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Salzmann-Erikson M. An Integrative Review on Psychiatric Intensive Care. Issues Ment Health Nurs 2023; 44:1035-1049. [PMID: 37874667 DOI: 10.1080/01612840.2023.2260478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
Psychiatric intensive care units (PICUs) provide care and treatment when psychiatric symptoms and behaviors exceed general inpatient resources. This integrative review aimed to synthesize PICU research published over the past 5 years. A comprehensive search in MEDLINE, PsycINFO, PubMed and Scopus identified 47 recent articles on PICU care delivery, populations, environments, and models. Research continues describing patient demographics, and high rates of challenging behaviors, self-harm, and aggression continue being reported. Research on relatives was minimal. Patients describe restrictive practices incongruent with recovery philosophies, including controlling approaches and sensory deprivation. Some initiatives promote greater patient autonomy and responsibility in shaping recovery, yet full emancipatory integration remains limited within PICU environments. Multidisciplinary collaboration is needed to holistically advance patient-centered, equitable, and integrative PICU care. This review reveals the complex tensions between clinical risk management and emancipatory values in contemporary PICU settings. Ongoing reporting of controlling practices counters the recovery movement progressing in wider mental healthcare contexts. However, care innovations centered on patient empowerment and humane environments provide hope for continued evolution toward more liberation-focused PICU approaches that uphold both patient and provider perspectives.
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Affiliation(s)
- Martin Salzmann-Erikson
- Department of Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
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Raaj S, Navanathan S, Matti B, Bhagawan A, Twomey P, Lally J, Browne R. Admission patterns in a psychiatric intensive care unit in Ireland: a longitudinal follow-up. Ir J Psychol Med 2023; 40:361-368. [PMID: 33890559 DOI: 10.1017/ipm.2021.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This study aims to describe the course of admission and clinical characteristics of admissions to a psychiatric intensive care unit (PICU) in the Phoenix Care Centre (PCC), Dublin, Ireland. METHODS This retrospective chart study was conducted at the PCC, Dublin, Ireland. The cohort included all admission episodes (n = 91 complete data) over a three-year study period between January 2014 and January 2017. RESULTS The mean age of admitted cases was 37.1 (s.d. = 11.3; range 18-63). The mean length of stay (LOS) was 59.3 days (s.d. = 61.0; median 39.5 days). All patients were admitted under Mental Health Act legislation. Antipsychotic polypharmacy was used in 61% (n = 55) of the admissions. A diagnosis of acute psychotic disorder (B = -1.027, p = 0.003, 95% CI: -1.691, -0.363) was associated with reduced LOS in PICU. CONCLUSION Our study describes the cohort of patients admitted as being predominantly male, younger-aged, single, having a diagnosis of schizophrenia and being legally detained. The primary indication for referral is risk of assault, which highlights the need for the intensive and secure treatment model that a PICU can provide.
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Affiliation(s)
- S Raaj
- Psychiatry Intensive Care Unit, Phoenix Care Centre, Dublin, Ireland
- Department of Liaison Psychiatry, Mater Misericordiae University Hospital, Dublin 7, Ireland
- Department of Psychiatry, School of Medicine, University College Dublin, Dublin, Ireland
| | - S Navanathan
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Psychiatry Old Age, Ashlin Centre, Beaumont Hospital, Dublin, Ireland
| | - B Matti
- Department of Psychiatry, St. Patrick University Hospital, Dublin 8, Ireland
| | - A Bhagawan
- Psychiatry Intensive Care Unit, Phoenix Care Centre, Dublin, Ireland
| | - P Twomey
- Psychiatry Intensive Care Unit, Phoenix Care Centre, Dublin, Ireland
| | - J Lally
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Psychiatry, Mater Misericordiae University Hospital, Dublin 7, Ireland
- Department of Psychiatry, St. Vincent's Hospital Fairview, Dublin, Ireland
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - R Browne
- Psychiatry Intensive Care Unit, Phoenix Care Centre, Dublin, Ireland
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
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Hu YH, Hung JH, Hu LY, Huang SY, Shen CC. An analysis of Chinese nursing electronic medical records to predict violence in psychiatric inpatients using text mining and machine learning techniques. PLoS One 2023; 18:e0286347. [PMID: 37285344 DOI: 10.1371/journal.pone.0286347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 05/14/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND The prevalence of violence in acute psychiatric wards is a critical concern. According to a meta-analysis investigating violence in psychiatric inpatient units, researchers estimated that approximately 17% of inpatients commit one or more acts of violence during their stay. Inpatient violence negatively affects health-care providers and patients and may contribute to high staff turnover. Therefore, predicting which psychiatric inpatients will commit violence is of considerable clinical significance. OBJECTIVE The present study aimed to estimate the violence rate for psychiatric inpatients and establish a predictive model for violence in psychiatric inpatients. METHODS We collected the structured and unstructured data from Chinese nursing electronic medical records (EMRs) for the violence prediction. The data was obtained from the psychiatry department of a regional hospital in southern Taiwan, covering the period between January 2008 and December 2018. Several text mining and machine learning techniques were employed to analyze the data. RESULTS The results demonstrated that the rate of violence in psychiatric inpatients is 19.7%. The patients with violence in psychiatric wards were generally younger, had a more violent history, and were more likely to be unmarried. Furthermore, our study supported the feasibility of predicting aggressive incidents in psychiatric wards by using nursing EMRs and the proposed method can be incorporated into routine clinical practice to enable early prediction of inpatient violence. CONCLUSIONS Our findings may provide clinicians with a new basis for judgment of the risk of violence in psychiatric wards.
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Affiliation(s)
- Ya-Han Hu
- Department of Information Management, National Central University, Taoyuan City, Taiwan
- Asian Institute for Impact Measurement and Management, National Central University, Taoyuan City, Taiwan
| | - Jeng-Hsiu Hung
- Department of Obstetrics and Gynecology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Li-Yu Hu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Sheng-Yun Huang
- Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan
| | - Cheng-Che Shen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan
- Center for Innovative Research on Aging Society (CIRAS), National Chung Cheng University, Minxiong, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
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Weltens I, Bak M, Verhagen S, Vandenberk E, Domen P, van Amelsvoort T, Drukker M. Aggression on the psychiatric ward: Prevalence and risk factors. A systematic review of the literature. PLoS One 2021; 16:e0258346. [PMID: 34624057 PMCID: PMC8500453 DOI: 10.1371/journal.pone.0258346] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 09/26/2021] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION On psychiatric wards, aggressive behaviour displayed by patients is common and problematic. Understanding factors associated with the development of aggression offers possibilities for prevention and targeted interventions. This review discusses factors that contribute to the development of aggression on psychiatric wards. METHOD In Pubmed and Embase, a search was performed aimed at: prevalence data, ward characteristics, patient and staff factors that are associated with aggressive behaviour and from this search 146 studies were included. RESULTS The prevalence of aggressive behaviour on psychiatric wards varied (8-76%). Explanatory factors of aggressive behaviour were subdivided into patient, staff and ward factors. Patient risk factors were diagnosis of psychotic disorder or bipolar disorder, substance abuse, a history of aggression, younger age. Staff risk factors included male gender, unqualified or temporary staff, job strain, dissatisfaction with the job or management, burn-out and quality of the interaction between patients and staff. Staff protective factors were a good functioning team, good leadership and being involved in treatment decisions. Significant ward risk factors were a higher bed occupancy, busy places on the ward, walking rounds, an unsafe environment, a restrictive environment, lack of structure in the day, smoking and lack of privacy. CONCLUSION Despite a lack of prospective quantitative data, results did show that aggression arises from a combination of patient factors, staff factors and ward factors. Patient factors were studied most often, however, besides treatment, offering the least possibilities in prevention of aggression development. Future studies should focus more on the earlier stages of aggression such as agitation and on factors that are better suited for preventing aggression such as ward and staff factors. Management and clinicians could adapt staffing and ward in line with these results.
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Affiliation(s)
- Irene Weltens
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Maarten Bak
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands.,Mondriaan Mental Health Institute, Maastricht / Heerlen, The Netherlands
| | - Simone Verhagen
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands.,Mondriaan Mental Health Institute, Maastricht / Heerlen, The Netherlands
| | - Emma Vandenberk
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Patrick Domen
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands.,Mondriaan Mental Health Institute, Maastricht / Heerlen, The Netherlands
| | - Thérèse van Amelsvoort
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands.,Mondriaan Mental Health Institute, Maastricht / Heerlen, The Netherlands
| | - Marjan Drukker
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands
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Winkler D, Kaltenboeck A, Frey R, Kasper S, Pjrek E. Changes over time of the diagnostic and therapeutic characteristics of patients of a psychiatric intensive care unit in Austria. Compr Psychiatry 2019; 93:20-26. [PMID: 31280143 DOI: 10.1016/j.comppsych.2019.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The aim of this repeated cross-sectional study was to compare patients from a psychiatric intensive care unit (PICU) over ≫30 years regarding their diagnostic and therapeutic characteristics. METHOD Three samples including 100 consecutive inpatients each from the Viennese PICU were submitted to a chart review: sample no. 1 from the years 1985/86, no. 2 from 1995/96 and no. 3 from 2007/08. RESULTS Changes in referral modes were associated with a decrease of patients with substance induced disorders and an increase of patients with affective disorders over time. The rate of admissions after accidents and suicides was stable. The use of cranial MRI increased, while intravenous psychopharmacotherapy and parenteral nutrition decreased. Involuntary admission occurred in 43% and in 37% of patients physical restraints were necessary. We saw a shift from tricyclic antidepressants to SSRIs and SNRIs from sample 1 to 3. Likewise, we observed the emergence of atypical antipsychotics and a reduction of use of typical neuroleptics mainly from sample 2 to 3. The percentage of patients receiving benzodiazepines increased over time, while the mean dosage of benzodiazepines decreased. 7% of patients received electroconvulsive therapy. CONCLUSIONS The changes over time in our samples reflect the medical progress made during the last decades. Future studies should focus on evaluation of efficacy of psychiatric intensive care using standardized measurements.
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Affiliation(s)
- Dietmar Winkler
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria.
| | - Alexander Kaltenboeck
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria; Department of Psychiatry, University of Oxford, United Kingdom
| | - Richard Frey
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Edda Pjrek
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
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d'Ettorre G, Pellicani V. Workplace Violence Toward Mental Healthcare Workers Employed in Psychiatric Wards. Saf Health Work 2017; 8:337-342. [PMID: 29276631 PMCID: PMC5715456 DOI: 10.1016/j.shaw.2017.01.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 09/19/2016] [Accepted: 01/12/2017] [Indexed: 12/01/2022] Open
Abstract
Background Workplace violence (WPV) against healthcare workers (HCWs) employed in psychiatric inpatient wards is a serious occupational issue that involves both staff and patients; the consequences of WPV may include increased service costs and lower standards of care. The purpose of this review was to evaluate which topics have been focused on in the literature and which are new in approaching the concern of patient violence against HCWs employed in psychiatric inpatient wards, in the past 20 years. Methods We searched for publications in PubMed and Web of Science using selected keywords. Each article was reviewed and categorized into one or more of the following four categories based on its subject matter: risk assessment, risk management, occurrence rates, and physical/nonphysical consequences. Results Our search resulted in a total of 64 publications that matched our inclusion criteria. The topics discussed, in order of frequency (from highest to lowest), were as follows: “risk assessment,” “risk management,” “occurrence rates,” and “physical/nonphysical consequences.” Schizophrenia, young age, alcohol use, drug misuse, a history of violence, and hostile-dominant interpersonal styles were found to be the predictors of patients’ violence. Conclusion Risk assessment of violence by patients appeared the way to effectively minimize the occurrence of WPV and, consequently, to better protect mental HCWs. We found paucity of data regarding psychologic sequelae of WPV. According to these findings, we suggest the need to better investigate the psychologic consequences of WPV, with the aim of checking the effective interventions to assist HCW victims of violence and to prevent psychologic illness.
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Affiliation(s)
- Gabriele d'Ettorre
- Health Unit of Occupational Prevention and Protection, Local Health Authority of Brindisi, Brindisi, Italy
- Corresponding author. Unit of Occupational Prevention and Protection, Local Health Authority of Brindisi (ASL Brindisi), Di Summa Square, Brindisi 72100, Italy.Unit of Occupational Prevention and ProtectionLocal Health Authority of Brindisi (ASL Brindisi)Di Summa SquareBrindisi72100Italy
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Neeilan R, O'Brien A. A retrospective study describing the characteristics of one Mental Health Trust's admissions under sections 47 and 48 of the Mental Health Act 1983. MEDICINE, SCIENCE, AND THE LAW 2017; 57:1-6. [PMID: 28262050 DOI: 10.1177/0025802416677192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Sections 47 and 48 of the Mental Health Act 1983 allow prisoners to be transferred from prison to an appropriate health-care setting in order to be treated. There is an awareness that delays exist when transferring prisoners to hospital. However, literature regarding the delay in returning these patients from hospital is limited. The admissions from prison to a Psychiatric Intensive Care Unit (PICU) in South West London were compared to non-offenders on the PICU in order to compare the average length of stay for both groups and the time taken for the discharge from PICU once felt clinically appropriate. The study also compared demographic profiles, reason for admissions, psychiatric diagnosis and index offences. Over six years, there were 18 admissions from prison to a PICU. The control group comprised 37 non-offenders admitted to the same PICU. On average the prison group took longer to be deemed clinically ready for discharge and, even once clinically ready, then took longer to be discharged. The average length of stay in PICU was 77.83 days for prisoners, and 16.46 days for non-offenders. All 55 admissions were between 1 January 2008 and 31 December 2014. The offender pathway and the difference in the length of stay between prisoners and non-offenders in a PICU warrants further exploration. Possible recommendations to reduce the length of stay of prisoners include improved information sharing between prisons and hospital, and clearer guidelines regarding the level of security required.
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Iozzino L, Ferrari C, Large M, Nielssen O, de Girolamo G. Prevalence and Risk Factors of Violence by Psychiatric Acute Inpatients: A Systematic Review and Meta-Analysis. PLoS One 2015; 10:e0128536. [PMID: 26061796 PMCID: PMC4464653 DOI: 10.1371/journal.pone.0128536] [Citation(s) in RCA: 202] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 04/26/2015] [Indexed: 12/20/2022] Open
Abstract
Background Violence in acute psychiatric wards affects the safety of other patients and the effectiveness of treatment. However, there is a wide variation in reported rates of violence in acute psychiatric wards. Objectives To use meta-analysis to estimate the pooled rate of violence in published studies, and examine the characteristics of the participants, and aspects of the studies themselves that might explain the variation in the reported rates of violence (moderators). Method Systematic meta-analysis of studies published between January 1995 and December 2014, which reported rates of violence in acute psychiatric wards of general or psychiatric hospitals in high-income countries. Results Of the 23,972 inpatients described in 35 studies, the pooled proportion of patients who committed at least one act of violence was 17% (95% confidence interval (CI) 14–20%). Studies with higher proportions of male patients, involuntary patients, patients with schizophrenia and patients with alcohol use disorder reported higher rates of inpatient violence. Conclusion The findings of this study suggest that almost 1 in 5 patients admitted to acute psychiatric units may commit an act of violence. Factors associated with levels of violence in psychiatric units are similar to factors that are associated with violence among individual patients (male gender, diagnosis of schizophrenia, substance use and lifetime history of violence).
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Affiliation(s)
- Laura Iozzino
- Psychiatric Epidemiology and Evaluation Unit, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
- Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy
| | - Clarissa Ferrari
- Psychiatric Epidemiology and Evaluation Unit, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Matthew Large
- Prince of Wales Hospital Sydney, Sydney, Australia
- University of New South Wales, Sydney, Australia
| | - Olav Nielssen
- St. Vincent’s Hospital Sydney, Sydney, Australia
- University of New South Wales, Sydney, Australia
| | - Giovanni de Girolamo
- Psychiatric Epidemiology and Evaluation Unit, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
- * E-mail:
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Salzmann-Erikson M. Stability in intensive psychiatry: a concept analysis. Perspect Psychiatr Care 2014; 50:122-31. [PMID: 24689492 DOI: 10.1111/ppc.12030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 04/23/2013] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The aim of this concept analysis is to describe, explore, and explain stability in the context of mental health nursing in intensive psychiatry. DESIGN AND METHODS A modified version of Wilson's method of concept analysis was used. FINDINGS Stability is the ability to be resistant to changes. Stability can take different directions after a distortion: re-gaining, neo-gaining, and apo-gaining. Stability may also be achieved through active (adding or using power, making adjustments, parrying, and idling) and passive systems (environmental conditions and constituent materials). PRACTICE IMPLICATIONS This article contributes by providing knowledge and insight for nurses on the roles they play in intensive psychiatry as stabilizers.
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Affiliation(s)
- Martin Salzmann-Erikson
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden; Dalarna University School of Health and Society, Falun, Sweden; Division of Mental Health and Addiction, Department of Acute Psychiatry, Oslo University Hospital, Ullevål, Oslo, Norway
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Cornaggia CM, Beghi M, Pavone F, Barale F. Aggression in psychiatry wards: a systematic review. Psychiatry Res 2011; 189:10-20. [PMID: 21236497 DOI: 10.1016/j.psychres.2010.12.024] [Citation(s) in RCA: 205] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 12/04/2010] [Accepted: 12/08/2010] [Indexed: 01/13/2023]
Abstract
Although fairly frequent in psychiatric in-patient, episodes of aggression/violence are mainly limited to verbal aggression, but the level of general health is significantly lower in nurses who report 'frequent' exposure to violent incidents, and there is disagreement between patients and staff concerning predictors of these episodes. We searched the Pubmed, Embase and PsychInfo databases for English, Italian, French or German language papers published between 1 January 1990 and 31 March 2010 using the key words "aggress*" (aggression or aggressive) "violen*" (violence or violent) and "in-patient" or "psychiatric wards", and the inclusion criterion of an adult population (excluding all studies of selected samples such as a specific psychiatric diagnosis other than psychosis, adolescents or the elderly, men/women only, personality disorders and mental retardation). The variables that were most frequently associated with aggression or violence in the 66 identified studies of unselected psychiatric populations were the existence of previous episodes, the presence of impulsiveness/hostility, a longer period of hospitalisation, non-voluntary admission, and aggressor and victim of the same gender; weaker evidence indicated alcohol/drug misuse, a diagnosis of psychosis, a younger age and the risk of suicide. Alcohol/drug misuse, hostility, paranoid thoughts and acute psychosis were the factors most frequently involved in 12 studies of psychotic patients. Harmony among staff (a good working climate) seems to be more useful in preventing aggression than some of the other strategies used in psychiatric wards, such as the presence of male nurses.
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Affiliation(s)
- Cesare Maria Cornaggia
- Department of Clinical Psychiatry, University of Milano-Bicocca, Monza, Italy; Organic Psychiatry Unit, Zucchi Clinical Institute, Carate Brianza, Italy
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Aggression patterns and clinical predictors of inpatient aggression in a mental health low secure unit population. ACTA ACUST UNITED AC 2008. [DOI: 10.1017/s1742646408001283] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Bowers L, Jeffery D, Bilgin H, Jarrett M, Simpson A, Jones J. Psychiatric intensive care units: a literature review. Int J Soc Psychiatry 2008; 54:56-68. [PMID: 18309759 DOI: 10.1177/0020764007082482] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Psychiatric Intensive Care Units (PICU) have been part of most inpatient psychiatric services for some time, although information about their functioning and outcome has not previously been collated. AIM To conduct a systematic literature review to assess the current state of knowledge about such services. METHOD A search of electronic databases was undertaken, followed by obtaining additional references from items obtained. RESULTS Over 50 papers in English containing some empirical data were identified. Most studies were retrospective. Typical PICU patients are male, younger, single, unemployed, suffering from schizophrenia or mania, from a Black Caribbean or African background, legally detained, with a forensic history. The most common reason for admission is for aggression management, and most patients stay a week or less. Evidence of the efficacy of PICU care is very poor. CONCLUSIONS Most research so far has been small scale, and more substantial work using better methodologies is clearly required.
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Abstract
OBJECTIVE An overview of studies on predictors and on the accuracy of prediction of inpatient violence should be given. METHOD To date, the published data do not allow a systematic meta-analysis due to different sample characteristics, different measures and definitions of violence, and different time frames of observation. Published studies were reviewed regarding significant predictors of inpatient violence. RESULTS Predictors of violence in institutional settings are different from predictors of violence in the community: variables such as sex, age, diagnosis and alcohol abuse play a minor role, while clinical and psychopathological variables are prominent. Only history of violence is a robust static predictor. The total level of positive and general psychotic symptoms seems to enhance the violence risk of inpatients, whereas results concerning specific features like delusions or command hallucinations are contradictory due to inevitable problems of sample selection. The accuracy of clinical predictions is better than chance but limited by the effects of therapeutic interventions and research artefacts. CONCLUSION The author argues that more precise determinations of the violence risk in institutions will fail and that the role of environmental factors has often been underestimated.
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Affiliation(s)
- T Steinert
- Centre of Psychiatry Weissenau, Department of Psychiatry I, University of Ulm, Ravensburg-Weissenau, Germany
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Johnston SJ. Risk assessment in offenders with intellectual disability: the evidence base. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2002; 46 Suppl 1:47-56. [PMID: 12031017 DOI: 10.1046/j.1365-2788.2002.t01-1-00003.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
A review of the current literature on risk assessment and management in offenders with intellectual disability (ID) revealed little direct evidence for the specific population. Theoretical models and non-ID populations have been abstracted and adapted, but not validated, for those with ID. The varying conceptual frameworks of risk, and its assessment and management, must be considered in context. Difficulties remain with the consideration of offences versus offence-like behaviour, offender versus those with similar needs, and indeed, what is regarded as 'intellectual disability'. Mainstream forensic assessment has moved towards a more dynamic appreciation of risk and risk management, as opposed to risk elimination. This development is more in line with the normalization principles of 'risk-taking' in ID. Consideration is given to future research and development priorities.
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Affiliation(s)
- S J Johnston
- Rampton Hospital, Nottinghamshire Healthcare NHS Trust, Retford, Notts, UK.
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