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Delforterie MJ, Hesper BL, Nijman HLI, Korzilius HPLM, Turhan A, Didden R. The predictive value of the dynamic risk outcome scales (DROS) for recidivism in (forensic) clients with mild intellectual disabilities or borderline intellectual functioning. J Appl Res Intellect Disabil 2023. [PMID: 36883334 DOI: 10.1111/jar.13090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/13/2023] [Accepted: 02/20/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND The dynamic risk outcome scales (DROS) was developed to assess treatment progress of clients with mild intellectual disability or borderline intellectual functioning using dynamic risk factors. We studied the predictive value of the DROS on various classifications and severity levels of recidivism. METHOD Data of 250 forensic clients with intellectual disabilities were linked to recidivism data from the Judicial Information Service in the Netherlands. Receiver operating characteristics (ROC) analyses were used to determine the predictive values. RESULTS The DROS total score could not significantly predict recidivism. A DROS recidivism subscale predicted general, violent and other recidivism. These predictive values were comparable to those of a Dutch tool validated for risk assessment in the general forensic population. CONCLUSIONS The DROS recidivism subscale predicted various classifications of recidivism better than chance. At present, the DROS appears to have no added value beyond the HKT-30 for the purpose of risk assessment.
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Affiliation(s)
- M J Delforterie
- Trajectum, Specialized and Forensic Care, Zwolle, the Netherlands.,Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
| | - B L Hesper
- Trajectum, Specialized and Forensic Care, Zwolle, the Netherlands
| | - H L I Nijman
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands.,Fivoor, Specialized and Forensic Care, Utrecht, the Netherlands
| | - H P L M Korzilius
- Institute for Management Research, Radboud University, Nijmegen, the Netherlands
| | - A Turhan
- Trajectum, Specialized and Forensic Care, Zwolle, the Netherlands.,Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
| | - R Didden
- Trajectum, Specialized and Forensic Care, Zwolle, the Netherlands.,Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
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2
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Noorthoorn EO, Smits HJH, Penterman EJM, Seelen-de Lang BL, Nieuwenhuis JG, Nijman HLI. The associations of quality of life and general functioning with trauma, borderline intellectual functioning and mild intellectual disability in outpatients with serious mental illness. Res Dev Disabil 2021; 115:103988. [PMID: 34090085 DOI: 10.1016/j.ridd.2021.103988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/12/2021] [Accepted: 05/09/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Trauma and intellectual disability are highly prevalent in the serious mental ill (SMI). Little is known of their impact on general functioning and quality of life. AIM This study investigated the association of trauma and intellectual disability (ID) with general functioning and quality of life in SMI. METHODS Patient characteristics and diagnoses were extracted from electronic patient records. We used the Trauma Screening Questionnaire (TSQ), the Screener for Intelligence and Learning Disabilities (SCIL), the Health of the Nation Outcome Scale (HoNOS) and the Manchester Short Assessment of Quality of Life (MANSA) to asses trauma, intellectual impairment, general functioning and quality of life. Proportions on cut-off scores were analysed with cross-tabulations, questionnaire scores with t-tests. Multivariable associations were determined by logistic regression analysis. RESULTS 611 patients from an outpatient service were assessed. Trauma and ID were associated with each other (r = -0.207). Trauma was associated with worse general functioning and a lower quality of life. Mild intellectual disability (MID) or borderline intellectual functioning (BIF) were associated with worse general functioning. CONCLUSIONS For patients with SMI, trauma and ID should be identified early in care to treat the lower general functioning and quality of life it caused.
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Affiliation(s)
- E O Noorthoorn
- GGnet Geestelijke Gezondheidszorg, Vordenseweg 12, 7531 PA, Warnsveld, the Netherlands.
| | - H J H Smits
- GGZ Oost Brabant, Violierstraat 11, 5402 LA, Uden, the Netherlands
| | - E J M Penterman
- GGZ Oost Brabant, Violierstraat 11, 5402 LA, Uden, the Netherlands
| | | | - J G Nieuwenhuis
- GGnet Geestelijke Gezondheidszorg, Vordenseweg 12, 7531 PA, Warnsveld, the Netherlands
| | - H L I Nijman
- Fivoor, Den Dolder, Distelvlinder 5, 3734 AA, Den Dolder, the Netherlands; Behavioral Science Institute (BSI), Radboud University, Houtlaan 4, 6525 XZ, Nijmegen, the Netherlands
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3
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Veereschild HM, Noorthoorn EO, Nijman HLI, Mulder CL, Dankers M, Van der Veen JA, Loonen AJM, Hutschemaekers GJM. Diagnose, indicate, and treat severe mental illness (DITSMI) as appropriate care: A three-year follow-up study in long-term residential psychiatric patients on the effects of re-diagnosis on medication prescription, patient functioning, and hospital bed utilization. Eur Psychiatry 2020; 63:e47. [PMID: 32381136 PMCID: PMC7358634 DOI: 10.1192/j.eurpsy.2020.46] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background. While polypharmacy is common in long-term residential psychiatric patients, prescription combinations may, from an evidence-based perspective, be irrational. Potentially, many psychiatric patients are treated on the basis of a poor diagnosis. We therefore evaluated the DITSMI model (i.e., Diagnose, Indicate, and Treat Severe Mental Illness), an intervention that involves diagnosis (or re-diagnosis) and appropriate treatment for severely mentally ill long-term residential psychiatric patients. Our main objective was to determine whether DITSMI affected changes over time regarding diagnoses, pharmacological treatment, psychosocial functioning, and bed utilization. Methods. DITSMI was implemented in a consecutive patient sample of 94 long-term residential psychiatric patients during a longitudinal cohort study without a control group. The cohort was followed for three calendar years. Data were extracted from electronic medical charts. As well as diagnoses, medication use and current mental status, we assessed psychosocial functioning using the Health of the Nations Outcome Scale (HoNOS). Bed utilization was assessed according to length of stay (LOS). Change was analyzed by comparing proportions of these data and testing them with chi-square calculations. We compared the numbers of diagnoses and medication changes, the proportions of HoNOS scores below cut-off, and the proportions of LOS before and after provision of the protocol. Results. Implementation of the DITSMI model was followed by different diagnoses in 49% of patients, different medication in 67%, some improvement in psychosocial functioning, and a 40% decrease in bed utilization. Conclusions. Our results suggest that DITSMI can be recommended as an appropriate care for all long-term residential psychiatric patients.
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Affiliation(s)
- H M Veereschild
- GGNet Community Mental Health Center, Warnsveld, The Netherlands
| | - E O Noorthoorn
- GGNet Community Mental Health Center, Warnsveld, The Netherlands
| | - H L I Nijman
- Fivoor, Forensic Psychiatric Institute, Rotterdam, The Netherlands.,Department of Social Sciences, Clinical Psychology at the Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - C L Mulder
- Public Mental Health Care, Parnassia Psychiatric Institute, Rotterdam, The Netherlands.,Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands
| | - M Dankers
- Dutch Institute for Rational Use of Medicine, Utrecht, The Netherlands
| | - J A Van der Veen
- GGNet Community Mental Health Center, Warnsveld, The Netherlands
| | - A J M Loonen
- Pharamacology Department of Pharmacotherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - G J M Hutschemaekers
- Department of Social Sciences, Clinical Psychology at the Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.,Pro Persona Mental Health Care, Nijmegen, The Netherlands
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Delforterie MJ, Hesper BL, Nijman HLI, Korzilius HPLM, Turhan A, Didden R. [The predictive value of the Dynamic Risk Outcome Scales (DROS) for predicting recidivism in (forensic) patients with mild intellectual disabilities or borderline intellectual functioning]. Tijdschr Psychiatr 2020; 62:1040-1048. [PMID: 33443757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The Dynamic Risk Outcome Scales (DROS) was developed to assess treatment progress of patients with mild intellectual disability (MID) or borderline intellectual functioning (BIF) and severe behavioral and/or psychiatric problems. Because of the focus on dynamic risk factors, practitioners also see this instrument as a tool for risk assessment.<br/> AIM: To investigate the predictive value of the DROS on different classifications and severities of recidivism.<br/> METHOD: DROS data from the routine outcome monitoring (ROM) of 250 forensic patients with MID-BIF who were discharged between 2007 and end of 2014 were linked to recidivism data from the Judicial Information Service.<br/> RESULTS: The DROS total score predicted general, violence and sexual recidivism better than chance (AUCs > 0.58), although the effect was small. A DROS-recidivism subscale predicted general, violence and other recidivism with a medium to large effect (AUCs > 0.67). The predictive values of the DROS total score and DROS-recidivism subscale were comparable to those of the Historic, Clinical, Future (in Dutch: HKT)-30.<br/> CONCLUSION: The DROS total score and DROS-recidivism subscale predict different classifications of recidivism better than chance. However, for risk assessment the DROS appears to have no added value to the HKT-30.
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Smits HJH, Seelen-de Lang BL, Nijman HLI, Penterman EJM, Nieuwenhuis JG, Noorthoorn EO. [The predictive value of mild intellectual disability/ borderline intellectual functioning and ptsd for treatment results in severely mentally Ill patients]. Tijdschr Psychiatr 2020; 62:868-877. [PMID: 33184818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Little is known about the influence of mild intellectual disability/borderline intellectual functioning (mid/biF) or posttraumatic stress disorder (ptsd) on treatment results in severely mentally ill (smi). <br/> AIM: To investigate whether screeners determining mid/biF or ptsd are associated with less favorable treatment outcome in smi.<br/> METHOD: The screener for intelligence and learning disabilities (scil) was used to screen for mid/biF. The trauma screening questionnaire (tsq) was used to detect ptsd. Outcomes of these screeners were associated with repeated measures on the health of the nation outcome scales (HoNOS) in 628 smi at the Mental Care Centre of Oost Brabant.<br/> RESULTS: In 628 patients one or more HoNOS was acquired. In 352 (56%) patients a scil was acquired, in 334 (53%) patients a tsq. The largest improvement was observed in patients not meeting the criteria for mid/biF and/or ptsd. Less improvement was observed in patients with ptsd and a suspected iq between 70-85, estimated with the scil. No significant change on the HoNOS was observed in patients with an estimated iq below 70.<br/> CONCLUSION: Routine screening for mid/biF and ptsd symptoms is important for early recognition of the disorder, resulting in providing better treatment interventions for patients with mid/biF and ptsd.
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van den Hazel T, Didden R, Nijman HLI, de Beurs DP. [Suicide in individuals with mild intellectual disabilities]. Tijdschr Psychiatr 2020; 62:1022-1029. [PMID: 33443755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Little is known about suicide among individuals with mild intellectual disabilities (mid).<br/> AIM: To explore risk factors for suicide among a small group of clients with mid who committed suicide.<br/> METHOD: Case files of 11 clients with mid were analysed using the Integrated Motivational Volitional model.<br/> RESULTS: Most suicides seem to have taken place impulsively and not on the basis of a predetermined plan. Most clients had comorbid mental health problems, predominantly trauma-related, impulse control and externalizing behavioural problems. The (imminent) loss of contact, such as in the case of transfer from one ward to another ward or to a facility, seems an important risk factor for suicide. <br/> CONCLUSION: Clients with mid residing in a treatment facility may have an increased risk of suicide because of an interaction between client characteristics and treatment context.
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Neijmeijer LJ, Korzilius HPLM, Kroon H, Nijman HLI, Didden R. Flexible assertive community treatment for individuals with a mild intellectual disability or borderline intellectual functioning: results of a longitudinal study in the Netherlands. J Intellect Disabil Res 2019; 63:1015-1022. [PMID: 30991450 PMCID: PMC6850160 DOI: 10.1111/jir.12619] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/13/2019] [Accepted: 03/14/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Assertive community treatment (ACT) and Flexible assertive community treatment (FACT) are organisation models for intensive assertive outreach that were originally developed for individuals with severe mental illness. The models are increasingly applied to people with mild intellectual disability (MID) or borderline intellectual functioning (BIF) and challenging behaviour or mental illness. Research on these types of care for this population is limited. To gain experience in FACT MID/BIF in the Netherlands and to obtain insight in its outcomes, four organisations specialised in the treatment of individuals with MID/BIF and challenging behaviour participated in a 6-year implementation and research project. METHODS A longitudinal study was set up to investigate outcomes over time. Outcome measures concerned admissions to (mental) health care, social and psychological functioning, (risk of) challenging and criminal behaviour, social participation and client satisfaction. Data were analysed using descriptive statistics and linear mixed models. RESULTS Over time, clients showed improvement in their social and psychiatric functioning and living circumstances. The number of admissions to (mental) health care diminished as well as the number of contacts with police and justice, the level of social disturbance and the risk factors for challenging and criminal behaviour. Problems related to finances, work and substance abuse remained unchanged. CONCLUSIONS The results are encouraging and give rise to continued development of and broader research on FACT MID/BIF.
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Affiliation(s)
- L. J. Neijmeijer
- Behavioural Science Institute (BSI)Radboud University, Nijmegen, the Netherlands & TrajectumZwollethe Netherlands
| | | | - H. Kroon
- Tranzo, School of Social and Behavioral SciencesTilburg University, ilburg, the Netherlands & Trimbos Institute, Netherlands Institute of Mental Health and AddictionUtrechtthe Netherlands
| | - H. L. I. Nijman
- Behavioural Science Institute (BS)Radboud University, Nijmegen, the Netherlands & FivoorDen Dolderthe Netherlands
| | - R. Didden
- Behavioural Science Institute (BSI)Radboud University, Nijmegen, the Netherlands & TrajectumZwollethe Netherlands
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de Looff PC, Cornet LJM, Embregts PJCM, Nijman HLI, Didden HCM. Associations of sympathetic and parasympathetic activity in job stress and burnout: A systematic review. PLoS One 2018; 13:e0205741. [PMID: 30335812 PMCID: PMC6193670 DOI: 10.1371/journal.pone.0205741] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 10/01/2018] [Indexed: 12/19/2022] Open
Abstract
This systematic review examines the relationship between sympathetic and parasympathetic activity on the one hand and job stress and burnout on the other, and is registered at PROSPERO under CRD42016035918. Background: Previous research has shown that prolonged job stress may lead to burnout, and that differences in heart rate variability are apparent in people who have heightened job stress. Aims: In this systematic review, the associations between job stress or burnout and heart rate (variability) or skin conductance are studied. Besides, it was investigated which–if any–guidelines are available for ambulatory assessment and reporting of the results. Methods: We extracted data from relevant databases following the PRESS checklist and contacted authors for additional resources. Participants included the employed adult population comparing validated job stress and burnout questionnaires examining heart rate and electrodermal activity. Synthesis followed the PRISMA guidelines of reporting systematic reviews. Results: The results showed a positive association between job stress and heart rate, and a negative association between job stress and heart rate variability measures. No definite conclusion could be drawn with regard to burnout and psychophysiological measures. No studies on electrodermal activity could be included based on the inclusion criteria. Conclusions: High levels of job stress are associated with an increased heart rate, and decreased heart rate variability measures. Recommendations for ambulatory assessment and reporting (STROBE) are discussed in light of the findings.
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Affiliation(s)
- P. C. de Looff
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Wier, Specialized and Forensic Care, Fivoor, Den Dolder, The Netherlands
- Expertcentre “De Borg”, Den Dolder, The Netherlands
- * E-mail:
| | - L. J. M. Cornet
- Psychology of Conflict, Risk and Safety, University of Twente, Enschede, The Netherlands
| | - P. J. C. M. Embregts
- Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - H. L. I. Nijman
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Wier, Specialized and Forensic Care, Fivoor, Den Dolder, The Netherlands
- Expertcentre “De Borg”, Den Dolder, The Netherlands
| | - H. C. M. Didden
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Expertcentre “De Borg”, Den Dolder, The Netherlands
- Trajectum, Specialized and Forensic Care, Zwolle, The Netherlands
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Bousardt AMC, Noorthoorn EO, Hoogendoorn AW, Nijman HLI, Hummelen JW. On the Link Between Emotionally Driven Impulsivity and Aggression: Evidence From a Validation Study on the Dutch UPPS-P. Int J Offender Ther Comp Criminol 2018; 62:2329-2344. [PMID: 28569075 DOI: 10.1177/0306624x17711879] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The UPPS-P seems to be a promising instrument for measuring different domains of impulsivity in forensic psychiatric patients. Validation studies of the instrument however, have been conducted only in student groups. In this validation study, three groups completed the Dutch UPPS-P: healthy student ( N = 94) and community ( N = 134) samples and a forensic psychiatric sample ( N = 73). The five-factor structure reported previously could only be substantiated in a confirmatory factor analysis over the combined groups but not in the subsamples. Subgroup sample sizes might be too small to allow such complex analyses. Internal consistency, as assessed by Cronbach's alpha, was high on most subscale and sample combinations. In explaining aggression, especially the initial subscale negative urgency (NU) was related to elevated scores on self-reported aggression in the healthy samples (student and community). The current study is the second study that found a relationship between self-reported NU and aggression highlighting the importance of addressing this behavioural domain in aggression management therapy.
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Affiliation(s)
- A M C Bousardt
- 1 Forensic Psychiatric Ward de Boog, Warnsveld, GGNet, The Netherlands
| | - E O Noorthoorn
- 1 Forensic Psychiatric Ward de Boog, Warnsveld, GGNet, The Netherlands
- 2 Stichting Benchmark GGZ, Bilthoven, The Netherlands
| | | | | | - J W Hummelen
- 1 Forensic Psychiatric Ward de Boog, Warnsveld, GGNet, The Netherlands
- 5 University of Groningen, The Netherlands
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Penterman EJM, Sabelis FGLM, Rasing SPA, van der Staak CPF, Nijman HLI. [The validity of acute assessments of psychiatric conditions made by psychiatric emergency staff]. Tijdschr Psychiatr 2016; 58:777-784. [PMID: 27868172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Earlier research carried out by the outreach psychiatric emergency team in the region of Uden / Veghel in the Netherlands indicated that the preliminary diagnosis of patients in crisis was associated with aggressive behaviour during the later contact between the patient and the staff of the psychiatric emergency team. An accurate diagnosis by the staff of the psychiatric emergency team is important because it should guide the patient towards the right type of treatment by the most appropriate team. The staff of the psychiatric emergency service who make the initial diagnosis are pressed for time and have only limited information.<br/> AIM: To find out what differences there are between the crisis team's initial diagnosis of the psychiatric condition of the patient in crisis and the later diagnosis made after more extensive psychiatric tests are carried out following the regular intake procedure.<br/> METHOD: Our study was based om 129 patients who, in the period of 2009 and 2010, were not known to mental health service and had not had any previous contact with the psychiatric emergency service. The first assessment of a patient's psychiatric condition made by a member of the psychiatric emergency service was compared with the later diagnosis made by a professional psychiatrist after the regular intake procedure. We then investigated the degree of agreement between the two diagnoses using Cohen's kappa so that we could test the validity of the initial screening of the patient's condition.<br/> RESULTS: We found that the staff of the psychiatric emergency team was able to achieve a result that was better than could be expected on the basis of chance. The Cohen's kappas varied between 0.81 for psychotic disorders to 0.31 for borderline personality disorders. Borderline personality disorders, however, tended to be overestimated by the psychiatric emergency staff.<br/> CONCLUSION: Although there was only limited agreement regarding various conditions, it is encouraging that the psychiatric emergency staff were able to assess psychotic disorders accurately on the basis of the initial information they had received. This result is important because in other studies psychotic symptoms were found to be associated with a higher likelihood of aggression during the later outreach consultation.
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Vermeulen RC, Nijman HLI, van de Sande R, Lohuis-Heesink HAGM. [Associations of short-term evaluation assessments and patient characteristics with the use of coercive measures]. Tijdschr Psychiatr 2016; 58:632-640. [PMID: 27639885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Dutch mental health care institutes are currently making a tremendous effort to reduce the number of coercive measures they impose, such as seclusion. Despite this effort, a group of patients are still being subjected to enforced medication or seclusion. AIM To obtain more knowledge about which patient characteristics are associated with coercive measures and thereby to identify signs that could be acted upon at an earlier stage to prevent deterioration of the patient's condition and reduce the need for coercive measures. METHOD We performed a prospective, naturalistic three-month study involving patients in two acute psychiatric admission wards. To collect the data we required, we used two short-term risk-assessment instruments: the Brøset Violence Checklist (BVC) and the Kennedy Axis V (KA-V). By means of statistical analyses we investigated which patient characteristics were associated with the use of coercive measures. RESULTS Of the 179 patients, 52 patients (29%) were subjected to a coercive measure during the admission procedure. The following patient characteristics were found to be associated with coercive measures: a bipolar disorder, involuntarily admission, display of physical violence just before admission, scores on the BVC and the KA-V items assessing 'social skills' and 'violence'. The two BVC items 'attacks on objects' and 'display of physical violence just before admission' were the ones most strongly associated with seclusion. CONCLUSION Although the sensitivity of the regression model was modest, the associated patient characteristics, combined with the two short-term risk assessment scores, may be helpful for identifying at an early stage those patients who run a high risk of being subjected to coercive measures.
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Penterman EJM, van der Staak CPF, Nijman HLI. [Estimating and reporting aggression in relation to personal characteristics of emergency service workers]. Tijdschr Psychiatr 2014; 56:448-454. [PMID: 25070569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Research on aggression in mental health care has focused mainly on patient characteristics, whereas very little research has been done on the characteristics of the care providers in their reporting of aggression. AIM To study the characteristics of the care providers of an emergency service in relation to the reporting of aggression. METHOD All emergency service workers( n = 21) in the Uden-Veghel region were asked to complete a neo-pi-r form. Before 576 outreach contacts had been made with patients in psychiatric crises, the Checklist of Risks in the Crisis-team (crc) was also completed and in cases where the patient exhibited aggressive behaviour, a soas-r form was filled in, following contact with the patient. RESULTS Significant differences were found between the psychiatric emergency service workers with regard to the mean estimates of the likelihood that they would experience aggression during the consultation and with regard to the proportion of patient contacts for which emergency workers reported aggression. There were indications that the level of conscientiousness of the emergency service workers was positively associated with a higher chance that they would report aggressive behaviour following the consultation. Furthermore, altruism was found to be negatively associated with the likelihood, as predicted by the service workers, that they would be confronted with aggression during contact with the patient. CONCLUSION Possibly, workers who scored high on conscientiousness and who work thoroughly and in a orderly and systematic manner and who keep to the rules are less flexible in their response to the patient during the interaction. As a result, the patient became irritated more quickly. On the other hand, it could be that conscientious workers completed the form-filling more carefully when aggression had to be reported and as a result they made higher preliminary estimates of the likelihood of aggression and a reported a larger number of incidents of actual aggression.
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Janssen WA, Noorthoorn EO, Nijman HLI, Bowers L, Hoogendoorn AW, Smit A, Widdershoven GAM. Differences in seclusion rates between admission wards: does patient compilation explain? Psychiatr Q 2013; 84:39-52. [PMID: 22581029 DOI: 10.1007/s11126-012-9225-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Comparison of seclusion figures between wards in Dutch psychiatric hospitals showed substantial differences in number and duration of seclusions. In the opinion of nurses and ward managers, these differences may predominantly be explained by differences in patient characteristics, as these are expected to have a large impact on these seclusion rates. Nurses assume more admissions of severely ill patients are related to higher seclusion rates. In order to test this hypothesis, we investigated differences in patient and background characteristics of 718 secluded patients over 5,097 admissions on 29 different admission wards over seven Dutch psychiatric hospitals. We performed an extreme group analysis to explore the relationship between patient and ward characteristics and the wards' number of seclusion hours per 1,000 admission hours. In a multivariate and a multilevel analysis, various characteristics turned out to be related to the number of seclusion hours per 1,000 admission hours as well as to the likelihood of a patient being secluded, confirming the nurses assumptions. The extreme group analysis showed that seclusion rates depended on both patient and ward characteristics. A multivariate and multilevel analyses revealed that differences in seclusion hours between wards could partially be explained by ward size next to patient characteristics. However, the largest deal of the difference between wards in seclusion rates could not be explained by characteristics measured in this study. We concluded ward policy and adequate staffing may, in particular on smaller wards, be key issues in reduction of seclusion.
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Affiliation(s)
- W A Janssen
- Board Agency, GGNet Mental Healthcare, Box 2003, NL-7230 GC Warnsveld, The Netherlands.
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Penterman EJM, Nijman HLI, Saalmink K, Rasing S, van der Staak CPF. [Assessing aggressive behaviour at the psychiatric emergency service with a checklist: a replication study]. Tijdschr Psychiatr 2013; 55:93-100. [PMID: 23408361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND In an earlier study it was found that aggressive behaviour by patients treated by the psychiatric emergency service could be predicted by the use of a newly developed instrument, the Checklist of Risks/ Crisis team (CRC). In this earlier study it was suggested that a replication study, with a larger database, was definitely needed in order to check these findings. AIM To find out in what circumstances patients (aggressive or non-aggressive) make contact with the crisis team and to ascertain the predictive validity of the CRC. METHODS During a period of four years (from 1 January 2006 to 31 December 2009) staff members completed the CRC before paying outreach visits to patients experiencing psychiatric crises in the community. In addition, if patients showed any aggressive behaviour during the visit, this was documented by means of the Staff Observation Aggression Scale-Revised (SOAS-r). RESULTS Our study replicated the earlier finding that the structured clinical risk assessment made on a visual analogue scale (VAS) of the CRC, together with the additional item about whether there were any potentially dangerous persons in the vicinity of the patient, seem to be useful "predictors" of aggression in the future (with correct classification in respectively 91 and 92%). CONCLUSION The class CRC, detailed monitoring of aggressive incidents by means of the SOAS-r, and the weekly discussions about these incidents all seem to be good instruments for analysing incidents and for increasing the safety of staff members. The methods and techniques introduced at the beginning of the project have gone hand in hand with the reduction in the number of aggressive acts directed at members of the psychiatric emergency service.
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van de Sande R, Nijman HLI, Noorthoorn EO, Wierdsma AI, Hellendoorn E, van der Staak C, Mulder CL. Aggression and seclusion on acute psychiatric wards: effect of short-term risk assessment. Br J Psychiatry 2011; 199:473-8. [PMID: 22016437 DOI: 10.1192/bjp.bp.111.095141] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Short-term structured risk assessment is presumed to reduce incidents of aggression and seclusion on acute psychiatric wards. Controlled studies of this approach are scarce. AIMS To evaluate the effect of risk assessment on the number of aggression incidents and time in seclusion for patients admitted to acute psychiatric wards. METHOD A cluster randomised controlled trial was conducted in four wards over a 40-week period (n = 597 patients). Structured risk assessment scales were used on two experimental wards, and the numbers of incidents of aggression and seclusion were compared with two control wards where assessment was based purely on clinical judgement. RESULTS The numbers of aggressive incidents (relative risk reduction -68%, P<0.001) and of patients engaging in aggression (relative risk reduction RRR = -50%, P<0.05) and the time spent in seclusion (RRR = -45%, P<0.05) were significantly lower in the experimental wards than in the control wards. Neither the number of seclusions nor the number of patients exposed to seclusion decreased. CONCLUSIONS Routine application of structured risk assessment measures might help reduce incidents of aggression and use of restraint and seclusion in psychiatric wards.
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Affiliation(s)
- R van de Sande
- Mental Health Centre Bavo-Europoort, Rotterdam, and Hogeschool Utrecht, University of Applied Science, Utrecht, The Netherlands.
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Janssen WA, van de Sande R, Noorthoorn EO, Nijman HLI, Bowers L, Mulder CL, Smit A, Widdershoven GAM, Steinert T. Methodological issues in monitoring the use of coercive measures. Int J Law Psychiatry 2011; 34:429-438. [PMID: 22079087 DOI: 10.1016/j.ijlp.2011.10.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE In many European countries, initiatives have emerged to reduce the use of seclusion and restraint in psychiatric institutions. To study the effects of these initiatives at a national and international level, consensus on definitions of coercive measures, assessment methods and calculation procedures of these coercive measures are required. The aim of this article is to identify problems in defining and recording coercive measures. The study contributes to the development of consistent comparable measurements definitions and provides recommendations for meaningful data-analyses illustrating the relevance of the proposed framework. METHODS Relevant literature was reviewed to identify various definitions and calculation modalities used to measure coercive measures in psychiatric inpatient care. Figures on the coercive measures and epidemiological ratios were calculated in a standardized way. To illustrate how research in clinical practice on coercive measures can be conducted, data from a large multicenter study on seclusion patterns in the Netherlands were used. RESULTS Twelve Dutch mental health institutes serving a population of 6.57 million inhabitants provided their comprehensive coercion measure data sets. In total 37 hospitals and 227 wards containing 6812 beds were included in the study. Overall seclusion and restraint data in a sample of 31,594 admissions in 20,934 patients were analyzed. Considerable variation in ward and patient characteristics was identified in this study. The chance to be exposed to seclusion per capita inhabitants of the institute's catchment areas varied between 0.31 and 1.6 per 100.000. Between mental health institutions, the duration in seclusion hours per 1000 inpatient hours varied from less than 1 up to 18h. The number of seclusion incidents per 1000 admissions varied between 79 up to 745. The mean duration of seclusion incidents of nearly 184h may be seen as high in an international perspective. CONCLUSION Coercive measures can be reliably assessed in a standardized and comparable way under the condition of using clear joint definitions. Methodological consensus between researchers and mental health professionals on these definitions is necessary to allow comparisons of seclusion and restraint rates. The study contributes to the development of international standards on gathering coercion related data and the consistent calculation of relevant outcome parameters.
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Affiliation(s)
- W A Janssen
- Kenniscentrum GGNet, Warnsveld, The Netherlands.
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Scheifes A, Stolker JJ, Egberts ACG, Nijman HLI, Heerdink ER. Representation of people with intellectual disabilities in randomised controlled trials on antipsychotic treatment for behavioural problems. J Intellect Disabil Res 2011; 55:650-664. [PMID: 21155914 DOI: 10.1111/j.1365-2788.2010.01353.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Behavioural problems are common in people with intellectual disability (ID) and are often treated with antipsychotics. AIM To establish the frequency and characteristics of people with ID included in randomised controlled trials (RCTs) on antipsychotic treatment for behavioural problems, and to investigate the quality of these RCTs. METHODS A literature search in EMBASE, PubMed and Cochrane was performed and reviewed. RESULTS People with ID participated in 27 of the 100 included RCTs. The RCTs were of good quality but smaller compared with trials in patients with dementia or schizophrenia (average sample sizes = 55, 124 and 374). In 13/27 trials no clear definition of ID was given. Over 25 different outcome measures were used to assess behavioural problems. CONCLUSIONS Studies in which people with ID are included are of a sufficient quality, but of a small size. The heterogeneity in the characteristics of the ID population included as well as in the applied assessment instruments makes performing meta-analyses unfeasible.
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Affiliation(s)
- A Scheifes
- Altrecht Institute for Mental Health Care, Den Dolder, the Netherlands
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Penterman EJM, Smeets JML, van der Staak CPF, Nijman HLI. [Personality traits of staff members of the psychiatric emergency services]. Tijdschr Psychiatr 2011; 53:145-151. [PMID: 21404171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND In the course of their duties staff members of the psychiatric emergency services may quite often find themselves in unpredictable and, in some cases, threatening situations. For this reason, staff working for the emergency services need to have specific personality traits. AIM To investigate whether staff members of the emergency services differ from well-educated members of the general public as far as personality traits are concerned. METHOD The staff of the mental health teams of Oost Brabant in the Netherlands (Uden/ Veghel and Helmond regions) were asked to complete an NEO-PI-R designed to assess their main personality traits. Of the 59 staff members who were invited to participate, 44 completed and returned the questionnaire (76%). The scores of the 44 staff members were compared to those of a norm group of persons with a similar educational level in the general population. RESULTS The staff of the crisis teams were found to have significantly lower scores on the personality dimension 'Neurotism' and particularly on the facets 'Vulnerability' and 'Self-consciousness' of this dimension. The psychiatric crisis staff had higher scores on the facets 'Competence' and 'Self-discipline' and lower scores on the 'Candour/Frankness/Openness'. Compared to the social workers, the psychiatrists scored higher on the facets 'Assertiveness' and 'Openness to ideas'. CONCLUSION The lower scores found on the main personality dimension 'Neuroticism' and particularly on the facet 'Vulnerability' suggest that members of the psychiatric crisis team remain calm in stressful situations and are emotionally rather stable persons. Such personality traits can be important in threatening situations where peace and calm have to be preserved. However, in view of the limited sample size and the relatively large number of statistical tests, the findings of this exploratory study should be interpreted with caution.
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Affiliation(s)
- E J M Penterman
- Stagebegeleider Sociale Psychiatrie bij de ggz Oost-Brabant, Regio Uden/Veghel.
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Goedhard LE, Stolker JJ, Nijman HLI, Egberts TCG, Heerdink ER. Trials assessing parmacotherapeutic management of aggression in psychiatric patients: comparability with clinical practice. Pharmacopsychiatry 2010; 43:205-9. [PMID: 20589596 DOI: 10.1055/s-0030-1254091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION In a previous review of randomized controlled trials (RCTs) on the pharmacotherapeutic management of aggression, it was shown that there is only weak evidence of effectiveness. In the present study we aim to determine comparability of patients included in these RCTs and patients of psychiatric long-stay wards. METHODS Exclusion criteria that were used in at least 20% of the RCTs were applied to a sample of aggressive inpatients from clinical practice, in order to find what proportion of these patients would be eligible to participate in the reviewed, high quality RCTs. RESULTS Only 30% of aggressive psychiatric patients as seen in clinical practice would be eligible to participate in a typical randomized controlled trial based on the most frequently applied exclusion criteria. DISCUSSION The low comparability of patients included in RCTs with those seen in clinical practice may decrease the generalizability of the findings form RCTs to clinical practice.
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Affiliation(s)
- L E Goedhard
- Altrecht Institute for Mental Health Care, Den Dolder, The Netherlands
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Penterman EJM, Nijman HLI. [Assessing aggression in patients of the mental health crisis service]. Tijdschr Psychiatr 2009; 51:355-364. [PMID: 19517364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Care workers of the outreach psychiatric crisis team are frequently confronted with aggressive patients. To prevent dangerous situations from developing it could be advantageous to have in place a method of risk assessment that is based on information about patients before they are actually contacted by the crisis team. AIM To test the predictive validity of an instrument specifically designed to assess the risks of aggression from severely disturbed psychiatric patients before they are seen by the crisis team. METHODS Over a period of two years and prior to any outreach contact with patients in crisis situations a Checklist of Risks to the Crisis team (CRC) was completed. Then, following outreach contact with the patient any perceived aggression was recorded by means of the Staff Observation Aggression Scale-Revised (SOAS-R). RESULTS Aggressive behaviour by patients was observed during 51 of 499 crisis contacts with members of the outreach crisis team. On the basis of three factors in the CRC, namely the clinical assessment on a visual-analogue scale, an estimate of the number of aggressive persons in the vicinity of the crisis patient concerned and the reporting of crises by the patient himself, it was possible to predict outwardly directed aggression with a sensitivity of 74% and a specificity of 84%. CONCLUSIONS Although the findings still need to be reproduced, an instrument such as the crc could be very useful to members of the crisis service.
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de Jonge E, Nijman HLI, Lammers SMM. [Behavioural changes during forensic psychiatric treatment: a multicenter study]. Tijdschr Psychiatr 2009; 51:205-215. [PMID: 19434575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND In forensic psychiatry it is essential that patients' risks of reoffending are assessed as reliably as possible. The risk assessment instrument hkt-30 assesses both static and dynamic risk factors. It is assumed that dynamic risk factors should change when a patient receives treatment. AIM To find out whether dynamic risk factors changed during the course of forensic psychiatric treatment. METHOD The hkt-30 was administered 984 times for forensic psychiatric patients in 3 different forensic psychiatric centres, in the period June 2003-November 2006. For 513 patients the instrument was administered at least once, for 313 this was done at least twice and for 158 patients for three years in succession. By subdividing the research group into 'new', 'old' and 'transferred' patients we were able to examine in which phase of treatment the largest changes in hkt-30 scores occurred. RESULTS More than half the scores for dynamic risk factors, as well as the total score, declined significantly as treatment progressed, but the differences were small in absolute terms. The three subgroups of patients hardly differed from each other with regard to the degree of change. CONCLUSION The scores for the risk factors, assumed in theory to be changeable, seemed to become lower as the treatment progressed. However, it is not yet certain whether these lower scores were in fact directly linked to a reduction on the risk of reoffending.
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Goedhard LE, Stolker JJ, Nijman HLI, Egberts ACG, Heerdink ER. Aggression of Psychiatric Patients Associated with the Use of As-needed Medication. Pharmacopsychiatry 2007; 40:25-9. [PMID: 17327957 DOI: 10.1055/s-2007-961817] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Previous studies showed that aggression is an important reason to prescribe as-needed medication. The objective of this study was to compare the use of as-needed medication in aggressive and non-aggressive psychiatric patients and to explore patterns of administration of as-needed medication around aggressive incidents. METHODS An observational study in three psychiatric wards was conducted. Incidence densities of as-needed medication were determined for aggressive and non-aggressive patients and expressed as incidence density ratios [IDRs]. Intensity of as-needed medication used before and following aggressive incidents were determined within a 48-hours time-window. RESULTS Aggressive patients had an increased use of both psychotropic and somatic as-needed medication (IDR, 2.5; 95% CI, 2.2-2.7 and IDR, 2.1; 95% CI, 1.8-2.4, respectively). Of the psychotropic medication for aggressive patients, 15% was administered in a time-window of 48 hours around an aggressive incident; in this time-window more as-needed medication was administered following an aggressive incident compared to earlier treatments. CONCLUSION An increased use of both psychotropic and somatic as-needed medication is associated with aggressive behavior. Psychotropic as-needed medication is more frequently administered shortly after an aggressive incident than shortly before. However, more often as-needed medication is administered outside the 48 hours time-window around an aggressive incident.
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Affiliation(s)
- L E Goedhard
- Altrecht Institute for Mental Health Care, Den Dolder, The Netherlands
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Abstract
OBJECTIVE Research of the determinants of inpatient aggression indicates that certain environmental hospital variables play a role in triggering aggression in psychiatric hospitals. Yet, how patient, staff and ward variables interact in eliciting aggression is not well understood. METHOD On the basis of earlier findings, a model was proposed in which psychopathology and distorted cognitions of the patient are combined with environmental and communicational stressors that are specific for psychiatric wards. RESULTS The proposed model elucidates how certain patient, staff and ward characteristics may interact in causing aggression. The model also emphasizes that repeated inpatient aggression may be the result of a vicious circle, i.e. inpatient violence is often followed by an increase in environmental and/or communication stress on the patient, thereby heightening the risk of a repeated outburst of violence. CONCLUSION Although tentative, the model may shed light on the mechanisms that lead to (repeated) violence.
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Affiliation(s)
- H L I Nijman
- Forensic Psychiatric Hospital De Kijvelanden, Poortugaal, the Netherlands
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Abstract
OBJECTIVE Research on the prevalence and causes of in-patient aggression has been hindered by the use of different methods for measuring aggression. Since Palmstierna and Wistedt presented the Staff Observation Aggression Scale (SOAS) in 1987, this data collection method has been used in various studies, which may make comparisons more useful. METHOD Studies with SOAS aggression data were compiled using MEDLINE, the Internet, and references from SOAS papers. RESULTS Reviews of studies on psychometric properties suggest fair to good inter-rater reliability and validity for SOAS assessments. The number of aggressive incidents per patient per year found on acute admissions wards (n = 38) considerably varied, with a range of 0.4-33.2 incidents (mean = 9.3). CONCLUSION Although the aggression data included in the present review were obtained in highly comparable ways, substantial differences in aggression rates between wards were still found. Some countries (e.g. the Netherlands) appear to have a relatively high incidence of aggression on acute wards.
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Stolker JJ, Hugenholtz GWK, Heerdink ER, Nijman HLI, Leufkens HGM, Nolen WA. [Seclusion of admitted psychotic patients: later in the case of antipsychotic use and also possibly less often]. Ned Tijdschr Geneeskd 2003; 147:557-61. [PMID: 12693086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
OBJECTIVE To establish the incidence and determinants of seclusion and to gain insights into the use of antipsychotics before and after the seclusion of acutely admitted patients. DESIGN Retrospective cohort analysis. METHOD We collected data from a consecutive sample of 996 patients in adult psychiatric admission wards for the period 1997-1999. Secluded patients were compared with non-secluded patients and the correlations between antipsychotic use and seclusion were calculated. RESULTS The average age of the 996 patients (507 men and 489 women) was 38.0 years (median: 37.0; range: 16-84). Seclusion was applied in the case of 285 patients (28.6%). Young age (< 30 years), low Global Assessment of Functioning score (< 55), involuntary hospitalisation and bipolar disorder (manic episode) were significantly associated with seclusion. For patients with psychotic disorders who used antipsychotics during the first week, the median time from admission to seclusion was 7 days (in patients not using antipsychotics this was 2.5 days). Furthermore, the use of antipsychotics was, although not significant, associated with a lower risk of seclusion (relative risk: 0.7; 95% CI: 0.5-1.2). In a substantial number of the psychotic patients, antipsychotic treatment was initiated during or shortly after seclusion; they used these drugs more often than psychotic non-secluded patients (relative risk: 2.0; 95% CI: 1.2-3.4). CONCLUSION The use of antipsychotics is associated with a later application of seclusion as well as its possible delay. For a considerable number of patients, treatment with antipsychotics was started either during or shortly after seclusion.
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Affiliation(s)
- J J Stolker
- Institute for Pharmaceutical Sciences, Disciplinegroep Farmaco-epidemiologie en Farmacotherapie, Utrecht.
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