Specificity of Insecure Attachment in Adolescents With Borderline Personality Disorder in Psychiatric Inpatient and Community-Dwelling Adolescents

Borderline personality disorder (BPD) has been conceptualized as a disorder of attachment. However, the specificity of attachment insecurity to BPD in adolescents remains unclear. In this study, an inpatient sample (n = 521), of which 173 (33.2%) met the criteria for BPD, and a control sample of community-dwelling adolescents (n = 294) ages 12-17 were compared on a self-report measure of attachment security. In addition, hierarchical regression analyses were carried out to examine the incremental contribution of BPD symptoms, over and above internalizing and externalizing symptoms, in predicting attachment security. Results showed expected group differences such that adolescents with BPD evidenced higher levels of attachment insecurity to both fathers and mothers than psychiatric and community-dwelling controls. BPD features also incremented internalizing and externalizing problems associated with attachment security. However, because psychiatric controls also evidenced high levels of attachment insecurity, we conclude that while attachment insecurity is particularly salient for BPD, it is not necessarily specific to the disorder.

Association between perceived social support and suicide ideation distress among psychiatric inpatients: The role of thwarted interpersonal needs

INTRODUCTION

The interpersonal theory of suicide posits that thwarted belongingness (TB) and perceived burdensomeness (PB) are proximal risk factors for suicide ideation; however, there are mixed results regarding this hypothesis among psychiatric inpatients.

OBJECTIVE

The current study examined the mediating role of TB and PB in the relationship between perceived social support (i.e., support from family, friends, a significant other, and total) and suicide ideation distress among psychiatric inpatients.

METHODS

Participants (short-term psychiatric inpatients; N = 139) were administered self-report assessments cross-sectionally.

RESULTS

Nonparametric mediation results indicated that the total (additive) indirect effects of TB and PB, in parallel, were significant in all models, yet there were only significant specific (unique) indirect effects of PB.

CONCLUSION

TB and PB, in combination, may be proximal risk factors for suicide ideation distress among psychiatric inpatients with lower perceived social support from family, friends, a significant other, and in total. These findings are congruent with the interpersonal theory of suicide's propositions that the combination of TB and PB increases the risk for suicide ideation. Clinicians may consider using interventions that target increasing perceived social support and decreasing TB and PB (i.e., cognitive behavioral therapy and social skills training) for this population.

Cause-specific mortality after discharge from inpatient psychiatric care in Taiwan: A national matched cohort study

AIMS

We aimed to investigate the trajectories of absolute and relative risks of cause-specific mortality among patients discharged from inpatient psychiatric services.

METHODS

We conducted a national matched cohort study (2002-2013) using data from the Taiwan National Health Insurance database linked to national cause-of-death data files. Patients discharged from inpatient psychiatric care without prior psychiatric hospitalizations were individually matched to 20 comparison individuals based on sex and age. The rates, rate differences, and relative risks (hazard ratios, HRs) of cause-specific mortality were calculated at six follow-up periods post-discharge. Cumulative mortality incidence was assessed at 5 years of follow-up.

RESULTS

The mortality risks of all causes were increased among patients (n = 158 065) relative to comparison individuals (n = 3 161 300). Mortality rate differences were greater for natural causes, while relative risks (HRs) were higher for unnatural causes. Suicide was the leading cause of death within the first year of discharge, while circulatory and respiratory diseases were the leading causes of death from the second year. The mortality rates and HRs for all causes of death (except homicide) were highest during the first 3 months. The elevated risk of unnatural-cause mortality declined rapidly after discharge but remained high in the long term; in contrast, risk elevation for natural-cause mortality was more stable over time. Approximately one-eighth of patients (12.9%, 95% confidence interval 12.7-13.7%) died within 5 years of follow-up.

CONCLUSIONS

Integrated physical and mental health care is needed to reduce excess mortality, particularly during the first 3 months post-discharge, among psychiatric patients.

Differences in body mass index trajectories of adolescent psychiatric inpatients by sex, age, diagnosis and medication: an exploratory longitudinal, mixed effects analysis

BACKGROUND

Adolescents in secure psychiatric care typically report high obesity rates. However, longitudinal research exploring the rate and extent of change is sparse. This study aimed to analyse sex differences in longitudinal body mass index (BMI) change for adolescents receiving treatment in a secure psychiatric hospital.

METHODS

The sample comprised 670 adolescents in secure psychiatric care. BMI trajectories from admission to 50 months of hospitalisation were produced using sex-stratified multilevel models. Systematic difference in mean BMI trajectories according to age at admission (14, 15, 16, or 17 years), medication (Olanzapine or Sodium Valproate), and primary diagnosis (Psychotic, non-Psychotic or Functional/behavioural disorders) were investigated.

RESULTS

Together, males and females experienced a mean BMI increase of 2.22 m/kg2 over the 50-month period. For females, BMI increased from 25.69 m/kg2 to 30.31 m/kg2 , and for males, reduced from 25.01 m/kg2 to 23.95 m/kg2 . From 30 to 50 months, a plateau was observed for females and a reduction in BMI observed for males. Psychotic disorders in males (β 3.87; CI 1.1-6.7) were associated with the greatest rate of BMI change. For medication, Olanzapine in females was associated with the greatest rate of change (β1.78; CI -.89-4.47).

CONCLUSIONS

This is the first longitudinal study exploring longitudinal BMI change for adolescent inpatients. Results highlight that individual differences in adolescent inpatients result in differing levels of risk to weight gain in secure care. Specifically, males with psychotic disorders and females taking Olanzapine present the greatest risk of weight gain. This has implications for the prioritisation of interventions for those most at risk of weight gain.

Year one review: Staff perception on the implementation of the chair restraint on an adolescent psychiatric inpatient unit

This pediatric psychiatric mental health hospital implemented a new mechanical restraint, the chair restraint, as an additional safety management intervention, to join the already utilized six-point board.

PURPOSE

The purpose of this project was to assess perceptions, thoughts, and feelings of psychiatric mental health nursing staff when utilizing the chair restraint on an adolescent unit. Furthermore, to explore decision making related to choosing the chair restraint verses choosing to use the six-point board as a safety management intervention.

METHODOLOGY

This was a phenomenological qualitative study, utilizing semistructured interviews to explore the experiences of nursing staff, consisting of behavioral health specialists, and direct-care staff nurses who work on an adolescent psychiatric unit utilizing both chair restraint and the six-point board. Ten nursing staff were interviewed. Using thematic analysis, staff perceptions, thoughts, and feelings when using mechanical restraints for safety management were explored. Demographics were collected however, there was no variability in the responses and saturation was reached.

FINDINGS

Five themes emerged from the interviews. The Five themes that emerged were: Restraint chair was less traumatic and preferred, feelings of defeat when de-escalation was not successful, pushing away emotions as protection, units were short staffed, and patient behaviors were seen as a potential barrier to eliminating the six-point board.

CONCLUSION

The results of this study will be used to guide to further develop behavioral health education, orientation for new staff, and to understand ways to support staff through their experiences in managing a patient's unsafe behaviors.

Erroneous Thought in Inpatients with Major Depressive Disorder: The Role of Psychological Trauma During Childhood and Adulthood

BACKGROUND

The pathogenic role of trauma in psychotic-like experiences has yet to be clarified. The aim of this study was to investigate the role of childhood and adulthood trauma on erroneous thoughts among patients with major depressive disorder.

MATERIALS AND METHODS

Inpatients with major depressive disorder (MDD) and healthy controls (HCs) were enrolled, and paper-and-pencil questionnaires were applied. Clinical rating and self-reported scales were used to measure levels of depression, dissociation, psychological trauma, parental maltreatment, and erroneous thoughts. Pearson's correlation analysis was conducted to explore potentially significant associations between erroneous thoughts and other independent variables, and standardized regression coefficients of hierarchical regression analysis were used to predict the significant relationships between erroneous thoughts and adulthood or childhood trauma.

RESULTS

A total of 99 participants were included into the analysis, of whom 59 were patients with MDD and 40 were HCs. After treatment, the patients with MDD showed significantly higher levels of depression, childhood maltreatment, interpersonal trauma and erroneous thoughts than the HCs. After estimating and verifying correlations with hierarchical regression among the patients with MDD, a link between adulthood betrayal trauma and higher level of conviction along with the number of erroneous thoughts was found. However, no significant association was identified between childhood trauma and erroneous thought. The concurrent level of depression significantly predicted a higher level of being preoccupied, along with the number of erroneous thoughts.

CONCLUSION

The current study fills a gap in the literature by showing a link between adulthood trauma and erroneous thoughts in non-psychotic patients. Further studies with well-controlled comparisons and prospective cohort with longer follow-up are warranted to extend the applicability and generalizability of the current study.

Predictors for Depression, Sleep Disturbance, and Subjective Pain among Inpatients with Depressive Disorders during the COVID-19 Pandemic: A Cross-Sectional Study

The coronavirus disease 2019 (COVID-19) pandemic can have a negative impact on patients with mood disorders. The aim of this study is to explore the societal influence of COVID-19 and associated impacts on levels of depression, sleep disturbance, and subjective pain among patients with mood disorders. This cross-sectional study recruited inpatients with depression and bipolar disorder. Levels of depression, sleep disturbance, subjective pain, and related demographic variables were collected through self-reported questionnaires. Potential factors associated with levels of depression, sleep disturbance, and subjective pain were identified using univariate linear regression and further entered into a stepwise multivariate linear regression model to identify the independent predictors. A total of 119 participants were included in the analysis, of whom 50.42% had bipolar disorder and 49.58% had unipolar depression. Multivariate analysis showed that a higher level of depression was associated with female subjects, subjects with partners, present history of psychological trauma, and drinking alcohol. Sleep disturbance was associated with subjects with partners and drinking alcohol. A higher level of subjective pain was associated with a higher level of social anxiety and a history of psychological trauma. The current study identified several predictors of psychological burden and subjective pain among inpatients with depression during the COVID-19 pandemic. Further investigations are warranted to extend the application and generalizability of our results.

Prevalence of Extrapyramidal Symptoms in In-Patients With Severe Mental Illnesses: Focus on Parkinsonism

Patients with severe mental illnesses may present extrapyramidal symptoms as part of a concomitant neurological disorder or secondary to medications. Extrapyramidal symptoms are frequently unrecognized, have negative consequences for adherence to treatment, negatively affect quality of life and can induce stigma. We estimated and correlated with demographic and clinical variables prevalence of extrapyramidal symptoms in in-patients with severe mental illnesses. Additionally we evaluated ¹²³I-FP-CIT SPECT binding to striatal dopamine transporter in subjects with clinical manifestations suggestive of Parkinson's Disease and recorded therapeutic management and clinical evolution for 6-months. Extrapyramidal symptoms were present in 144 out of 285 patients (50.5%), mainly tremor (94 patients, 33%). There were 38 patients (13.3%) with parkinsonism and they had older age, more medical comorbidities and medical treatments. In 15/38 patients striatal dopamine transporter binding was abnormal resulting in dose reduction or change of psychotropic drugs as well as combination with antiparkinson therapy. Our study confirmed the clinical and epidemiological relevance of extrapyramidal symptoms among inpatients with severe mental illnesses. A small percentage of patients with extrapyramidal symptoms had features compatible with possible diagnosis of Parkinson's Disease. ¹²³I-FP-CIT SPECT was useful to identify dopaminergic dysfunction and initiate dopamine replacement therapy.

Emotion-Oriented Coping Style Predicts Self-Harm in Response to Acute Psychiatric Hospitalization

Psychiatric hospitalization can cause significant distress for patients. Research has shown that to cope with the stress, patients sometimes resort to self-harm. Given the paucity of research on self-harm among psychiatric inpatients, a better understanding of transdiagnostic processes as predictors of self-harm during psychiatric hospitalization is needed. The current study examined whether coping styles predicted self-harm after controlling for commonly associated factors, such as age, gender, and borderline personality disorder. Participants were 72 patients (mean age = 39.32 years, SD = 12.29, 64% male) admitted for inpatient treatment at a public psychiatric hospital in Sydney, Australia. Participants completed self-report measures of coping styles and ward-specific coping behaviors, including self-harm, in relation to coping with the stress of acute hospitalization. Results showed that younger age, diagnosis of borderline personality disorder, and higher emotion-oriented coping were associated with self-harm. After controlling for age and borderline personality disorder, higher levels of emotion-oriented coping were found to be a significant predictor of self-harm. Findings were partially consistent with hypotheses; emotion-oriented but not avoidance-oriented coping significantly predicted self-harm. This finding may help to identify and provide psychiatric inpatients who are at risk of self-harm with appropriate therapeutic interventions.

Participant Reactions to Suicide-Focused Research

Background: Concerns exist regarding the perceived risks of conducting suicide-focused research among an acutely distressed population. Aims: The current study assessed changes in participant distress before and after participation in a suicide-focused research study conducted on a psychiatric inpatient unit. Method: Participants included 37 veterans who were receiving treatment on a psychiatric inpatient unit and completed a survey-based research study focused on suicide-related behaviors and experiences. Results: Participants reported no significant changes in self-reported distress. The majority of participants reported unchanged or decreased distress. Reviews of electronic medical records revealed no behavioral dysregulation and minimal use of as-needed medications or changes in mood following participation. Limitations: The study's small sample size and veteran population may limit generalizability. Conclusion: Findings add to research conducted across a variety of settings (i.e., outpatient, online, laboratory), indicating that participating in suicide-focused research is not significantly associated with increased distress or suicide risk.

Psychologists' Perspectives on the implementation of Psychological Therapy for Psychosis in the Acute Psychiatric Inpatient Setting

Psychological therapies should be delivered in psychiatric inpatient settings to people experiencing psychosis. However, inpatient populations present with complex needs and usually are admitted only briefly. This makes the delivery of psychological therapies for people experiencing psychosis particularly challenging. Our aim was to explore the adaptations required to deliver psychological therapies to this population from the perspective of inpatient psychological practitioners. Twelve participants were recruited, and a qualitative semistructured interview schedule was administered examining their perspectives on important factors required to deliver psychological interventions in this context. Data were analyzed using thematic analysis. Three superordinate themes were identified: "crisis-focused psychological approaches," "working with and supporting the wider system," and "environmental adaptations." Traditional psychological therapies are a challenge to deliver in inpatient environments due to complex needs, essentiality of team working, and brief admission. Several adaptations are required to ensure psychological therapy is effective in this setting.

The role of psychology in a multidisciplinary psychiatric inpatient setting: Perspective from the multidisciplinary team

OBJECTIVES

Psychologists routinely work in psychiatric inpatient settings and it is acknowledged that they cannot work in isolation from the multidisciplinary team. The aim of this study was to examine the multidisciplinary team's perspective on the role of psychology within the acute psychiatric inpatient setting.

DESIGN

A qualitative approach was taken utilizing semi-structured interviews for data collection.

METHODS

Interviews were undertaken with 12 multidisciplinary team members (occupational therapists, psychiatric nurses, psychiatrists, and clinical managers) examining their perspectives on the role of psychology within the acute psychiatric inpatient setting. Thematic analysis was used to analyse data.

RESULTS

The analysis identified two key themes 'psychological treatments', which describes the perceived function of psychology on the ward, and 'integrated psychological working' outlining key issues that psychologists should consider when working in multidisciplinary teams.

CONCLUSIONS

Psychology is seen by multidisciplinary team members as an integral, but not first line, treatment option in the psychiatric inpatient setting. Both direct work and indirect work were valued by multidisciplinary staff participants. The multidisciplinary team do not have a clear understanding of the role of psychology. Education dialogue about the role are required.

PRACTITIONER POINTS

The role of psychology in the psychiatric inpatient setting is valued by the multidisciplinary team. Psychology was not viewed as a first-line treatment option in the psychiatric inpatient setting but an 'add-on' to medical treatment. Psychology was a valued source of support for skilling-up and offering reflective space to the multidisciplinary team. Psychologists need to better promote their role and their skills to the multidisciplinary team.

Function and progression of non-suicidal self-injury and relationship with suicide attempts: A qualitative investigation with an adolescent clinical sample

AIM

To investigate the function and progression of non-suicidal self-injury (NSSI) and its relationship with suicide attempts.

METHOD

Qualitative in-depth interviews were conducted with 15 adolescents psychiatrically hospitalized following a suicide attempt who reported NSSI. Applied thematic analysis was used to identify and examine themes from the interview data.

RESULTS

Thematic analysis revealed that the primary function of NSSI was relief from emotional pain, though the function often changed over time. NSSI was often not directly related to patients' suicide attempts, yet risk of suicidal behavior seemed to increase once NSSI lost its effectiveness, and suicide became the only option.

CONCLUSION

Clinicians need to understand and monitor the functions of NSSI, and its relationship with suicidality, to prevent suicide attempts among adolescents.

Cultural Change: Implementation of a Recovery Program in a Veterans Health Administration Medical Center Inpatient Unit

INTRODUCTION

The Freedom Commission's recommendations, Substance Abuse and Mental Health Services Administration's framework, and policy directives on recovery-oriented services have fueled the recovery transformation. Mental health recovery services have been implemented in a broad range of outpatient settings. However, psychiatric inpatient units remained embedded in the traditional model of care.

AIMS

The purpose of this article is to describe an ongoing quality improvement implementation of recovery services in a Veterans Health Administration acute psychiatric inpatient unit.

METHOD

An interprofessional Partnership for Wellness delivered 4 to 6 hours per day of evidence-based recovery and holistic population-specific health programs. Veteran, system, and program indicators were measured.

RESULTS

Preliminary indicators over a 2-year period suggest that Veterans rated group content and relevance high, pre-post psychiatric rehospitalization rates decreased by 46%, and fidelity to recommended strategies was high.

CONCLUSIONS

The project success reflects strong leadership, a partnership of committed staff, effective training, and an organizational culture exemplifying excellence in Veteran services and innovation.

A review of ECG and QT interval measurement use in a public psychiatric inpatient setting

OBJECTIVES

There is an increased rate of sudden cardiac death (SCD) in mental health patients. Some antipsychotic medications are known to prolong the QT interval, thus increasing a patient's risk of SCD via the arrhythmia, torsades de pointes (TdP). Our aim was to evaluate assessment for QT prolongation within a public inpatient mental health facility by auditing electrocardiograph (ECG) use.

METHODS

We reviewed records of all mental health inpatient admissions to a public emergency mental health inpatient unit between 1 January 2016 and 11 February 2016. ECG availability was noted and QT interval was manually measured and assessed for risk of TdP using the QT nomogram when present. Demographic information and medication use was collected.

RESULTS

Of 263 mental health inpatient admissions, 50 (19%) presentations had an ECG. A total of four (8%) had a prolonged QT interval. Of the 50 patients with an ECG, 12 (24%) were taking medication known to prolong the QT interval.

CONCLUSIONS

There was very limited risk assessment for QT prolongation in a public hospital psychiatric inpatient unit, with less than 20% of patients having an ECG performed. Our study supports an association between QT-prolonging drugs and a clinically significant prolonged QT interval; however, a larger study with routine ECG screening is required.

Self-Reported and Interviewer-Rated Oral Health in Patients With Schizophrenia, Bipolar Disorder, and Major Depressive Disorder

PURPOSE

To compare self-reported (SR) and interviewer-rated (IR) oral health between schizophrenia (SZ), bipolar disorder (BP), and major depressive disorder (MDD) patients.

DESIGN AND METHODS

356 patients with SZ, BP, or MDD underwent assessments of psychopathology, side effects, SR, and IR oral health status.

FINDINGS

118 patients (33.1%) reported poor oral health; the corresponding proportion was 36.4% in BP, 34.8% in SZ, and 25.5% in MD (p = .21). SR and IR oral health correlated only modestly (r = 0.17-0.36) in each group.

PRACTICE IMPLICATIONS

Psychiatric patients need to be assessed for both SR and IR oral health.

Effects of a Regulatory Protocol for Mechanical Restraint and Coercion in a Spanish Psychiatric Ward

PURPOSE

There is still limited information on what type of measures are most efficient to reduce coercion. The aim of this study was to determine if the introduction of a new regulatory protocol in a specific psychiatric ward in Andalusia (Spain) contributed to reducing the use of mechanical restraint.

DESIGN AND METHODS

The study included a comparison of two time periods: 2005 (one year before the implementation of the new regulatory protocol) and 2012, in all hospitalized patients (N=1,094). The study also analyzes with logistic regression the variables related to a shorter duration of mechanical restraint.

FINDINGS

Mechanical restraint rate per year was reduced, not significantly, from 18.2% to 15.1%. The average duration of each mechanical restraint episode was significantly reduced from 27.91 to 15.33 hr. The following variables have been associated with a shorter period of coercion: being female and the year of restraint (2012).

PRACTICE IMPLICATIONS

Specific plans are required, including different interventions, in order to achieve marked reduction in the use of coercive measures.

Mental health professionals' perspectives on the implementation of smoke-free policies in psychiatric units across England

BACKGROUND

The original audit on which this 2013 secondary analysis is based, was conducted in 2010. It explored implementation of smoke-free policies from the perspective of unit managers in 147 psychiatric units across England comprising a randomly selected sample of nine different unit types.

MATERIAL

Two main themes are presented: positive perspectives of smoke-free policy implementation, and barriers and problems with smoke-free policy implementation. Analysis of unit managers' experiences and perspectives found that 96% of participants thought smoke-free policy had achieved positive outcomes for staff, patients, services and care.

DISCUSSION

Consistency of response was the most prominent factor associated with policy success. Quality of the physical environment and care delivery were clear positive outcomes which enabled the environment to be more conducive to supporting staffs' and patients' quit attempts. Lack of consistency and a prevailing culture of acceptance of smoking were identified as some of the most reported perceived continuing problems. Solutions included the need to acknowledge that this type of complex systems change takes time and ongoing staff education and training.

CONCLUSION

Our results demonstrate the importance of taking into account the experiences and attitudes of staff responsible for enacting smoke-free policy.

Frequency of physical restraint and its associations with demographic and clinical characteristics in a Chinese psychiatric institution

PURPOSE

Physical restraint (PR) is a highly controversal topic in psychiatry. Little is known about PR among psychiatric inpatients in China. This study examined the frequency of PR and its relationships with demographic and clinical characteristics among a large psychiatric institution in the Hunan Province, China.

DESIGN AND METHODS

The study included a consecutively assessed sample of 160 psychiatric inpatients. Sociodemographic and clinical data including use of PR were collected from the medical records using a form designed for this study and confirmed via interview.

FINDINGS

The frequency of PR was 51.3% in the whole sample; 63.2% among female and 39.2% among male patients. In multiple logistic regression analysis PR was independently associated with male gender (p = 0.001, odds ratio [OR] = 0.2, 95% confidence interval [CI] 0.1-0.6), less outpatient treatment prior to admission (p = 0.03, OR = 0.3, 95% CI 0.1-0.9), more frequent use of mood stabilizers (p = 0.002, OR = 5.6, 95% CI 1.9-16.7), more aggressive behavior prior to admission (p = 0.002, OR = 1.1, 95% CI 1.04-1.2), and younger age (p = 0.04, OR = 0.97, 95% CI 0.93-0.99).

PRACTICE IMPLICATIONS

PR is very common in clinical practice in China. Its demographic and clinical correlates are similar to findings in Western settings.

Staff representations and tobacco-related practices in a psychiatric hospital with an indoor smoking ban

The present study describes representations about smoking and practices related to patient smoking among staff of a large public psychiatric hospital. A survey was performed using a specially designed questionnaire. The return rate was 72.4% (n = 155). A large proportion of staff recognized the importance of both smoking status and mental health for patient's well-being (46.9%), and believed that smoking cessation was possible for psychiatric patients (58.6%). However, the role of the psychiatric hospital was perceived as providing information (85.3%) and helping to diminish cigarette consumption (51%), rather than proposing smoking cessation (29.5%). Staff daily practice included reminding patients of smoking restrictions (43.9%), managing cigarettes (46.5%), and nicotine replacement therapy (24.3%). A principal component analysis of tobacco-related practices revealed two main factors (59.8% of variance): basic hospital actions (factor 1) and more specialized interventions (factor 2), which were significantly associated with higher worries about personally developing smoke-related illnesses (Spearman r = 0.38, P < 0.0001). Compared with non-smokers, smokers reported higher perceived vulnerability to develop an illness due to tobacco and a higher level of worry about this. The discussion highlights the need to redefine roles and expectancies of mental health staff, and improve training and collaboration with experts, in order to improve efficiency concerning tobacco issues.

The Effect of Violence on the Diagnoses and the Course of Illness Among Female Psychiatric Inpatients

INTRODUCTION

The aim of the study was to determine the rate of exposure to domestic violence among female inpatients at any period of their lives; to investigate the effect of different forms of violence on the diagnoses and the course of the illness.

METHOD

The study was conducted on 102 female inpatients treated at Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery. The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) was administered and socio-demographic and clinical data was collected. A form designed for the assessment of violence was used to evaluate domestic violence.

RESULTS

Ninety patients reported that they had been subjected to some kind of violence at some period of their lives. The parents or husbands were the most frequently reported persecutors. Seventy-three patients reported that they had been subjected to violence before the onset of their illness. Seventy-one had been subjected to physical, 79 to verbal, 42 to sexual, 52 to economic violence, and 49 to constraints on social relationship formation. Comorbid diagnosis of post traumatic stress disorder (PTSD) was related to all types of violence. The rate of suicide attempt was found to be significantly related to verbal-emotional violence. Only 12 patients had previously reported being subjected to domestic violence to their psychiatrist.

CONCLUSION

Domestic violence, an often overlooked phenomenon, is prevalent among women with psychiatric disorders. Subjection to domestic violence is found to be correlated with PTSD and suicidal attempt.

Online comments on smoking bans in psychiatric hospitals units

OBJECTIVE

Individuals with mental health concerns are disproportionately affected by and suffer the negative consequences of tobacco use disorder, perhaps because smoking has historically been part of psychiatry's culture. In the early 1990s, psychiatric inpatient facilities were exempted from U.S. hospital smoking bans, in response to public outcry with national media attention. Almost 2 decades later, the current study characterizes online conversation about psychiatric hospital smoking bans. Previous commenting studies have demonstrated commenting's negativity, documenting the "nasty effect" wherein negative comments color perceptions of neutral articles. Thus, we focused particular attention on cited barriers to implementing health-positive smoke-free policies.

METHODS

We collected online comments (N = 261) responding to popular media articles on smoking bans in inpatient psychiatry between 2013 and 2014 and conducted an inductive and exploratory qualitative content analysis.

RESULTS

Verifying previous studies documenting the prevalence of negative commenting, of the comments explicitly supporting or refuting psychiatry smoking bans, there were over twice as many con comments (n = 44) than pro (n = 18). Many commenters argued for access to outdoor smoking areas and warned of patient agitation and risk posed to care workers. Identified content themes included psychiatric medication and negative side effects, broken mental health systems and institutions, denigration of the health risks of tobacco in the context of mental illness, typical pro-smoking arguments about "smokers' rights" and alternatives (including e-cigarettes), addiction, and stigma.

CONCLUSIONS

The current findings provide a platform to begin to understand how people talk about mental health issues and smoking. Our analysis also raised complex issues concerning forces that impact U.S. patients with serious mental illness but over which they have little control, including medication, the U.S. health system, stigma, perceptions that life with chronic serious mental illness is not worth living, and psychological and physical pain of coping with mental illness. In consideration of identified barriers raised in opposition to smoking bans in inpatient psychiatry, efforts should emphasize patient stakeholder involvement; patient, visitor, and staff protection from smoke exposure; the effectiveness of nicotine replacement for managing withdrawal; and the lack of evidence that cigarettes are therapeutic.

Should clinicians use average or peak scores on a dynamic risk-assessment measure to most accurately predict inpatient aggression?

Recent advancements in risk assessment have led to the development of dynamic risk-assessment measures that are predictive of inpatient aggression in the short term. However, there are several areas within this field that warrant further empirical investigation, including whether the average, maximum, or most recent risk state assessment is the most valid for predicting subsequent aggression in the medium term. This prospective study compared the predictive validity of three indices (i.e. mean score, peak score, and most recent single time-point rating) of the Dynamic Appraisal of Situational Aggression (DASA) for inpatient aggression. Daily risk ratings were completed for 60 psychiatric inpatients (from the acute wards of a forensic psychiatric hospital) for up to 6 months; a total of 1054 DASA ratings were obtained. Results showed that mean and peak scores on the DASA were better predictors of interpersonal violence, verbal threat, and any inpatient aggression than the DASA single time-point most recent ratings. Overall, the results support the use of the prior week's mean and peak scores to aid the prediction of inpatient aggression within inpatient forensic psychiatric settings in the short to medium term. These results also have practical implications for clinicians considering risk-management strategies and the scoring of clinically-relevant items on risk-assessment measures.

Influence of patient characteristics on duration of seclusion/restrain in acute psychiatric settings in Japan

AIM

The aim of this study was to investigate the current state of duration of seclusion/restraint in acute psychiatric settings in Japan and the effect of patient characteristics on duration of seclusion/restraint.

METHODS

During an 8-month period starting from November 2008, duration of seclusion/restraint and patient characteristics were investigated in 694 psychiatric inpatients who experienced seclusion/restraint in three emergency and three acute wards at four psychiatric hospitals. Reasons for starting seclusion/restraint were also assessed. Analysis was performed using generalized linear models, with the duration of seclusion/restraint as the dependent variable and patient characteristics and reasons for starting seclusion/restraint as independent variables.

RESULTS

Of the patients secluded/restrained, 58.6% had a primary diagnosis of schizophrenia (F20-F29) and a large proportion (37.9%) were secluded/restrained due to hurting others. Median hours ofseclusion/restraint were 204 and 82 h, respectively. The duration of seclusion was longer for patients with F20-F29 than those with disorders due to psychoactive substance use (F10-F19) or other diagnoses (F40-F99), and when the reason was danger of hurting others. In contrast, the duration of restraint in female patients and in patients with F10-F19 diagnosis was shorter.

CONCLUSION

The duration of seclusion/restraint at acute psychiatric care wards in Japan are much longer than those reported by previous overseas studies. Although Japanese structure issues such as more patients per ward and a lower ratio of nurses need to be considered, skills for dealing with patients with primary diagnosis of F20-F29 secluded due to danger posed to others should be improved.