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Adult Psychiatric Unit: Seclusion and Restraints

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37 papers 100 to 500 followers in hopes of reducing the need for S&R events and to increase the efficacy of humane treatments while in locked seclusion and restraints
By Edwin Kim Addiction Psychiatrist
Viola Korczak, Adrienne Kirby, Naren Gunja
OBJECTIVE: Chemical agents commonly used to sedate agitated patients in the emergency department include benzodiazepines, antipsychotics, or a combination of the 2 classes. Our objective was to determine if a class or combination therapy is (1) more effective, as measured by the proportion sedated at 15-20 minutes and the need for repeat sedation, and (2) safer, as measured by the proportion of reported adverse events. METHODS: Systematic literature review and meta-analysis of studies comparing 2 or more chemical agents for sedation of agitated patients in the emergency department were carried out in PubMed, PsycINFO, Embase, and the Cochrane database...
December 2016: American Journal of Emergency Medicine
Laura E O'Shea, Geoffrey L Dickens
OBJECTIVE: Periodic structured violence risk assessment is the principle method underlying treatment planning for mentally disordered offenders but little is known about how risk changes over time. We aimed to determine whether hospitalised patients underwent reliable clinical change in assessed risk. METHOD: We used a pseudo-prospective longitudinal study design. Demographic, clinical and risk assessment data of adult inpatients (N=480) who had been routinely assessed with the HCR-20 on two to four occasions over a mean period of 17 months (SD=2) were collated...
October 2015: Comprehensive Psychiatry
Alexandra Garcia-Mansilla, Barry Rosenfeld, Keith R Cruise
Research to date has not adequately demonstrated whether the HCR-20 Violence Risk Assessment Scheme (HCR-20; Webster, Douglas, Eaves, & Hart, 1997), a structured violence risk assessment measure with a robust literature supporting its validity in male samples, is a valid indicator of violence risk in women. This study utilized data from the MacArthur Study of Mental Disorder and Violence to retrospectively score an abbreviated version of HCR-20 in 827 civil psychiatric patients. HCR-20 scores and predictive accuracy of community violence were compared for men and women...
September 2011: Behavioral Sciences & the Law
Catrin Morrissey, Chris Beeley, John Milton
BACKGROUND: The HCR-20 is a widely used 20 item structured professional judgement aid to risk assessment and management, but longitudinal studies of its value are rare, particularly with people at high risk of reoffending. AIMS: To investigate whether the HCR-20 discriminates between patient subgroups in one high-security hospital in England, whether scores reduce with hospital treatment and whether lower scores predict discharge. METHODS: Repeated HCR-20 ratings were made by clinical teams across five services within the hospital, two of them (women and men with intellectual disability) national services...
July 2014: Criminal Behaviour and Mental Health: CBMH
Taro Kishi, Shinji Matsunaga, Nakao Iwata
We performed an updated systematic review and meta-analysis of randomized controlled trials (RCTs) of intramuscular (IM)-olanzapine (OLA-IM) versus controls in agitated patients. The risk ratio, number-needed-to-treat/harm, and standardized mean difference based on a random effects model were calculated. We identified 13 RCTs (19 comparisons) as follows: 7 comparisons with 1059 patients for OLA-IM versus placebo; 5 comparisons with 613 patients for OLA-IM versus haloperidol (HAL)-IM; 2 comparisons with 108 patients for OLA-IM versus ziprasidone (ZIP)-IM; 2 comparisons with 110 patients for OLA-IM versus HAL-IM plus midazolam; and 3 comparisons with 412 patients for OLA-IM versus HAL-IM plus promethazine, 2 comparisons with 355 patients for OLA-IM versus lorazepam-IM (LOR-IM); and 1 comparison with 67 patients for OLA-IM versus HAL-IM plus LOR-IM...
September 2015: Journal of Psychiatric Research
E Hollander
Obsessive-compulsive disorder (OCD) is one of the most common psychiatric disorders, occurring in 2% to 3% of the U.S. population. Borderline personality disorder is found in 2% of the U.S. population. These disorders denote the endpoints on a spectrum of compulsive and impulsive disorders. One endpoint marks compulsive or risk-aversive behaviors characterized by overestimation of the probability of future harm, highlighted by OCD. The other endpoint designates impulsive action characterized by the lack of complete consideration of the negative results of such behavior, such as borderline and antisocial personality disorders...
1999: Journal of Clinical Psychiatry
Michelle Richardson, Geoffrey Brennan, Karen James, Mary Lavelle, Laoise Renwick, Duncan Stewart, Len Bowers
OBJECTIVE: This study aims to (a) describe what conflict (aggression, absconding etc.) and containment (de-escalation, restraining etc.) events occur before and after events of medication nonadherence on acute psychiatric wards and (b) identify which patient characteristics are associated with medication nonadherence. METHOD: Conflict and containment events for each shift over the first 2 weeks of admission were coded retrospectively from nursing records for a sample of 522 adult psychiatric inpatients...
November 2015: General Hospital Psychiatry
Viktor Voros, Peter Osvath, Sandor Fekete, Tamas Tenyi
Introduction. Elevated serum CK levels often occur in psychiatric in-patient practice. Although the majority of cases are benign and temporary, it is important to recognize and treat these conditions. Aims. To discuss the etiology, the clinical significance and the management of elevated creatine kinase levels in psychiatric in-patient practice, focusing on antipsychotic-induced rhabdomyolysis. To compare the pathogenesis and the clinical features of rhabdomyolysis and neuroleptic malignant syndrome. Methods...
2008: International Journal of Psychiatry in Clinical Practice
Rose Ries, Amirali Sayadipour
We review the literature on management of psychosis and agitation in medical-surgical patients who have or are at risk for prolonged QT interval, a risk factor for torsade de pointes (TdP), and we describe our protocols for treating these patients. We searched PubMed and PsycInfo for relevant studies and found few papers describing options for treating psychosis and agitation in these patients. Prolonged QTc interval has been more often associated with low-potency phenothiazines such as thioridazine; however, it may occur with high potency typical antipsychotics such as fluphenazine and haloperidol as well as with atypical antipsychotics such as quetiapine, risperidone, olanzapine, iloperidone, and particularly ziprasidone...
September 2014: Journal of Psychiatric Practice
Emily N Stilwell, Sarah E Yates, Nancy C Brahm
Violence among those diagnosed with schizophrenia has been reported but is not a diagnostic component of the disorder. The position of the courts regarding fulfillment of the requisite intent to commit violent acts has not been extensively reported. This article discusses the impact of a diagnosis of schizophrenia in an individual and how the pharmacist can help integrate information into the health care system. The recent Supreme Court case of Clark versus Arizona and the older case of Patterson versus Cockrell are discussed with respect to the concept of intent (to commit the act) and the implications this has on an individual in the midst of a psychotic episode...
December 2011: Research in Social & Administrative Pharmacy: RSAP
Norbert Konrad, Justus Welke, Annette Opitz-Welke
PURPOSE OF REVIEW: Prison psychiatry is a secluded area of the psychiatric care system, which in fact often provides treatment for those who do not have access to community-based healthcare systems. The aim of this review is to give an impression of the special challenges of psychiatric work behind bars and to emphasize current trends in prison psychiatry. RECENT FINDINGS: In prisoners, mental disorders are more common than in the general population. There is evidence that prison suicide rates do not reflect general population suicide rates, suggesting that variation in prison suicide rates possibly also reflects differences in the provision of psychiatric care...
September 2012: Current Opinion in Psychiatry
Clive Ballard, Anne Corbett
PURPOSE OF REVIEW: Agitation and aggression commonly arise in people with Alzheimer's disease (AD) and other dementias. They are distressing for the individual and often confer risk to them and to others, as well as raising significant clinical challenges. This review outlines the current evidence for pharmacological and nonpharmacological approaches to the treatment of agitation and aggression in these patients. RECENT FINDINGS: There is a growing body of literature supporting the use of nonpharmacological approaches as well as the treatment of pain as a first-line management strategy prior to psychopharmacotherapy...
May 2013: Current Opinion in Psychiatry
Hanna Pickard, Seena Fazel
PURPOSE OF REVIEW: To review recent research on the relationship between substance abuse, crime, violence and mental illness, and suggest how this research could aid forensic psychiatrists, psychologists and other mental health professionals in assessing and managing risk, and balancing patient care and public protection. RECENT FINDINGS: Substance abuse in mentally ill forensic psychiatric patients should be considered an important risk factor for violence and re-offending...
July 2013: Current Opinion in Psychiatry
Angela F Nederlof, Gabriela V Koppenol-Gonzalez, Peter Muris, Johannes E Hovens
In meta-analytic studies it was found that patients diagnosed with a psychotic disorder are at increased risk for displaying violent behavior. However, it remains largely unclear which specific factors contribute to the heightened risk for aggression in this patient group, nor what the views of psychiatrists are on this issue. A cross-sectional survey study was carried out and a survey questionnaire was developed to investigate the view of 652 psychiatrists on the relative contributions of various factors (e...
October 2013: Clinical Schizophrenia & related Psychoses
Dante Durand, Leticia L Delgado, Dhizarah Matus de la Parra-Pellot, Diana Nichols-Vinueza
BACKGROUND: Synthetic cannabinoid (SC) or "spice" refers to a variety of herbal/chemical mixtures, which mimic the effects of marijuana. They are generally marked as "herbal incense" and best known by the brand names of "K2," "spice," "aroma," "Mr. Nice Guy" and "dream." Little data are available on the psychopathological and physical effects of SC. CASE DESCRIPTION: We reported on a 23-year-old man without prior psychiatric history who developed acute psychosis and severe rhabdomyolysis (creatine phosphokinase [CPK]: 44,300 UI/L) associated with "Mr...
January 2015: Clinical Schizophrenia & related Psychoses
Glenn Currier, Patrick Walsh
Agitation is common in patients with acute schizophrenia and bipolar disorder, and rapid and effective treatment of acute agitation is an important clinical goal. Loxapine is a first-generation antipsychotic medication available in the United States in oral form for more than three decades. In December 2012, an inhaled version of vaporized loxapine was approved by the U.S. FDA for the treatment of agitated adults in the context of schizophrenia or bipolar disorder. In this review, we examine available literature to describe efficacy and safety of inhaled loxapine in healthy patients and in those with pulmonary compromise...
April 2013: Clinical Schizophrenia & related Psychoses
Takuto Ishida, Takefumi Suzuki, Koichiro Watanabe, Hitoshi Sakurai, Hiroyuki Uchida, Masaru Mimura
OBJECTIVE: Physical restraint sometimes causes deep vein thrombosis (DVT) and pulmonary embolism. Although unfractionated heparin (UFH) is used for the prophylaxis of DVT, its effectiveness remained unknown for restrained patients. METHOD: We conducted a chart review of restrained inpatients at Sakuragaoka Memorial Hospital in Japan. Restrained patients received subcutaneous injection of UFH 5000 IU bid from December 2008 to September 2010 [heparin (+) period] while UFH was not used from December 2010 to September 2012 [heparin (-) period]...
November 2014: General Hospital Psychiatry
Tegan Podubinski, Stuart Lee, Yitzchak Hollander, Michael Daffern
OBJECTIVE: This study assessed the extent to which psychiatric symptoms and aggression-related personality as well as cognitive and affective variables predicted interpersonal hostile-dominance (HD) in psychiatric inpatients. METHOD: Two hundred patients admitted to hospital for psychiatric treatment were recruited, including 132 men and 68 women, with an age range of 19-64 years (M = 38.32 years, SD = 11.13 years). Each participant was assessed within five days of admission using the Impact Message Inventory-Circumplex (IMI-C), the Psychopathy Checklist: Screening Version (PCL:SV), the State-Trait Anger Expression Inventory-2 (STAXI-2), the Schedule of Imagined Violence (SIV), the Measures of Criminal Attitudes and Associates (MCAA), and the Positive and Negative Syndrome Scale (PANSS)...
2014: Psychiatry
Keith R Stowell, Peter Florence, Herbert J Harman, Rachel L Glick
It is difficult to fully assess an agitated patient, and the complete psychiatric evaluation usually cannot be completed until the patient is calm enough to participate in a psychiatric interview. Nonetheless, emergency clinicians must perform an initial mental status screening to begin this process as soon as the agitated patient presents to an emergency setting. For this reason, the psychiatric evaluation of the agitated patient can be thought of as a 2-step process. First, a brief evaluation must be aimed at determining the most likely cause of agitation, so as to guide preliminary interventions to calm the patient...
February 2012: Western Journal of Emergency Medicine
Paola Rocca, Vincenzo Villari, Filippo Bogetto
Throughout history most societies have assumed a link between mental disorders and violence. Although the majority of users of mental health services are not violent, it is clear that a small yet significant minority are violent in inpatient settings and in the community. The assessment of a violent patient may be very difficult due to the lack of a full medical and psychiatric history and the non-cooperativeness of the patient. Thus a full assessment is important for the early decisions that the clinician has to take in a very quick and effective way...
June 2006: Progress in Neuro-psychopharmacology & Biological Psychiatry
2014-09-18 00:32:06
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