Patient‐rated impulsivity and aggression compared with clinician‐rated risk in a forensic psychiatric sample:Predicting inpatient incidents

Background Measures of impulsivity and aggression help to indicate risk of future violence or rule‐breaking. Both clinician‐rated risk assessment and self‐report measures have been used but hardly ever compared in their ability to predict inpatient incidents. Aims To compare the self‐report on the Barratt Impulsiveness Scale (BIS‐11) and Buss‐Perry Aggression Questionnaire (BPAQ) with the clinician‐rated HKT‐30, a Dutch adaptation of the Historical Clinical Risk Management‐20, for their capacity to predict inpatient incidents. Methods All men newly admitted to a forensic psychiatric hospital were invited to participate in this study unless in intensive care. Tests of correlation were run between the BIS‐11 and BPAQ scale scores and the HKT‐30. Each was then tested separately for capacity to predict the number of aggressive and nonaggressive incidents while resident. Finally, scores of all rating scales were entered together into a negative binomial regression to compare their relative strengths in predicting later incidents. Results Patient and staff baseline impulsivity and aggression ratings correlated moderately well. All measures performed well in univariate analyses of relationship between baseline measures and later incidents. In final models, which included both patient and staff baseline ratings, the HKT‐30 generally outperformed the self‐report measures in the prediction of aggressive and nonaggressive incidents in both the first year and total length of stay. Implications for clinical practice Our findings suggest that some reliance may be placed on patient ratings of their own propensity for impulsive and/or violent acts, but, when used, they should remain combined with clinician‐rated risk assessment for the time being. Future research should explore their utility in dialogue about treatment, and also the relative strength of staff response to each

Trauma, Attempted Suicide, and Morning Cortisol in a Community Sample of Adolescents

Individuals exposed to trauma or who have attempted suicide may show abnormal cortisol profiles; those exposed to significant trauma show reduced, while those who attempt suicide show increased cortisol output, although the evidence is inconsistent. This study explores the associations between morning cortisol, trauma, and suicide attempts or ideation among young people. In a community-based sample of 501 15-year-olds, using data from a DSM-IV-compatible interview on suicidal-behavior/ideation, trauma, and morning cortisol, we found no association between these factors and morning cortisol. A significant gender interaction was found for those threatened with a weapon—men showing a negative and women a positive association, suggesting that any cortisol/trauma association may be partially explained by coexisting behavioral problems and gender

Supporting Japanese mothers of children with ADHD: cultural adaptation of the New Forest Parent Training Programme

International practice guidelines recommend medication and behavioral intervention as evidenced-based treatments for attention deficit hyperactivity disorder (ADHD). Currently in Japan, the availability of non pharmacological interventions for ADHD is limited. We report the results of a pilot and a proof-of-concept study for a new behavioral intervention for Japanese mothers of children with ADHD. The pilot study delivered a standard six-session behavioral intervention and two parent-support sessions. Participants approved the group format and requested additional support to change parenting practices and behavioral strategies targeting ADHD symptoms. For the proof-of-concept study, the intervention was revised to include five sessions of pre intervention support followed by six sessions of the New Forest Parent Training Programme (NFPP), an evidence based intervention for ADHD. The revised intervention, NFPP-Japan, was associated with reductions in the mothers’ reports of children's ADHD symptoms and aggression, more effective parenting practices, and reduced parenting stress. The pilot and proof-of-concept studies indicate that it is possible to successfully modify Western behavioral interventions for Japanese mothers and to justify a randomized controlled trial evaluation of the NFPP-Japan, which is currently underway

Psychometric testing of three Chinese online-related addictive behavior instruments among Hong Kong university students

Objective: To validate the Chinese version of the nine-item Internet Gaming Disorder Scales- Short Form (IGDS-SF9), Bergen Social Media Addiction Scale (BSMAS), and Smartphone Application-Based Addiction Scale (SABAS) among Hong Kong university students. Participants and Methods: Participants aged between 17 and 30 years participated in the present study (n=307; 32.4% males; mean [SD] age=21.64 [8.11]). All the participants completed the IGDS-SF9, BSMAS, SABAS, and the Hospital Anxiety and Depression Scale (HADS). Confirmatory factor analyses (CFAs) were used to examine the factorial structures and the unidimensionality for IGDS-SF9, BSMAS, and SABAS. Results: CFAs demonstrated that the three scales were all unidimensional with satisfactory fit indices: comparative fit index = 0.969 to 0.992. In addition, the IGDS-SF9 and BSMAS were slightly modified based on the modification index in CFA. Conclusions: The Chinese IGDS-SF9, BSMAS, and SABAS are valid instruments to assess the addiction levels of internet-related activities for Hong Kong university students

Act In case of Depression: The evaluation of a care program to improve the detection and treatment of depression in nursing homes. Study Protocol

Contains fulltext : 95616.pdf (publisher's version ) (Open Access)BACKGROUND: The aim of this study is evaluating the (cost-) effectiveness of a multidisciplinary, evidence based care program to improve the management of depression in nursing home residents of somatic and dementia special care units. The care program is an evidence based standardization of the management of depression, including standardized use of measurement instruments and diagnostical methods, and protocolized psychosocial, psychological and pharmacological treatment. METHODS/DESIGN: In a 19-month longitudinal controlled study using a stepped wedge design, 14 somatic and 14 dementia special care units will implement the care program. All residents who give informed consent on the participating units will be included. Primary outcomes are the frequency of depression on the units and quality of life of residents on the units. The effect of the care program will be estimated using multilevel regression analysis. Secondary outcomes include accuracy of depression-detection in usual care, prevalence of depression-diagnosis in the intervention group, and response to treatment of depressed residents. An economic evaluation from a health care perspective will also be carried out. DISCUSSION: The care program is expected to be effective in reducing the frequency of depression and in increasing the quality of life of residents. The study will further provide insight in the cost-effectiveness of the care program. TRIAL REGISTRATION: Netherlands Trial Register (NTR): NTR1477

Comprehensive early intervention for patients with first-episode psychosis in Japan (J-CAP): study protocol for a randomised controlled trial

<p>Abstract</p> <p>Introduction</p> <p>Comprehensive approaches for patients with psychotic symptoms play essential roles in the symptomatic and functional outcomes of patients, especially during disease onset. In Japan, the shortage of mental health services, particularly for outpatients, and community-based supports has been a major problem. The purpose of this trial is to investigate the effectiveness and affordability of 18-month comprehensive early intervention services for patients with first-episode psychosis compared with typical treatment.</p> <p>Methods</p> <p>This interventional, parallel, single-blinded (open but blinded raters trial) was effectively designed. The participants are patients with a diagnosis of F2 or F3 (International Classification of Disease, 10 th revision), with psychotic symptoms. The inclusion criteria were an age of 15-35 years, onset of psychotic symptoms within 5 years, first-episode psychosis, and residence in the catchment area of each site. Allocation will be conducted equally between case management and standard care groups. After enrollment, standard care will be provided for both groups, and community-based care to promote recovery for 18 months will be provided for the comprehensive approach group. The primary outcome will be the function domain of the global assessment of functioning scores at 18 months after enrollment. Data assessment will be performed at enrollment and 18, 36, and 60 months after enrollment. The target sample size will be 150, and registration will occur from March 1, 2011, to September 30, 2012.</p> <p>Discussion</p> <p>This trial will provide promising results about the effectiveness and cost-effectiveness of early intervention services in Japan to improve the quality and quantity of community mental health services.</p> <p>Trial registration</p> <p>This trial was registered in The University Hospital Medical Information Network Clinical Trials Registry (No. UMIN000005092).</p

The effect of a training programme on school nurses’ knowledge, attitudes, and depression recognition skills: The QUEST cluster randomised controlled trial

Background Mental health problems in children and young people are a vital public health issue. Only 25% of British school children with diagnosed mental health problems have specialist mental health services contact; front-line staff such as school nurses play a vital role in identifying and managing these problems, and accessing additional services for children, but there appears limited specific training and support for this aspect of their role. Objectives To evaluate the effectiveness of a bespoke short training programme, which incorporated interactive and didactic teaching with printed and electronic resources. Hypothesized outcomes were improvements in school nurses’ knowledge, attitudes, and recognition skills for depression. Design A cluster-randomised controlled trial. Participants and setting 146 school nurses from 13 Primary Care Trusts (PCTs) in London were randomly allocated to receive the training programme. Methods School nurses from 7 PCTs (n = 81) were randomly allocated to receive the training intervention and from 6 PCTs (n = 65) for waiting list control. Depression detection was measured by response to vignettes, attitudes measured with the Depression Attitude Questionnaire, and knowledge by the QUEST knowledge measure. These outcomes were measured at baseline and (following training) 3 months and nine months later, after which nurses in the control group received the training programme. Results At 3 months, 115 nurses completed outcome measures. Training was associated with significant improvements in the specificity of depression judgements (52.0% for the intervention group and 47.2% for the control group, P = 0.039), and there was a non-significant increase in sensitivity (64.5% compared to 61.5% P = 0.25). Nurses’ knowledge about depression improved (standardised mean difference = 0.97 [95% CI 0.58 to 1.35], P < 0.001); and confidence about their professional role in relation to depression increased. There was also a significant change in optimism about depression outcomes, but no change in tendency to defer depression management to specialists. At 9-month follow-up, improved specificity in depression identification and improved knowledge were maintained. Conclusions This school nurse development programme, designed to convey best practice for the identification and care of depression, delivered significant improvements in some aspects of depression recognition and understanding, and was associated with increased confidence in working with young people experiencing mental health problems