Skin autofluorescence assessment of cardiovascular risk in people with severe mental illness

Background People with severe mental illness (SMI) show significantly shorter life expectancy, mostly due to more prevalent cardiovascular disease. Although age is a prominent contributor to contemporary risk assessment and SMI usually affects younger people, these assessments still do not reveal the actual risk. By assessing advanced glycation end products (AGEs), cardiovascular risk can be assessed independent of age. Aims To establish whether detection of AGEs with the AGE-reader will give a more accurate cardiovascular risk assessment in people with SMI. Method We compared assessment with the AGE-reader with that of the Systematic Coronary Risk Evaluation (SCORE) table in a group of 120 patients with SMI. Results The AGE-reader showed an increased cardiovascular risk more often than the SCORE table, especially in the youngest group. Conclusions Because of its ease of use and substantiation by studies done on other chronic diseases, we advocate use of the AGE-reader in daily care for patients with SMI to detect cardiovascular risk as early as possible. However, the findings of the current study should be evaluated with caution and should be seen as preliminary findings that require confirmation by a prospective longitudinal cohort study with a substantial follow-up observation period. (c) The Royal College of Psychiatrists 2018

An international study of the prevalence of substance use in patients with delusional infestation

To the Editor: Delusional infestation (DI) is a disorder characterised by the belief of being infested with living organisms or objects.1 Insects and worms are the most common concerns. Objects, such as fibers or threads, are increasingly reported by patients. DI can be primary or secondary to mental illness, physical illness, prescribed medication, and misuse of substances such as amphetamines, cannabis, codeine, cocaine, or opiates. Dermatologists are usually the specialists to whom a patient with DI is referred because patients believe that they have primarily a skin diseas

“Disruptive Behavior” or “Expected Benefit” Are Rationales of Seclusion Without Prior Aggression

Objective: In the Netherlands, seclusion of patients with a psychiatric disorder is a last-resort measure to be used only in the event of (imminent) severe danger or harm. Although aggressive behavior is often involved, seclusions not preceded by aggression also seem to occur. We sought insight into the non-aggressive reasons underlying seclusion and investigated the factors associated with it. Method: We included all patients admitted to a Dutch psychiatric hospital in 2008 and 2009. Seclusions had been registered on Argus-forms, and aggression incidents had been registered on the Staff Observation Aggression Scale-Revised (SOAS-R), inspectorate forms and/or patient files. Determinants of seclusion with vs. without prior aggression were analyzed using logistic regression. Reasons for seclusion without prior aggression were evaluated qualitatively and grouped into main themes. Results: Of 1,106 admitted patients, 184 (17%) were secluded at some time during admission. Twenty-one (11.4%) were excluded because information on their seclusion was lacking. In 23 cases (14%), neither SOAS-R, inspectorate forms nor individual patient files indicated any aggression. Univariable and multivariable regression both showed seclusion without preceding aggression to be negatively associated with daytime and the first day of hospitalization. In other words, seclusion related to aggression occurred more on the first day, and during daytime, while seclusion for non-aggressive reasons occurred relatively more after the first day, and during nighttime. Our qualitative findings showed two main themes of non-aggressive reasons for seclusion: “disruptive behavior” and “beneficial to patient.” Conclusion: Awareness of the different reasons for seclusion may improve interventions on reducing its use. Thorough examination of different sources showed that few seclusions had not been preceded by aggression. The use of seclusion would be considerably reduced through interventions that prevent aggression or handle aggression incidents in other ways than seclusion. However, attention should also be paid to the remaining reasons for seclusion, such as handling disruptive behavior and focusing on the beneficial effects of reduced stimuli. Future research on interventions to reduce the use of seclusion should not only aim to reduce seclusion but should also establish whether seclusions preceded by aggression decrease different from seclusions that are not preceded by aggression

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

BackgroundEmpirical knowledge of predictors' of physical inpatient aggression may provide staff with tools to prevent aggression or minimise its consequences. AimTo test the value of a self-reported measure of impulsivity for predicting inpatient aggression. MethodsSelf-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. ResultsThe 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 12weeks of admission. Conclusions and implications for practiceThe 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. Copyright (c) 2015 John Wiley & Sons, Ltd

Staff and caregiver attitude to coercion in India

Objectives: The objective of this study was to assess attitudes of Indian psychiatrists and caregivers toward coercion. Materials and Methods: The study was conducted at the Department of Psychiatry, Krishna Rajendra Hospital, Mysore, India. Staff Attitude to Coercion Scale (SACS), a 15-item questionnaire, was administered to self-selected psychiatrists across India and caregivers from Mysore to measure attitudes on coercion. Data were analyzed using descriptive statistics and investigating differences in subgroups by means of Chi-square test, Student′s t-test, and analysis of variance. Reliability of the SACS was tested in this Indian sample. Results: A total of 210 psychiatrists and 210 caregivers participated in the study. Both groups agreed that coercion was related to scarce resources, security concerns, and harm reduction. Both groups agreed that coercion is necessary, but not as treatment. Older caregivers and male experienced psychiatrists considered coercion related to scarce resources to violate patient integrity. All participants considered coercion necessary for protection in dangerous situations. Professionals and caregivers significantly disagreed on most items. The reliability of the SACS was reasonable to good among the psychiatrists group, but not in the caregiver group (alpha 0.58 vs. 0.07). Conclusion: Caregivers and psychiatrists felt that the lack of resources is one of the reasons for coercion. Furthermore, they felt that the need on early identification of aggressive behavior, interventions to reduce aggressiveness, empowering patients, improving hospital resources, staff training in verbal de-escalation techniques is essential. There is an urgent need in the standardized operating procedure in the use of coercive measure in Indian mental health setting

Perceived coercion in persons iwth mental disorder in India:A cross sectional study

Background: Little is known about how patients in India perceive coercion in psychiatric care. Aims: To assess perceived coercion in persons with mental disorder admitted involuntarily and correlate with sociodemographic factors and illness variables. Materials and Methods: We administered the short MacArthur Admission Experience Interview Questionnaire to all consecutive involuntary psychiatric patients admitted in 2014 in Mysore, India. Multivariate linear regression was used. Results: Three hundred and one patients participated. "Perceived coercion" subscale scores increased with female gender, nuclear family status, Muslim and Christian religion, lower income, and depressive disorder. It decreased with former coercion, forensic history, and longer illness duration. Drug use increased total scores; the extended family item decreased them. "Negative pressure" increased with male gender, extended family, lower income, forensic history, and longer illness duration. Conclusions: The study shows perceived coercion is a reality in India. Levels of perceived coercion and the populations affected are similar to high-income countries

Value of Physical Activity and Sedentary Behavior in Predicting Depression in Older Adults

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