Self-injurious behavior in people with intellectual disabilities and co-occurring psychopathology using the Self-Harm Scale:A pilot study

Self-injurious behavior (SIB) is one of the most detrimental behaviors for the person showing it, as well as for their environment. Nevertheless, structured clinical assessments of SIB are scarce. Staff completed a Self-Harm Scale (SHS) every time they witnessed SIB in clients with an intellectual disability (ID) and co-occurring psychopathology (N = 33). Descriptive statistics were conducted to explore the nature of the incidents of SIB and the characteristics of the people involved in the incidents. In 41 weeks, 104 SIB incidents were reported for 8 out of 33 clients (24%). Incidents were most prevalent on Mondays (23%). As far as the methods of SIB concerned, cutting was the most used method (63%). Clients who showed SIB differed significantly from clients who did not on gender, having a personality disorder and communicative abilities. This study was one of the few that used an incident-based record form to report SIB by direct observation. It is hoped that the SHS helps to gain more information about SIB, to improve individualized interventions. Further research is necessary to determine the psychometric properties and clinical utility of the scale

Not recognized enough: The effects and associations of trauma and intellectual disability in severely mentally ill outpatients

Item does not contain fulltextBackground: Little is known about the association between trauma and intellectual disability in SMI patients. Aim: To establish the prevalence of trauma and its association with intellectual functioning in SMI outpatients. Methods: A cross-sectional study was conducted in two mental health trusts in the Netherlands. We used the Trauma Screening Questionnaire (TSQ) to screen for trauma and PTSD, and the Screener for Intelligence and Learning disabilities (SCIL) for suspected MID/BIF. Chi-square and t-tests were used to test differences in outcome over patient characteristics. Post-hoc analysis was used to investigate gender differences between patients with and without MID/BIF on trauma and sexual trauma. Results: Any trauma was found in 86% of 570 patients and 42% were suspected for PTSD. The SCIL suggested that 40% had Borderline Intellectual Functioning (BIF), half of whom were suspected of having Mild Intellectual Disability (MID). These patients had more traumatic experiences (1.89 in BIF, 1.75 in MID, against 1.41 in SCIL-negative patients). Female MID/BIF patients (61%) had experienced significantly more sexual abuse than male MID/BIF patients (23%). Conclusions: Significantly more SMI outpatients who screened positive for MID/BIF reported having experienced traumatic events than those who screened negative. Rates of all trauma categories were significantly higher in the screen-positive group, who were also more likely to have PTSD. Sexual abuse occurred more in all females but the SCIL positive women are even more often victim. Clinical practice has to pay more attention to all of these issues, especially when they occur together in a single patient.7 p

Toxocara vitulorum & Fasciola gigantica in cattle and buffalo in northern Laos

LUZIA RAST – PhD THESIS… abstract Toxocara vitulorum & Fasciola gigantica in Cattle and Buffalo in Northern Laos In South-East Asia agricultural production including livestock is predominately produced within mixed smallholder farming systems. These mostly operate at subsistence levels. Cattle and buffalo are typically kept as assets rather than for optimal production purposes. Economic growth and urbanisation in the region continues to lead to increased demand for red meat products. This provides opportunities and pressures for smallholder farmers to increase their livestock outputs and supply this market with consistent and high quality products. Laos is well placed to supply this increasing regional demand but constraints inhibiting optimal production outputs from smallholder farming systems need to be addressed. These constraints include low capacity animal health systems, lack of infrastructure, traditional low input/low output farming methods and endemic livestock diseases. There is limited documentation about disease prevalence in large ruminants and basic production benchmarks such as reproductive, morbidity and mortality rates. Anecdotal reports indicate that Fasciola gigantica and Toxocara vitulorum are endemic in Laos and contribute to substantial production losses. This is despite the availability of relative cheap and simple treatment technology for T.vitulorum and substantial past research investment in the region on both parasites. The research presented in this thesis contributes to knowledge on the prevalence of T.vitulorum and F.gigantica in cattle and buffalo and the impact of these parasitic infections on production in mixed smallholder farming systems in northern Laos, which are typical for many other parts of South-East Asia. It further contributes to defining and documenting basic large ruminant production parameters within these production systems and quantifies the financial impact of T.vitulorum treatment of calves. Importantly this research identified a large gap in knowledge and in the sustained adoption of effective control practices for large ruminant internal parasites and explored pathways and gives recommendations to address this. The thesis presents data from seven separate field studies completed in northern Laos between 2009 and 2012. Two cross-sectional field surveys were conducted and results showed that both T.vitulorum in cattle and buffalo calves and F.gigantica in adult cattle and buffalo had high apparent prevalence (22.6% and 17.2% respectively) and were geographically widespread throughout northern Laos. Results further indicated that both parasites affected cattle and buffalo at similar levels and that no specific clinical signs were associated with either parasite. This was in line with past research on F.gigantica infection but not for T.vitulorum with limited past research and anecdotal reports indicating that Toxocariasis causes diarrhoea and rough coats in calves and especially so in buffalo calves. Slaughterhouse surveys were conducted in five main provincial slaughterhouses in northern Laos. Results showed a prevalence of faecal eggs for F.gigantica (34.1%) plus liver lesions consistent with F.gigantica infection in 71.0% of slaughtered cattle and buffalo providing further evidence of the endemic nature of this parasite and its potential clinical impact across northern Laos. Additional findings of the slaughterhouse surveys were that a large proportion of slaughtered female animals were pregnant (44% cattle, 47% buffalo), 9.8% of slaughtered animals had FMD lesions and meat inspectors were rarely present for the entire slaughter process with no condemnation of any products. Two separate farmer surveys on a sample of farmers that had their large ruminants tested for either T.vitulorum or F.gigantica were conducted using face-to-face semi-structured interviews. Results of the T.vitulorum farmer survey (n=273) showed that there was a relative high rate of awareness (62.3%) about this parasite amongst farmers and that specific knowledge about its epidemiology and potential clinical impact was lacking. Only 2.5% of farmers used pyrantel treatment of calves at the recommended age and dose rate. Results of the farmer survey (n=326) for F.gigantica showed smallholders had very limited knowledge about Fasciolosis in large ruminants despite 20.6% reporting having seen leaf shaped parasites in livers of slaughtered cattle or buffalo in the past. None of the interviewed farmers treated larger ruminants to control liver fluke. Analyses of large ruminant production data found annual calf morbidity and mortality rates of 42.6% (CI 0.38-0.47) and 37.3% (CI 0.33-0.42) respectively; and adult morbidity and mortality rates of 7.4% (CI 0.06-0.09) and 2.8% (CI 0.003-0.05) respectively. Further, results showed low reproductive performance of 0.6 and 0.4 calf per year for cattle and buffalo respectively with first calving ages of 36 months reported for both species. Two separate field treatment trials were conducted. For T.vitulorum calves were treated when they were 90% reduction of faecal egg counts in adult cattle and buffalo four, eight and twelve weeks post treatment compared to untreated animals. In addition there was a trend of increased weight gain in treated buffalo compared to the untreated control group indicating that treatment of Fasciolosis may result in heavier buffalo. Financial analysis using partial budgeting and data from our surveys showed that there was a large net benefit of USD 3.69-14.86 per calf for treatment with pyrantel (12.5 mg/kg) once only between 14-21 days of age compared to no treatment. It was concluded that both T.vitulorum and F.gigantica are endemic in northern Laos and contribute to substantial production losses in this area. Smallholder farmers still keep large ruminants mostly as an asset and there is also a large knowledge gap amongst smallholder producers about internal parasites, their health and production effects and effective control methods. This knowledge gap and the lack of commercial driver contribute to the deficit of widespread adoption of parasite control methods by smallholder farmers despite their availability and known effectiveness. These results suggest, especially for T.vitulorum that if recommended control methods were widely adopted, large ruminant production output from smallholder farming systems could be increased through reduced calf morbidity and mortality rates

Comparing aversive and appetitive learning performances in individual honeybees

Background A neurobiological perspective has become accepted as a valuable approach for understanding anti-social behaviour. There is literature to suggest that, in non-offending populations, psychological treatments affect both neurobiological measures and clinical presentation. A theoretical position to this effect has been adopted with respect to offender treatment, but there has been no systematic review of empirical literature on this point. Aims This study aimed to ascertain from published literature firstly whether there is evidence of change in neuropsychological or physiological measures after behavioural treatments/programmes for people with anti-social behaviour and secondly whether these neurobiological changes are associated with behavioural change. Method A systematic search strategy was formulated to include studies considering neurobiological factors', anti-social population', treatment' and treatment outcome'. The Maryland Scientific Methods Scale was used to select relevant studies of sufficient methodological quality. Results Eleven studies were found, only one with adults. Overall, the values of specific neurobiological risk factors, particularly of basal cortisol, become less abnormal following intervention. There was some evidence for a link between change in neurobiological functioning and behavioural improvement. Conclusions Findings, although provisional, may provide new insights into the underlying mechanisms of interventions for anti-social behaviour. Future studies that include pre-treatment neurobiological assessment could help reveal physical vulnerabilities that interventions should target to improve treatment efficacy, and provide for objective, independent corroboration of change

Junior staffing changes and the temporal ecology of adverse incidents in acute psychiatric wards

Aim.  This paper reports an examination of the relationship between adverse incident rates, the arrival of new junior staff on wards, and days of the week on acute psychiatric wards. Background.  Incidents of violence, absconding and self-harm in acute inpatient services pose risks to patients and staff. Previous research suggests that the arrival of inexperienced new staff may trigger more adverse incidents. Findings on the relationship between incidents and the weekly routine are inconsistent. Method.  A retrospective analysis was conducted of formally reported incident rates, records of nursing student allocations and junior doctor rotation patterns, using Poisson Regression. Variance between days of the week was explored using contingency table analysis. The data covered 30 months on 17 psychiatric wards, and were collected in 2002–2004. Findings.  The arrival of new and inexperienced staff on the wards was not associated with increases in adverse incident rates. Most types of incidents were less frequent at weekends and midweek. Incident rates were unchanged on ward-round days, but increased rates were found on the days before and after ward rounds. Conclusion.  Increased patient tension is associated with raised incident rates. It may be possible to reduce incident rates by moderating stimulation in the environment and by mobilizing support for patients during critical periods

Behandeling en stigmamanagement bij opzettelijke zelfverwonding: het smalle pad tussen te veel en te weinig interveniëren

Opzettelijke zelfverwonding wordt gedefinieerd als de intentionele directe beschadiging van het eigen lichaam, zonder bewuste suïcidale intentie. De behandeling varieert van gedwongen opname in een psychiatrische instelling (in het Britse Gemenebest), tot een permissieve aanpak zonder behandeling en uiteenlopende behandelingsmogelijkheden er tussenin. Eerst wordt de gepastheid van de mate van interveniëren besproken in functie van verschillende diagnosen. Het tweede gedeelte van het artikel bespreekt het advies dat door hulpverleners verstrekt wordt aangaande de omgang met wonden en littekens en aangaande de mogelijkheden voor een (gewezen) zelfverwonder om het stigma van een deviante identiteit te vermijden. Een rondvraag bij Belgische hulpverleners bracht aan het licht dat velen onder hen adviseren om littekens te verbergen, terwijl er anderzijds aanwijzingen zijn dat niet-verbergen een teken van herstel is. Aangezien verbergen en smoesjes verzinnen ook kunnen leiden tot de instandhouding van een deviante identiteit, wordt gewezen op meer gepaste vormen van stigmamanagement

Kunnen we delinquenten niet beter behandelen?

Contains fulltext : 26912.pdf (publisher's version ) (Open Access)Valedictory lecture RU, 22 april 200542 p

Risicotaxatie en behandelevaluatie in de forensische psychiatrie - Een overzicht van recente promoties

Contains fulltext : 56521.pdf (publisher's version ) (Open Access)7 p

Prison dillema’s. Waarom insluiting zonder verlof- en behandelingsmogelijkheden contraproductief kan zijn

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Causes and prevention of aggression from psychotic inpatients

Contains fulltext : 190822.pdf (Publisher’s version ) (Open Access)Background: Patients with schizophrenia and other psychotic disorders have an increased likelihood of engaging in violent behavior. These increased risks of dangerous and aggressive behavior, in combination with a lack of insight in their own illness, relatively often make involuntary admission of acutely disturbed psychotic patients on locked psychiatric admissions wards often inevitable. On these locked psychiatric admissions wards, aggression from psychotic patients against staff and fellow patients is a prevalent phenomenon, with the mean in the Netherlands being about 18 aggressive incidents per bed per year on locked psychiatric admissions wards. Methods: In the lecture, a model of what causes or triggers aggressive behavior on (locked) psychiatric wards is presented. In this model, patient, ward and staff variables are integrated to explain why, and in what specific situations, psychotic patients particularly run a high risk of engaging in aggressive behavior. Results: Based on the presented model, a number of preventive measures can be formulated. On the patient level, the administration of anti-psychotic medication is used to reduce the negative cognitive schemes and delusional thoughts that are depicted in the center of the model. A more novel intervention at the patient level may be the additional administration of nutritional supplements with (among others) high levels of omega 3 fatty acids. The results of two Dutch studies on this topic will be briefly presented in the lecture, among which a RCT on the effects of the use of nutritional supplements on aggressiveness. On the staff level, the use of short-term (daily) risks assessments by the ward nursing staff, among others by means of the six item BrØset Violence Checklist (BVC), has been found to reduce aggressiveness and the use of coercive measures on psychiatric wards in two cluster randomized RCTs. On the ward level, studies indicate that aggression on psychiatric wards can be reduced by preventing overcrowding on psychiatric wards, and by providing more space and privacy to the patients. Discussion: 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.1 p