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

Seclusion and enforced medication in dealing with aggression:A prospective dynamic cohort study

AbstractBackgroundIn the Netherlands, seclusion is historically the measure of first choice in dealing with aggressive incidents. In 2010, the Mediant Mental Health Trust in Eastern Netherlands introduced a policy prioritising the use of enforced medication to manage aggressive incidents over seclusion. The main goal of the study was to investigate whether prioritising enforced medication over seclusion leads to a change of aggressive incidents and coercive measures.MethodsThe study was carried out with data from 2764 patients admitted between 2007 and 2013 to the hospital locations of the Mediant Mental Health Trust in Eastern Netherlands, with a catchment area of 500,000 inhabitants. Seclusion, restraint and enforced medications as well as other coercive measures were gathered systematically. Aggressive incidents were assessed with the SOAS-R. An event sequence analysis was preformed, to assess the whether seclusion, restraint or enforced medication were used or not before or after aggressive incidents.ResultsEnforced medication use went up by 363% from a very low baseline. There was a marked reduction of overall coercive measures by 44%. Seclusion hours went down by 62%. Aggression against staff or patients was reduced by 40%.ConclusionsWhen dealing with aggression, prioritising medication significantly reduces other coercive measures and aggression against staff, while within principles of subsidiarity, proportionality and expediency.</jats:sec

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

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-

A blind spot? Screening for mild intellectual disability and borderline intellectual functioning in admitted psychiatric patients: Prevalence and associations with coercive measures

Contains fulltext : 169048.pdf (publisher's version ) (Open Access)Background: Failure to detect psychiatric patients' intellectual disabilities may lead to inappropriate treatment and greater use of coercive measures. Aims: In this prospective dynamic cohort study we screened for intellectual disabilities in patients admitted to psychiatric wards, and investigated the use of coercive measures with these patients. Methods: We used the Screener for Intelligence and Learning disabilities (SCIL) to screen patients admitted to two acute psychiatric wards, and assessed patient characteristics and coercive measures during their stay and over the last 5 years. Results: Results on the SCIL suggested that 43.8% of the sample had Mild Intellectual Disability or Borderline Intellectual Functioning (MID/BIF). During their current stay and earlier stays in the previous 5 years, these patients had an increased risk of involuntary admission (OR 2.71; SD 1.28-5.70) and coercive measures (OR 3.95, SD 1.47-10.54). Conclusions: This study suggests that functioning on the level of MID/BIF is very prevalent in admitted psychiatric patients and requires specific attention from mental health care staff.10 p

Predictors for treatment outcome of binge eating with obesity: A naturalistic study

Item does not contain fulltextThis study examines predictors of short-term treatment outcome for obese individuals with binge eating disorder (BED). A battery of assessment questionnaires was given to 212 patients on admission of a CBT day-treatment program for BED. Treatment outcome assessed by changes in eating disorder symptomatology was measured in 182 completers. Linear regression analyses indicated that a combination of variables at baseline predicted 26% of the variance in treatment outcome. High social embedding and higher scores on openness (NEO-PI-R) were significantly related to more improvement after treatment. Higher scores on depressive symptoms (BDI), agoraphobia (SCL-90) and extraversion (NEO-PI-R) were significantly related to less improvement. The analyses show that the level of social embedding and psychopathological comorbidity (state and trait) are predictors for treatment outcome. This study confirms the notion that social context and comorbidity need to be taken into account as described in treatment guidelines of NICE and APA for BED

Predicting dropout from intensive outpatient cognitive behavioural therapy for binge eating disorder using pre-treatment characteristics: A naturalistic study

Background: Dropout rates in binge eating disorder (BED) treatment are high (17-30%), and predictors of dropout are unknown. Method: Participants were 376 patients following an intensive outpatient cognitive behavioural therapy programme for BED, 82 of whom (21.8%) dropped out of treatment. An exploratory logistic regression was performed using eating disorder variables, general psychopathology, personality and demographics to identify predictors of dropout. Results: Binge eating pathology, preoccupations with eating, shape and weight, social adjustment, agreeableness, and social embedding appeared to be significant predictors of dropout. Also, education showed an association to dropout. Discussion: This is one of the first studies investigating pre-treatment predictors for dropout in BED treatment. The total explained variance of the prediction model was low, yet the model correctly classified 80.6% of cases, which is comparable to other dropout studies in eating disorders

Factoren van invloed op separatie na agressie

Item does not contain fulltextachtergrond Agressie is deels de aanleiding van toegepaste dwang (12-100%, review Demeestere 1995). In het kader van een landelijk project gericht op reductie van dwang en drang werd de relatie russen agressie en separatie onderzocht, zodat een heldere uitgangssituatie geschetst kan worden waarop interventies kunnen plaatsvinden.&nbsp; Doel Welke patiënt-, contextuele en/of agressiefactoren zijn van invloed op de beslissing al dan niet te separeren na een agressie-incident? Methoden Alle patiënten opgenomen in een psychiatrisch ziekenhuis in de loop van één jaar werden geïncludeerd. Patiëntfactoren en contextuele factoren werden vastgelegd. Agressieincidenten en eenzame opsluiting (separatie en afzondering) werden bijgehouden. De agressieincidenten werden verdeeld in twee groepen: wel en niet gevolgd door eenzame opsluiting. Alle factoren werden univariaat gerelateerd aan de uitkomstvariabele door middel van kruistabellen met oddsratio of vergelijking van gemiddelden (t-test of mann-whitney-U-test). Significante factoren werden in groepen toegevoegd aan een logistisch regressiemodel, eerst de patiëntvariabelen, vervolgens de contextuele factoren en als laatste de agressiedeterminanten. Resultaten In het onderzoek konden 744 patiënten geïncludeerd worden; er waren 397 incidenten over het hele jaar in het gehele ziekenhuis. Voorlopige resultaten van de univariate analyses laten zien dat (jongere) leeftijd, bipolaire stoornis, psychosociale problemen, late dienst, gesloten afdeling, een heropname, onduidelijke provocatie, lichamelijke en/of gevaarlijke agressie, doelwit object, autoagressie, een hoge soasr-totaalscore (Staff Observation Agression Scale-Revised) en een hoge vas-score (visueel analoge schaal) positief gerelateerd zijn aan separatie na agressie. Negatief gerelateerd zijn: getrouwd zijn, depressieve stoornis, middelenafhankelijkheid, persoonlijkheidsstoornis, eerste agressie-incident en geen consequenties voor slachtoffer(s). Conclusie Definitieve cijfers zullen in de presentatie worden getoond.1 p

Predicting inpatient aggression by self-reported impulsivity in forensic psychiatric patients

Item does not contain fulltextBackground: Empirical knowledge of 'predictors' of physical inpatient aggression may provide staff with tools to prevent aggression or minimise its consequences. Aim: To test the value of a self-reported measure of impulsivity for predicting inpatient aggression. Methods: Self-report measures of different domains of impulsivity were obtained using the Urgency, Premeditation, Perseverance, Sensation seeking, Positive urgency (UPPS-P) impulsive behaviour scale with all 74 forensic psychiatric inpatients in one low-security forensic hospital. Aggressive incidents were measured using the Social Dysfunction and Aggression Scale (SDAS). The relationship between UPPS-P subscales and the number of weeks in which violent behaviour was observed was investigated by Poisson regression. Results: The impulsivity domain labelled ‘negative urgency’ (NU), in combination with having a personality disorder, predicted the number of weeks in which physical aggression was observed by psychiatric nurses. NU also predicted physical aggression within the first 12 weeks of admission. Conclusions: and implications for practice The results indicate that NU, which represents a patient's inability to cope with rejection, disappointments or other undesired feelings, is associated with a higher likelihood of becoming violent while an inpatient. This specific coping deficit should perhaps be targeted more intensively in therapy. Self-reported NU may also serve as a useful adjunct to other risk assessment tools and as an indicator of change in violence risk.13 p

Three pathways of seclusion reduction programs to sustainability: Ten years follow up in psychiatry

Item does not contain fulltextFrom 2004 onwards, above 50 seclusion reduction programs (SRP) were developed, implemented and evaluated in the Netherlands. However, little is known about their sustainability, as to which extent obtained reduction could be maintained. This study monitored three programs over ten years seeking to identify important factors contributing to this. We reviewed documents of three SRPs that received governmental funding to reduce seclusion. Next, we interviewed key figures from each institute, to investigate the SRP documents and their implementation in practice. We monitored the number of seclusion events and the number of seclusion days with the Argus rating scale over ten years in three separate phases: 2008–2010, 2011-2014 and 2015-2017. As we were interested in sustainability after the governmental funding ended in 2012, our focus was on the last phase. Although in different rate, all mental health institutes showed some decline in seclusion events during and immediately after the SRP. After end of funding one institute showed numbers going up and down. The second showed an increase in number of seclusion days. The third institute displayed a sustained and continuous reduction in use of seclusion, even several years after the received funding. This institute was the only one with an ongoing institutional SRP after the governmental funding. To sustain accomplished seclusion reduction, a continuous effort is needed for institutional awareness of the use of seclusion, even after successful implementation of SRPs. If not, successful SRPs implemented in psychiatry will easily relapse in traditional use of seclusion.16 p