Christoph Abderhalden

Structured risk assessment and violence in acute psychiatric wards: randomised controlled trial

BACKGROUND There is a lack of research on the possible contribution of a structured risk assessment to the reduction of aggression in psychiatric in-patient care. AIMS To assess whether such risk assessments decrease the incidence of violence and coercion. METHOD A cluster randomised controlled trial was conducted with 14 acute psychiatric admission wards as the units of randomisation, including a preference arm. The intervention comprised a standardised risk assessment following admission with mandatory evaluation of prevention in high-risk patients. RESULTS Incidence rates decreased substantially in the intervention wards, whereas little change occurred in the control wards. The adjusted risk ratios suggest a 41% reduction in severe aggressive incidents and a 27% decline in the use of coercive measures. The severity of aggressive incidents did not decrease. CONCLUSIONS Structured risk assessment during the first days of treatment may contribute to reduced violence and coercion in acute psychiatric wards.

Enhancing medication adherence in people with schizophrenia: An international programme of research

This paper describes the development of an adherence therapy intervention in schizophrenia and synthesizes the results to date of a collaborative international programme of research. Sticking to treatment is essential to control symptoms and prevent relapse, but as with other long-term conditions, medication adherence is poor. Adherence therapy seeks to facilitate a process of shared decision making, where both parties work towards agreed goals. Central is the theory that when patients make shared choices with a professional they are more likely to stick with them because they are personally owned and meaningful. The results of adherence therapy trials that seek to test this theory are mixed. Outcomes of trials might have been be affected by the point in the patients illness cycle when therapy was delivered and by sampling bias. Authors of trials of medication management and alliance training packages that aim to equip mental health workers with adherence therapy competencies show considerable promise in improving clinical outcomes. Helping patients manage their medication is central to the work of mental health nurses. We argue that the potential benefits to patients are such that there is sufficient evidence to recommend that all mental health nurses receive medication management training.

Predicting inpatient violence using an extended version of the Broset-Violence-Checklist: instrument development and clinical application.

BackgroundPatient aggression is a common problem in acute psychiatric wards and calls for preventive measures. The timely use of preventive measures presupposes a preceded risk assessment. The Norwegian Brøset-Violence-Checklist (BVC) is one of the few instruments suited for short-time prediction of violence of psychiatric inpatients in routine care. Aims of our study were to improve the accuracy of the short-term prediction of violence in acute inpatient settings by combining the Brøset-Violence-Checklist (BVC) with an overall subjective clinical risk-assessment and to test the application of the combined measure in daily practice.MethodWe conducted a prospective cohort study with two samples of newly admitted psychiatric patients for instrument development (219 patients) and clinical application (300 patients). Risk of physical attacks was assessed by combining the 6-item BVC and a 6-point score derived from a Visual Analog Scale. Incidents were registered with the Staff Observation of Aggression Scale-Revised SOAS-R. Test accuracy was described as the area under the receiver operating characteristic curve (AUCROC).ResultsThe AUCROC of the new VAS-complemented BVC-version (BVC-VAS) was 0.95 in and 0.89 in the derivation and validation study respectively.ConclusionThe BVC-VAS is an easy to use and accurate instrument for systematic short-term prediction of violent attacks in acute psychiatric wards. The inclusion of the VAS-derived data did not change the accuracy of the original BVC.

Vocally disruptive behavior in the elderly: a systematic review.

BACKGROUND Vocally disruptive behavior (VDB) in the elderly is a common condition, especially in people with dementia, but difficult to treat. It may occur in as many as 40% of nursing home residents. This study is a review of the existing literature on this condition. METHOD The literature review was conducted using PubMed (particularly Medline and the Cochrane database) and reference lists from relevant publications in English, French, and German. RESULTS Most studies are small and no conclusive prevalence data are available. Many biological and psychosocial treatments have been advocated, but most studies are little more than anecdotal case reports. It is evident that VDB can have deleterious consequences on others and the patients themselves, although no studies specifically examine the range or the pervasiveness of VDB. Etiopathogenic research on VDB is still in its infancy. CONCLUSIONS Most aspects surrounding VDB are insufficiently understood. The heterogeneity and multiple contributive factors regarding VDB suggest quite convincingly that a panoply of different interventions tailored to the individuals needs will be required to overcome VDB and the suffering related to it.

Ward safety perceived by ward managers in Britain, Germany and Switzerland: identifying factors that improve ability to deal with violence.

Little is known about how safe nurses feel on psychiatric wards across different European countries. This paper is aim to evaluate how ward safety is perceived by ward managers in Great Britain, Germany and Switzerland. We replicated a Swiss questionnaire study in Germany and Britain, which asked ward managers on adult psychiatric wards to give details about their ward including data on the management of aggression, staffing levels, staff training, standards and type of restraint used, alarm devices, treatment and management of aggression and the existence and perceived efficacy of standards (protocols, guidelines). The British sample had by far the highest staffing levels per psychiatric bed, followed by Switzerland and Germany. The British ward managers by far perceived violence and aggression least as a problem on their wards, followed by Germany and then Switzerland. British ward managers are most satisfied with risk management and current practice dealing with violence. German managers were most likely to use fixation and most likely to have specific documentation for coercive measures. Swiss wards were most likely to use non-specific bedrooms for seclusion and carry alarm devices. British wards were far more likely to have protocols and training for the treatment and management of violence, followed by Switzerland and Germany. British ward managers by far perceived violence and aggression to be a small problem on their wards compared with Swiss and German ward managers. This was associated with the availability of control and restraint teams, regular training, clear protocols and a lesser degree risk assessments, but not staffing levels.

Vocally disruptive behavior (VDB) in the institutionalized elderly: A naturalistic multiple case report

Employing a naturalistic multiple case study approach, we investigated the current clinical practice in the treatment and care of VDB among a convenience sample of 85 patients cared for in specialized old age psychiatric clinics and nursing homes in French and German-speaking Switzerland. We wished to clinically characterize VDB patients, to identify common approaches used to treat VDB in everyday practice, and to explore how the efficiency of the interventions employed was judged by the responsible carers. Data were collected by means of a questionnaire. Most patients with VDB in this study had dementia, of whom 75% had at least one current or premorbid psychiatric disorder and 25% had premorbid personality disorder. A majority of patients received multiple psychosocial care interventions that were often judged to be effective, but the potential of psychosocial interventions is underused. Many patients did not receive psychotropic medication specifically targeted at VDB, but about 70% of all prescriptions were judged to have positive effects. Premorbid psychiatric and personality disorders or traits are likely candidates to be entered into the etiopathogenic equation of VDB and set a new frame for approaches used to treat these underlying disorders.

Resident health-related quality of life in Swiss nursing homes.

BACKGROUND Health-related quality of life (HRQOL) levels and their determinants in those living in nursing homes are unclear. The aim of this study was to investigate different HRQOL domains as a function of the degree of cognitive impairment and to explore associations between them and possible determinants of HRQOL. METHOD Five HRQOL domains using the Minimum Data Set - Health Status Index (MDS-HSI) were investigated in a large sample of nursing home residents depending on cognitive performance levels derived from the Cognitive Performance Scale. Large effect size associations between clinical variables and the different HRQOL domains were looked for. RESULTS HRQOL domains are impaired to variable degrees but with similar profiles depending on the cognitive performance level. Basic activities of daily living are a major factor associated with some but not all HRQOL domains and vary little with the degree of cognitive impairment. LIMITATIONS This study is limited by the general difficulties related to measuring HRQOL in patients with cognitive impairment and the reduced number of variables considered among those potentially influencing HRQOL. CONCLUSION HRQOL dimensions are not all linearly associated with increasing cognitive impairment in NH patients. Longitudinal studies are required to determine how the different HRQOL domains evolve over time in NH residents.

Pflegediagnosen bei Patienten und Patientinnen psychiatrischer Aufnahmestationen in der Schweiz und in Österreich: Gemeinsamkeiten und Unterschiede

In der Schweiz und in Osterreich verbreitete sich die Arbeit mit Pflegediagnosen in den letzten Jahren stark. Bisher gibt es nur wenige empirische Studien uber den klinischen Gebrauch von Pflegedia...

Gesunde Hülle für die Seele

Menschen mit einer psychischen Erkrankung haben oftmals auch korperliche Beschwerden. Um die Risikofaktoren dafur zu erkennen und ihnen positiv entgegenzuwirken, wurde das Gesundheitsforderungsprofil Psychiatrie (GEP PSY ) entwickelt. Pflegende konnen mit dem Fragebogen Psychiatrie-Erfahrene systematisch zu ihrem Gesundheitsverhalten befragen und anschliesend beraten. Dadurch kann ihre korperliche Gesundheit nachhaltig verbessert werden.

Forschungsprioritäten für die Pflege in der Psychiatrie

Verschiedene nationale und internationale Organisationen betonen in neueren gesundheitspolitischen Positionspapieren, dass psychischer Gesundheit und psychischer Krankheit grosere Beachtung geschen...