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

Acute effects of alcohol on feedback processing and outcome evaluation during risky decision-making: an ERP study

Rationale: Although risky decision-making is one of the hallmarks of alcohol use disorders, relatively little is known about the acute psychopharmacological effects of alcohol on decision-making processes. Objective: The present study investigated the acute effects of alcohol on neural mechanisms underlying feedback processing and outcome evaluation during risky decision-making, using event-related brain potentials (ERPs). Methods: ERPs elicited by positive and negative feedback were recorded during performance of a modified version of the Balloon Analogue Risk Task in male participants receiving either a moderate dose of alcohol (0.65 g/kg alcohol; n = 32) or a non-alcoholic placebo beverage (n = 32). Results: Overall, there was no significant difference in the mean number of pumps between the alcohol and the placebo condition. However, when analyzing over time, it was found that the alcohol group made more riskier choices at the beginning of the task than the placebo group. ERPs demonstrated that alcohol consumption did not affect early processing of negative feedback, indexed by the feedback-related negativity. By contrast, alcohol-intoxicated individuals showed significantly reduced P300 amplitudes in response to negative feedback as compared to sober controls, suggesting that more elaborate evaluation to losses was significantly diminished. Conclusions: These results suggest that alcohol consumption does not influence the ability to rapidly evaluate feedback valence, but rather the ability to assign sufficient attention to further process motivationally salient outcomes. Blunted P300 amplitudes may reflect poor integration of feedback across trials, particularly adverse ones. Consequently, alcohol may keep people from effectively predicting the probability of future gains and losses based on their reinforcement history

Raising the Bar: Improving Methodological Rigour in Cognitive Alcohol Research

Background and Aims: A range of experimental paradigms claim to measure the cognitive processes underpinning alcohol use, suggesting that heightened attentional bias, greater approach tendencies and reduced cue-specific inhibitory control are important drivers of consumption. This paper identifies methodological shortcomings within this broad domain of research and exemplifies them in studies focused specifically on alcohol-related attentional bias. Argument and analysis: We highlight five main methodological issues: (i) the use of inappropriately matched control stimuli; (ii) opacity of stimulus selection and validation procedures; (iii) a credence in noisy measures; (iv) a reliance on unreliable tasks; and (v) variability in design and analysis. This is evidenced through a review of alcohol-related attentional bias (64 empirical articles, 68 tasks), which reveals the following: only 53% of tasks use appropriately matched control stimuli; as few as 38% report their stimulus selection and 19% their validation procedures; less than 28% used indices capable of disambiguating attentional processes; 22% assess reliability; and under 2% of studies were pre-registered. Conclusions: Well-matched and validated experimental stimuli, the development of reliable cognitive tasks and explicit assessment of their psychometric properties, and careful consideration of behavioural indices and their analysis will improve the methodological rigour of cognitive alcohol research. Open science principles can facilitate replication and reproducibility in alcohol research

Errors in the method of line-reversal

It is shown that with a favourable experimental design the random error in the temperature measurement of hot gases with the method of line-reversal is of the order of 1 deg. K at about 2500°K. A number of Systematic errors, each of the order of 10 deg.K, are considered. Some applications of the method are discussed quantitatively and a procedure is indicated for the reversal measurement of gas temperature which are higher than the brightness temperature of the available background light source

Exploring factors related to craving and relapse in alcohol-dependent outpatients

markdownabstractDespite years of research and improvements in treatment and prevention, relapse in alcohol dependence remains a problem. Even though many patients become abstinent or controlled drinkers after treatment, relapse rates remain high. Therefore, the goal of this thesis was to explore determinants of relapse, focusing on those determinants that are present in the moments leading up to a relapse, so-called proximal determinants. Using the dynamic model of relapse (Witkiewitz and Marlatt, 2004), proximal determinants of relapse were examined in this thesis. Especially the role of craving, negative affect, alcohol-related stimuli and implicit processes were subject of investigation. Additionally, since craving is often seen as important to relapse even though a firm empirical foundation is lacking, extra attention was given to craving and its determinants. Overall, negative affect, including stress, was an important predictor of both relapse and craving. More specifically, negative affect is an important determinant of relapse but is accompanied by other determinants when a patient relapses. However, predicting relapse based on a prior measurement of attentional bias or avoidance tendencies during treatment does not seem warranted even though these biases seem to be present in abstinent alcohol-dependent outpatients. When looking at determinants of craving, stress and anxiety are predictive of craving, and drinking to cope with negative affect seems to serve as a vulnerability for experiencing craving. Additionally, craving is accompanied by higher levels of stress and negative affect in those patients who had relapsed. However, patients infrequently experience craving and the intensity of episodes varies both between and within patients. Finally, the mere experience of craving was not a determinant for relapse