The use of mechanical restraints for the management of disturbed or violent psychiatric patients continues to be a controversial issue. A survey of their use was carried out by means of a questionnaire sent to 370 psychiatric facilities in Canada to which there was a 62.2% response. General hospital psychiatric units, psychiatric hospitals and mental retardation centres accounted for 83.0% (191) of the returns and were the only facilities analyzed. The study showed that the vast majority still use mechanical restraints. The types of restraints in order of frequency of use included posey belts or shirts, isolation room, straps, sheets, strait jackets, wet or dry packs, hydrotherapy, and others. Violent behaviour is the main reason for which restraints are used. Medical orders, recording procedures and staff training in techniques of managing disturbed behaviour are reviewed. An important finding is the significant majority of facilities that have no stated policy permitting or forbidding the use of restraints. The findings are briefly related to Tuke's work in 1882 pointing to similarities in practice. Finally, the authors emphasize the need to deal with this contentious issue in an enlightened manner reflecting modern day demands.
A unique exonic splice enhancer mutation in a family with X-linked mental retardation and epilepsy points to a novel role of the renin receptor
