia) exhibited more verbal disruption than residents with dementia (and without SMI), but the two subgroups did not differ in physically aggressive or socially inappropriate behavior. CONCLUSION Many VA nursing home residents have SMI. Their level of behavior problems is comparable with that of residents with dementia. Clinical practice and nursing home staff training must encompass geriatric mental health and behavior management to meet the needs of residents with SMI.
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Affiliation(s)
- John F McCarthy
- Veterans Affairs National Serious Mental Illness Treatment Research and Evaluation Center, Health Services Research and Development, VA Ann Arbor Healthcare System, Ann Arbor, Michigan 48113, USA.
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