Suicide and violence in patients with major psychiatric disorders

Gender differences in 353 inpatients with acute psychosis: The experience of one Psychiatric Emergency Service of Turin

The aim of the study is to evaluate gender-related socio-demographic and clinical differences in a large sample of inpatients with schizophrenia spectrum disorder. A sample of 353 acute patients, consecutively hospitalized between January 2007 and December 2008 in the Psychiatric Emergency Service of the San Giovanni Battista Hospital, was recruited. Psychiatric assessment included the Clinical Global Impression Scale-Severity (CGI-S), the Brief Psychiatric Rating Scale (BPRS) and the Global Assessment of Functioning (GAF). Differences between the groups were tested using chi-square test and ANOVA. Data were analyzed using a three-way MANOVA with the six BPRS scales with repeated measures for admission/discharge and BPRS total score baseline and independent groups for men and women. A two-way ANOVA for repeated measures was performed for CGI-S and GAF. Men were younger, more likely to be never married, more often substance abusers. Male patients showed both lower anxious-depressive and anergia symptom scores and higher activation symptom scores than female patients. Brief hospitalization was shown to be highly effective in both groups. Females showed a significantly better improvement in anergia and activation than males. The present evidence suggests that management of acute psychosis should target specific gender differences which should influence therapeutic approach in all its modalities.

Mental health-related risk factors for violence: using the evidence to guide mental health triage decision making

Mental health clinicians working in emergency crisis assessment teams or mental health triage roles are required to make rapid and accurate risk assessments. The assessment of violence risk at triage is particularly pertinent to the early identification and prevention of patient violence, and to enhancing the safety of clinical staff and the general public. To date, the evidence base for mental health triage violence risk assessment has been minimal. This study aimed to address this evidence gap by identifying best available evidence for mental health-related risk factors for patient-initiated violence. We conducted a systematic review based on the National Health and Medical Research Council of Australia's methodology for systematic reviews. A total of 6847 studies were retrieved, of which 326 studies met the study inclusion criteria. Of these studies, 277 met inclusion criteria but failed the quality appraisal process, thus a total of 49 studies were included in the final review. The risk factors that achieved the highest evidence grading were predominantly related to dynamic clinical factors immediately observable in the patient's general appearance, behaviour and speech. These factors included hostility/anger, agitation, thought disturbance, positive symptoms of schizophrenia, suspiciousness and irritability.