Managing acutely aggressive or agitated people in a psychiatric setting: a survey in Lebanon

Effectiveness of a Home Based Training Program on Caregivers Knowledge in Managing Aggressive Behavior of Patients With Mental Illness

In India, more than 90% of the patient with chronic mental illness stayed with their family members. Approximately 77.4% of caregivers experience moderate to severe levels of aggression. The purpose of this study was to evaluate the effectiveness of caregiver-training program on knowledge in managing aggressive behavior of mentally ill at home. Research design was pre-experimental. Seventy two caregivers were recruited using purposive sampling technique. The caregivers knowledge was assessed at 3 time points with regard to training program; before, immediately (post-test 1), and after 1 month (±1 week; post-test 2). The baseline knowledge was reflective of the deficiencies existing in the management of aggression of the mentally ill by caregivers. The knowledge of caregivers regarding the management of aggressive behavior of mentally ill, increased after caregiver training program, from the pre-test score of 17.63 ± 3.3 to post-test 1 score of 23.26 ± 2.9, and slightly decreased post-test 2 score of 21.01 ± 3.3 at p < .05. Repeated measure analysis of variance (ANOVA) was done to compare the differences in knowledge score over time with Bonferroni adjustment. This home based caregiver training program helped caregivers to identify etiological factors of aggression, warning signs of aggression and use of de-escalation strategies to manage aggressive behavior of mentally ill. Training caregivers regarding aggression management will make caregiver proficient in practicing safe approach during handling of aggressive patient which will ensure the physical safety of the caregiver as well as of the patient and let the patient stay at home.

COVID-19 and psychosis, depression, obsession and quality of life in Lebanese patients with schizophrenia: Any changes after 5 months of quarantine?

BACKGROUND

Previous research revealed an absence of any previous studies reporting the impact that pandemics may have on psychotic symptomology, nor on the physical health of people with psychosis in response to the epidemics of the COVID-19. The direction of the impact of the COVID-19 on schizophrenia is unknown, as the risk of infection could vary from patients to patients according to clinical comorbidities, cognitive impairment, acute symptoms, and family support. To the best of our knowledge, no study has provided details on the variation of symptoms in patients with schizophrenia during the quarantine of COVID-19 outbreak. Therefore, the primary objective of the study is to investigate the variation of psychotic symptoms, depression, obsession and quality of life in patients with schizophrenia before and after 5 months of quarantine and evaluate factors associated with these variations during the quarantine period.

METHODS

A cross-sectional study was performed on a sample of 190 chronic patients institutionalized for schizophrenia for more than 1 year at the Psychiatric Hospital of the Cross. The baseline assessment was done in December 2019; the second assessment was done in August 2020 (5 months after the lockdown).

RESULTS

Getting updates about the coronavirus minimally, some and most of the times were significantly associated with a decrease in positive psychotic and psychopathologic symptoms 5 months after quarantine compared to before it. Practicing religiosity some and all the time versus not was significantly associated with a decrease in negative, psychopathology symptoms and total PANSS score after 5 months of quarantine compared to before it. Finally, female gender (B = 1.77) was significantly associated with an increase in the WHO Domain 3 score (better social relations) after 5 months of quarantine compared to before it.

CONCLUSION

Patients with schizophrenia fare better symptomatically after 5 months of quarantine if they receive constant updates about COVID-19 and if they tended to practice religiosity.

First line in psychiatric emergency: pre-hospital emergency protocol for mental disorders in Iran

INTRODUCTION

This article is a report of designing a rapid and effective guide for paramedics who take care of patients in a pre-hospital setting to answer developing demands.

METHODS

The relevant literature was reviewed, and the topics were extracted. Then, the extracted items were discussed in an expert panel. Finally, items were discussed in a meeting including emergency technicians and emergency technical assistants to identify implementation problems.

RESULTS

Important topics for managing psychiatric patients were categorized at three levels: 1) Patient safety and security issues, 2) Patient status assessment and diagnosis, and 3) Patient management (medical, behavioral management, and referral to a treatment center).

DISCUSSION

This protocol can be a solution to improve emergency technician training. Such summarized protocols can be used for rapid review immediately before exposing a patient with an acute psychiatric condition. Due to specific cultural and different access to medicines in Iran, some issues are different.

Study protocol for a randomised controlled trial of haloperidol plus promethazine plus chlorpromazine versus haloperidol plus promethazine for rapid tranquilisation for agitated psychiatric patients in the emergency setting (TREC-Lebanon)

Background: Agitated and aggressive behaviours are common in the psychiatric setting and rapid tranquilisation is sometimes unavoidable. A survey of Lebanese practice has shown that an intramuscular haloperidol, promethazine and chlorpromazine combination is a preferred form of treatment but there are no randomised trials of this triple therapy. Methods: This is a pragmatic randomised trial. Setting - the psychiatric wards of the Psychiatric Hospital of the Cross, Jal Eddib, Lebanon. Participants - any adult patient in the hospital who displays an aggressive episode for whom rapid tranquilisation is unavoidable, who has not been randomised before, for whom there are no known contraindications. Randomisation - stratified (by ward) randomisation and concealed in closed opaque envelope by independent parties. Procedure - if the clinical situation arises requiring rapid tranquilisation, medical residents overseeing the patient will open a TREC-Lebanon envelope in which will be notification of which group of treatments should be preferred [Haloperidol + Promethazine + Chlorpromazine (HPC) or Haloperidol + Promethazine (HP)], along with forms for primary, secondary and serious adverse effects. Treatment is not given blindly. Outcome - primary outcome is calm or tranquil at 20 minutes post intervention. Secondary outcomes are calm/tranquil at 40, 60 and 120 minutes post intervention, asleep, adverse effects, use of straitjacket and leaving the ward. Follow-up will be up to two weeks post randomisation. Discussion: Findings from this study will compare the HPC versus HP combination used in Lebanon's psychiatry emergency routine practice. Trial registration: ClinicalTrials.gov NCT03639558. Registration date, August 21, 2018.