693 research outputs found
Patientârated impulsivity and aggression compared with clinicianârated risk in a forensic psychiatric sample:Predicting inpatient incidents
Background Measures of impulsivity and aggression help to indicate risk of future violence or ruleâbreaking. Both clinicianârated risk assessment and selfâreport measures have been used but hardly ever compared in their ability to predict inpatient incidents. Aims To compare the selfâreport on the Barratt Impulsiveness Scale (BISâ11) and BussâPerry Aggression Questionnaire (BPAQ) with the clinicianârated HKTâ30, a Dutch adaptation of the Historical Clinical Risk Managementâ20, 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 BISâ11 and BPAQ scale scores and the HKTâ30. 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 HKTâ30 generally outperformed the selfâreport 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 clinicianârated 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 weaponâmen 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 mothersâ 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
Experts Recommend Strategies for Strengthening the Use of Advanced Practice Nurses in Nursing Homes
Act In case of Depression: The evaluation of a care program to improve the detection and treatment of depression in nursing homes. Study Protocol
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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
Prevalence and impact of alcohol and other drug use disorders on sedation and mechanical ventilation: a retrospective study
BACKGROUND: Experience suggests that patients with alcohol and other drug use disorders (AOD) are commonly cared for in our intensive care units (ICU's) and require more sedation. We sought to determine the impact of AOD on sedation requirement and mechanical ventilation (MV) duration. METHODS: Retrospective review of randomly selected records of adult patients undergoing MV in the medical ICU. Diagnoses of AOD were identified using strict criteria in Diagnostic and Statistical Manual of Mental Disorders, and through review of medical records and toxicology results. RESULTS: Of the 70 MV patients reviewed, 27 had AOD (39%). Implicated substances were alcohol in 22 patients, cocaine in 5, heroin in 2, opioids in 2, marijuana in 2. There was no difference between AOD and non-AOD patients in age, race, or reason for MV, but patients with AOD were more likely to be male (21 versus 15, p < 0.0001) and had a lower mean Acute Physiology and Chronic Health Evaluation II (22 versus 26, p = 0.048). While AOD patients received more lorazepam equivalents (0.5 versus 0.2 mg/kg.day, p = 0.004), morphine equivalents (0.5 versus 0.1 mg/kg.day, p = 0.03) and longer duration of infusions (16 versus 10 hours/day. medication, p = 0.002), they had similar sedation levels (Richmond Agitation-Sedation Scale (RASS) -2 versus -2, p = 0.83), incidence of agitation (RASS ⼠3: 3.0% versus 2.4% of observations, p = 0.33), and duration of MV (3.6 versus 3.9 days, p = 0.89) as those without AOD. CONCLUSION: The prevalence of AOD among medical ICU patients undergoing MV is high. Patients with AOD receive higher doses of sedation than their non-AOD counterparts to achieve similar RASS scores but do not undergo longer duration of MV
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