Tom Palmstierna

Evaluation of the Drug Use Disorders Identification Test (DUDIT) in Criminal Justice and Detoxification Settings and in a Swedish Population Sample

Psychometric properties of the 11-item self-report Drug Use Disorders Identification Test (DUDIT) were evaluated in a sample of heavy drug users from prison, probation, and inpatient detoxification settings, and in a general Swedish population sample. In the drug user sample, the DUDIT predicted drug dependence with a sensitivity of 90% for both DSM-4 and ICD-10 and a respective specificity of 78 and 88%. Reliability according to Cronbach’s α coefficient was 0.80. In the population sample, 3.1% scored positive on the DUDIT; T-score values are suggested. The DUDIT screens effectively for drug-related problems in clinically selected groups and may prove useful in the context of public health surveys.

Staff observation aggression scale, SOAS: Presentation and evaluation

A new psychiatric report and rating scale assessing severity and frequency of aggressive behaviour is presented and evaluated. It is based on the staffs standardized reports of aggressive incidents. By using a special aggression report form, comprehensive and standardized information is obtained, thereby permitting scoring and further analysis of different aspects of aggressive incidents. The reliability of scoring is tested and found to be good as is the scales capacity to discriminate between different patterns of aggressive behaviour in different groups of patients. As a result of this and because of the simplicity of the scale, it is thought to be a potentially useful tool in scientific research on aggressive behaviour from psychiatric inpatients.

The Staff Observation Aggression Scale-revised (SOAS-R)

Proper assessment of aggressive behavior is essential for an understanding of its causes. In 1987, Palmstierna and Wistedt [Acta Psychiatr Scand 76:657-663] introduced the Staff Observation Aggression Scale (SOAS), an instrument for monitoring the frequency, nature, and severity of aggressive incidents. In the present study, the validity of the SOAS severity scoring system was examined, and the severity scores were refined. The SOAS was used to record aggression on six closed wards of three psychiatric hospitals. The SOAS severity scores of 556 aggressive incidents were compared with severity estimates given on Visual Analogue Scales (VASs) by staff members. The original SOAS scores were found to be moderately correlated with the estimates of severity given by staff on the VAS. The SOAS severity scoring system was refined on the basis of the staff severity estimates. The revised scoring method and other refinements in the contents of the instrument led to the construction of the SOAS-R. The SOAS-R seems to be a promising tool for monitoring a wide range of (self-) destructive acts on psychiatric wards.

Fifteen years of research with the Staff Observation Aggression Scale: a review

Objective:  Research on the prevalence and causes of in‐patient aggression has been hindered by the use of different methods for measuring aggression. Since Palmstierna and Wistedt presented the Staff Observation Aggression Scale (SOAS) in 1987, this data collection method has been used in various studies, which may make comparisons more useful.

The Prevalence and Nature of Intellectual Disability in Norwegian Prisons.

BACKGROUND The objective of the study was to calculate the prevalence of inmates with intellectual disabilities (ID), and identify historical, medical and criminological characteristics of a certain impact. METHODS A random sample of 143 inmates from a Norwegian prison cross sectional sample was studied. The Hayes Ability Screening Index (HASI) was validated with the Wechsler Abbreviated Scale of Intelligence (WASI). RESULTS The prevalence of inmates with ID, IQ < 70, was 10.8%. Some essential characteristics of inmates with ID were more frequent medication for mental disorders, a higher number of imprisonments, less drug abuse and less education than the other inmates. The results indicated that the HASI is a valid tool for screening of ID for the Norwegian inmates. CONCLUSIONS The prevalence of ID in Norwegian inmates is significant, measured by WASI and HASI. Identification, rehabilitation and care, concerning an intellectual handicap, are mostly absent in the Norwegian criminal justice system.

Occurrence of post traumatic stress symptoms and their relationship to professional quality of life (ProQoL) in nursing staff at a forensic psychiatric security unit: a cross-sectional study

BackgroundViolence is frequent towards nurses in forensic mental health hospitals. Implications of this high risk environment have not been systematically explored. This paper explores occurrence of symptoms on post traumatic stress and their relationship to professional quality of life.MethodsSelf report questionnaires assessing symptoms of post traumatic stress and professional quality of life were distributed among psychiatric nurses in a high security forensic psychiatric unit with high frequency of violent behaviour. Relationships between post traumatic stress symptoms, forensic nursing experience, type of ward and compassion satisfaction, burnout and compassion fatigue were explored.ResultsThe prevalence of post traumatic stress symptoms was low. Low scores were found on compassion satisfaction. Length of psychiatric nursing experience and low scores on compassion satisfaction were correlated to increased post traumatic stress symptoms.ConclusionAlthough high violence frequency, low rate of post traumatic stress symptoms and low compassion satisfaction scores was found. High staff/patient ratio and emotional distance between staff and patients are discussed as protective factors.

Predictive Validity and Other Psychometric Properties of the Short-Term Assessment of Risk and Treatability (START) in a Norwegian High Secure Hospital

Short- to medium-term risk assessment in psychiatric hospitals is a topic of clinical relevance that deserves attention from the research community. In this paper, the Short Term Assessment of Risk and Treatability, or START (Webster, Martin, Brink, Nicholls, & Middleton, 2004), a new structured instrument for judgment of dynamic risk and treatment factors is briefly described. Internal reliability properties are analyzed and the predictive validity for severe violence in a Norwegian high secure psychiatric hospital is investigated. The results indicate that the START has promise as a valid tool for short-term violence risk assessment. The authors make an argument for the importance and relevance of dynamic risk and strength factors in the short to medium term.

Nurses' short-term prediction of violence in acute psychiatric intensive care

Objective:  To evaluate the short‐term predictive capacity of the Brøset Violence Checklist (BVC) when used by nurses in a psychiatric intensive care unit.

Changes in the pattern of aggressive behaviour among inpatients with changed ward organization.

Aggressive behaviour by psychiatric inpatients was investigated on the same ward during two separate 6‐month periods before and after a 50% decrease in number of beds but without changes in catchment area. Character of the patient group, patient turnover and medical practices as well as total number of staff on duty on the ward was virtually the same during the two periods. It is therefore assumed that differences in aggressive behaviour are mainly explained by effects due to the decreased number of beds per se. It was found that the 50% reduction did not affect the overall aggression frequency. However, inter‐patient violence increased while the number of more severe aggressive incidents towards staff members decreased.

Validation of the Alcohol Use Disorders Identification Test and the Drug Use Disorders Identification Test in a Swedish sample of suspected offenders with signs of mental health problems: Results from the Mental Disorder, Substance Abuse and Crime study

Substance abuse is common among offenders. One method widely used for the detection of substance abuse is screening. This study explored the concurrent validity of the Alcohol Use Disorders Identification Test (AUDIT) and the Drug Use Disorders Identification Test (DUDIT) screening tools in relation to (a) substance abuse and dependency diagnoses and (b) three problem severity domains of the sixth version of the Addiction Severity Index in a sample of 181 suspected offenders with signs of mental health problems. The screening tools showed moderate to high accuracy for identification of dependency diagnoses. The AUDIT was associated with alcohol problem severity, whereas the DUDIT was associated with drug and legal problem severity. Administering the screening tools in the current population yields valid results. However, the suggested cutoff scores should be applied with caution due to the discrepancy between present and previous findings.