Rolf Wynn

Psychiatric inpatients' experiences with restraint

Twelve psychiatric inpatients were qualitatively interviewed after physical restraint. Of these, seven had also been pharmacologically restrained. Patients gave refusal of medication, refusal to follow staff directions, or their own aggression, as reasons why they had been restrained. While some felt that the use of restraint had been warranted, others were more critical. Many thought that restraint could have been avoided. Patients felt that being restrained evoked feelings of anxiousness, anger, and hostility. Some reported that they calmed down after having been restrained, while other did so only after having received additional pharmacological restraint. A few had suffered minor abrasions and two reported revived memories of prior abuse. Several believed that the use of restraint did protect them from hurting themselves or others. Some felt angry, fearful, and distrustful of staff after restraint, and some believed it had damaged the provider – patient alliance. Patients that had psychotic symptoms during restraint were more understanding of staffs decision to restrain. It is important to systematically debrief patients after restraint, thus helping patients understand why restraint was used and identify early problems that arise following the intervention. It is necessary to train staff in the early detection of aggression and in the use of less restrictive interventions.

The clinical case report: a review of its merits and limitations

BackgroundThe clinical case report has a long-standing tradition in the medical literature. While its scientific significance has become smaller as more advanced research methods have gained ground, case reports are still presented in many medical journals. Some scholars point to its limited value for medical progress, while others assert that the genre is undervalued. We aimed to present the various points of view regarding the merits and limitations of the case report genre. We searched Google Scholar, PubMed and select textbooks on epidemiology and medical research for articles and book-chapters discussing the merits and limitations of clinical case reports and case series.ResultsThe major merits of case reporting were these: Detecting novelties, generating hypotheses, pharmacovigilance, high applicability when other research designs are not possible to carry out, allowing emphasis on the narrative aspect (in-depth understanding), and educational value. The major limitations were: Lack of ability to generalize, no possibility to establish cause-effect relationship, danger of over-interpretation, publication bias, retrospective design, and distraction of reader when focusing on the unusual.ConclusionsDespite having lost its central role in medical literature in the 20th century, the genre still appears popular. It is a valuable part of the various research methods, especially since it complements other approaches. Furthermore, it also contributes in areas of medicine that are not specifically research-related, e.g. as an educational tool. Revision of the case report genre has been attempted in order to integrate the biomedical model with the narrative approach, but without significant success. The future prospects of the case report could possibly be in new applications of the genre, i.e. exclusive case report databases available online, and open access for clinicians and researchers.

Ebola, Twitter, and misinformation: a dangerous combination?

The recent Ebola outbreak in west Africa has affected countries deeply in need of foreign aid.1 People desperately need correct information on how to prevent and treat Ebola. Despite the poverty, the increasing spread of computers, tablets, and smartphones in the region creates an opportunity for the rapid dissemination of information through the internet and social media, but there is no guarantee that …

Use of the internet for health purposes: trends in Norway 2000–2010

AIM The aim of this work is to study the 10 year trends in the use and projected use of internet for health purposes in Norway. This includes more detailed analyses of changes in latter years, current uses, valuation as source of health information, reported effects and projected developments. METHOD Surveys on the use of the internet for health purposes have been conducted in Norway in the years 2000, 2001, 2003, 2005 and 2007. Representative samples were drawn from the population, and interviews were conducted by poll agencies using telephone (CATI). RESULTS Internet use for health purposes in the Norwegian population has increased dramatically over the last 7 years from 19% in 2000 to 67% in 2007. If this trend continues, we estimate that 84% of the Norwegian population will be using internet for health purposes by the year 2010. Reading about health or illness is the most common activity, and the rated importance of the internet as a source of health information is increasing. The internet is also used more for ordering medicines and other health-related products. Forty-four per cent of those having used the internet for health purposes reported having searched for lifestyle-related information, and 40% reported having felt inspired to change health behaviour. CONCLUSIONS The internet is an important source of health information, which is likely to increase in importance in the years to come. This study further underlines the potential of internet use for health promoting purposes, as well as the potential for exacerbating social disparities in health.

Staff's attitudes to the use of restraint and seclusion in a Norwegian university psychiatric hospital

A questionnaire-based study examining the experiences and attitudes of staff to restraint and seclusion in a Norwegian university psychiatric hospital demonstrated that a majority of staff believed the interventions were used correctly. Staff at wards with high usage of restraint and seclusion, and male staff, were most critical to how often the interventions were used. Most staff favoured the use of physical restraint, although they believed it was the intervention patients were least favourable to. Highly educated staff were not more critical to the use of restraint and seclusion than other staff. Despite the fact that a majority of staff believed that using restraint and seclusion made patients calmer and did not cause aggression, anxiety or injuries, about 70% had been assaulted by patients in connection with the interventions. Many staff believed the use of restraint and seclusion violated patients’ integrity, could harm the provider–patient alliance and could frighten other patients. Violence, self-harm and threats were given as main reasons for the use of restraint. Increased staffing and more attention by level-of-care staff were cited as the most important strategies for reducing the use of restraint and seclusion. There is a need for informing all staff about the negative effects of restraint and seclusion and for training staff in less restrictive ways in dealing with aggressive and violent patients.

Neurotrophic factors in serum following ECT: A pilot study

We examined changes in serum levels of a selection of neurotrophic factors, TSH, HGH and cortisol in conjunction with ECT treatment. Fifteen patients suffering from affective disorders were included, all were treated with antidepressants and psychotherapy and 10 also with ECT. The patients were examined clinically and with blood samples during treatment. Serum levels of cortisol, thyroid stimulating hormone (TSH), nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), neurotrophin-3 (NT3), neuropetide Y (NPY) and human growth hormone (HGH) were studied. No significant changes were found in levels of NGF, BDNF, NT3, HGH and TSH. A change in NPY levels was statistically significant, but of uncertain clinical value as it affected only two patients. Levels of cortisol rose significantly during treatment. We did find significant correlations between the base values of NGF and HAM-D scores at inclusion and between the end-values of NT3 and NPY and the HAM-D scores prior to discharge. We were unable to reproduce findings from animal studies suggesting that a range of neurotrophic factors rise during ECT treatment. This may be because of physiological differences between animals and humans or, possibly, a result of the small number of patients included in this pilot study.

Coercion in psychiatric care: clinical, legal, and ethical controversies

Despite a long-standing tradition of the use of coercion in psychiatric care, such as involuntary admission and treatment, few have systematically addressed this issue. In recent years, more research has been carried out, suggesting that the use of coercion has important and complex legal, ethical, and clinical implications. In the present article, types and rates of coercion are presented and central topics including competency, ethics, and the reasons given for the use of coercion, are critically discussed.

Psychopathy in women: theoretical and clinical perspectives

Prior research on psychopathy has primarily focused on the problem in men. Only a few studies have examined whether psychopathy even exists in women, and if so, how the disorder manifests itself in them. This paper presents a narrative review of the literature on gender and psychopathy. We briefly discuss why this is an important topic for women and we discuss its causes. The concept of psychopathy is defined and related to the diagnostic systems. The discussion includes a presentation of diagnostic tools, including the Hare Psychology Checklist – Revised, which are examined in relationship to the importance of biological gender. While emphasizing the similarities as well as the differences between the sexes, we discuss the matters of prevalence, behavioral expressions, comorbidity, progression, and treatment of the disorder.

The history of the case report: a selective review

The clinical case report is a popular genre in medical writing. While authors and editors have debated the justification for the clinical case report, few have attempted to examine the long history of this genre in medical literature. By reviewing selected literature and presenting and discussing excerpts of clinical case reports from Egyptian antiquity to the 20th century, we illustrate the presence of the genre in medical science and how its form developed. Central features of the clinical case report in different time periods are discussed, including its main components, structure, style and author presence.

Attitudes to coercion at two Norwegian psychiatric units

Background: Many countries allow for the use of restraint and seclusion in emergencies with psychiatric inpatients. Authors have suggested that the attitudes of staff are of importance to the use of restraint and seclusion. Aim: To examine the attitudes to coercion at two Norwegian psychiatric units. In contrast to the idea that attitudes to coercion vary much within and between institutions, we hypothesized that staffs attitudes would be quite similar. Methods: We distributed a questionnaire to staff at two psychiatric units in two Norwegian counties. Eight wards were included. The questionnaire contained fictitious case histories with one patient that was violent and one patient that was self-harming, and staff were asked to describe how they would intervene in each emergency. Emergency strategies were sorted according to degree of restrictiveness, from the highly restrictive (restraint, seclusion) to the unrestrictive (talking, offering medication). Data were analysed with regression analyses. Results: There was only a limited degree of variance in how staff at the different units and various groups of staff responded. Staff were more likely to favour a highly restrictive intervention when the patients were physically violent. Male staff and unskilled staff were significantly more prone to choosing a highly restrictive intervention. Conclusions: Our hypothesis was confirmed, as there was a limited degree of variance in staffs responses with respect to degree of restrictiveness. The study supported the idea that a range of different interventions are used in emergency situations.