Physical Violence During Mandatory Psychiatric Treatment: Prevalence and Patient Characteristics

2020 ◽  
Vol 47 (7) ◽  
pp. 771-789
Author(s):  
Nienke Verstegen ◽  
Vivienne de Vogel ◽  
Anneloes Huitema ◽  
Robert Didden ◽  
Henk Nijman
Keyword(s):  
Personality Disorder ◽  
Legal Status ◽  
Psychiatric Treatment ◽  
Physical Violence ◽  
Binary Logistic Regression ◽  
Patient Characteristics ◽  
Treatment Prevalence ◽  
Psychopathy Checklist Revised ◽  
Self Harm ◽  
Forensic Psychiatric

This study explores variables that predict physical violence in 614 (forensic) psychiatric inpatients. All violent incidents that occurred in a Dutch forensic psychiatric hospital between 2014 and 2019 ( N = 3,713) were coded with the Modified Overt Aggression Scale+ based on daily hospital reports and patients’ medical records. Binary logistic regression analyses examined which patient variables could differentiate between patients with and without physical violence during treatment and between patients with single and multiple incidents of physical violence. Variables included in the analyses were gender, legal status, borderline personality disorder, antisocial personality disorder, schizophrenia spectrum disorder, psychopathy (Psychopathy Checklist–Revised [PCL-R] score), self-harm during treatment, impulsivity, intellectual disability, and length of stay. A clear association was found between self-harm and inpatient physical violence on all outcome measures and in all analyses. Adequate monitoring of self-harm is advised as a strategy to early identify patients with a high risk to threaten ward safety.

Clinical Appraisals of Individual Differences in Treatment Responsivity Among Patients With Psychopathy: A Consensual Qualitative Research Study

2020 ◽  
pp. 009385482097059
Author(s):  
Evelyn Klein Haneveld ◽  
Wineke Smid ◽  
Kelsey Timmer ◽  
Jan H. Kamphuis
Keyword(s):  
Qualitative Research ◽  
Psychiatric Treatment ◽  
Negative Impact ◽  
Treatment Success ◽  
Patient Characteristics ◽  
Consensual Qualitative Research ◽  
Treatment Team ◽  
Psychopathy Checklist Revised ◽  
Forensic Psychiatric ◽  
Treatment Responsivity

This study addressed which factors expert clinicians consider crucial in successful completion versus dropout in the mandatory forensic psychiatric treatment of psychopathic patients in the Netherlands. Eleven clinicians were interviewed about patient characteristics, treatment (provider) characteristics, and other factors they deemed associated with failure (transfer to another facility) or completion. The interviews were coded using the guidelines of Consensual Qualitative Research (CQR). Overall, extremely high scores on Psychopathy Checklist–Revised (PCL-R) Facets 1 (Deceitful Interpersonal Style) and 2 (Defective Affective Experience) were thought to impede treatment retention, particularly by its negative impact on motivation and therapeutic relationship. Older patients, those with a prosocial network, and/or patients with comorbid borderline traits appeared to fare better. Treatment success was deemed more likely when treatment goals and expectations are stipulated in a concrete fashion, when an extended and gradual resocialization trajectory is offered, and the treatment team is expert, cohesive, and stable.

PCL-R Psychopathy Predicts Disruptive Behavior Among Male Offenders in a Dutch Forensic Psychiatric Hospital

2004 ◽  
Vol 19 (1) ◽  
pp. 13-29 ◽  
Author(s):  
MartIn Hildebrand ◽  
Corine De Ruiter ◽  
Henk Nijman
Keyword(s):  
Disruptive Behavior ◽  
Psychiatric Treatment ◽  
Physical Violence ◽  
Verbal Abuse ◽  
Language Version ◽  
Psychopathy Checklist ◽  
Forensic Hospital ◽  
Psychopathy Checklist Revised ◽  
Forensic Psychiatric ◽  
Verbal Threat

In this study, the relationship between psychopathy, according to the Dutch language version of Hare’s Psychopathy Checklist-Revised (PCL-R), and various types of disruptive behavior during inpatient forensic psychiatric treatment is investigated. Ninety-two male participants were administered the PCL-R following admission to an inpatient forensic hospital. From daily hospital information bulletins, incidents of verbal abuse, verbal threat, physical violence, and violation of hospital rules were derived. Also, the number of seclusion episodes was recorded. As expected, significant correlations were found between PCL-R scores and verbal abuse, verbal threat, violation of rules, total number of incidents, and frequency of seclusion. Psychopaths (PCL-R 30) were significantly more often involved in incidents than nonpsychopaths. Multiple regression analyses revealed that the PCL-R Factor 2 score in particular contributed uniquely to the prediction of the total number of incidents. The findings are discussed in terms of their clinical implications.

scholarly journals Legal status of persons with mental illness in Serbia

2004 ◽  
Vol 132 (11-12) ◽  
pp. 448-452 ◽  
Author(s):  
Aleksandar Jovanovic
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Mentally Ill ◽  
Legal Status ◽  
Psychiatric Treatment ◽  
Security Measures ◽  
Moral Integrity ◽  
General Law ◽  
Legal Competence ◽  
Forensic Psychiatric

In this study, legal status of the mentally ill has been discussed in the context of Serbian legislation. The topics covered are the following: 1) the admission of persons with mental illness to psychiatric institution, 2) general (legal) competence, 3) marital relations of persons with mental illness, 4) legal definitions of sanity and security measures of medical character. Serbia still has no general law on mental health which would be in accordance with European standards, and the existing legislation which deals with the rights of persons with mental illness is, to a large extent, incomplete and obsolete. The author appeals for passing the law on mental health which should: a) follow modern trends in psychiatry concerning the protection of human rights with the basic goal to protect society and mentally ill persons, b) to protect the professional and moral integrity of psychiatrists, c) to provide ethically and professionally acceptable authorization for the use of force, if necessary, in order to prevent criminal acts and/or self-injuries in patients suffering from severe psychical disorders, d) to conceptualize forensic psychiatric treatment (the security measures, corrective psychiatry) and the programs of rehabilitation as an integral part of the community mental health protection system.

Prevalence of physical violence in a forensic psychiatric hospital system during 2011–2013: Patient assaults, staff assaults, and repeatedly violent patients

CNS Spectrums ◽  
2015 ◽  
Vol 20 (3) ◽  
pp. 319-330 ◽  
Author(s):  
Charles Broderick ◽  
Allen Azizian ◽  
Rebecca Kornbluh ◽  
Katherine Warburton
Keyword(s):  
Legal Status ◽  
Physical Violence ◽  
Violence Risk ◽  
Hospital System ◽  
Violence Reduction ◽  
Patient Assault ◽  
State Psychiatric ◽  
Enhance Patient Safety ◽  
Forensic Psychiatric ◽  
New Treatments

IntroductionWe examined physical violence in a large, multihospital state psychiatric system during 2011–2013, and associated demographic and clinical characteristics of violent patients to better understand issues of patient and staff safety.MethodActs of physical violence committed by patients against other patients (n=10,958) or against staff (n=8429) during 2011–2013 were collected and analyzed for all hospitalized patients during the same time period to derive prevalence rates and associated odds ratios.ResultsOverall, 31.4% of patients committed at least 1 violent assault during their hospitalization. Differential risk factor patterns were noted across patient and staff assault. Younger age was associated with a higher prevalence of both patient and staff assault, as was nonforensic legal status. Females had a higher prevalence of staff assault than patient assault. Ethnic groups varied on rates of patient assault, but had no significant differences for staff assault. Schizoaffective disorder was associated with higher prevalence and odds of patient (OR 1.244, 95% CI 1.131 to 1.370) and staff (OR 1.346, 95% CI 1.202 to 1.507) assault when compared to patients diagnosed with schizophrenia. Most personality disorder diagnoses also had a higher prevalence and odds of physical violence. One percent of patients accounted for 28.7% of all assaults. Additionally, violent patients had a significantly longer length of hospitalization.DiscussionImplications of these findings to enhance patient safety and inform future violence reduction efforts, including the need for new treatments in conjunction with the use of violence risk assessments, are discussed.

Deliberate Self-harm and Predictors of Out-patient Attendance

1987 ◽  
Vol 150 (2) ◽  
pp. 246-247 ◽  
Author(s):  
G. O'Brien ◽  
A. R. Holton ◽  
K. Hurren ◽  
L. Watt ◽  
F. Hassanyeh
Keyword(s):  
Personality Disorder ◽  
Psychiatric Treatment ◽  
Psychiatric Practice ◽  
Deliberate Self Harm ◽  
Self Harm ◽  
Psychiatric Intervention ◽  
Patient Attendance

Kreitman (1979) reported that up to one-half of patients given out-patient appointments one week after an episode of deliberate self-harm (DSH) fail to attend, and gave a number of possible explanations for this. Firstly, parasuicide is often the result of a crisis which may have resolved (albeit temporarily) by the end of a further week. Secondly, someone in a state of heightened tension may find one week too long to wait, and may resort to other strategies to deal with his problems. Thirdly, many parasuicides may find a psychiatric label unacceptable in the context of their problems, and fourthly, an appoint ment made for a fixed day and a fixed hour may not fit the need for immediate action which the subjects subculture had inculcated in him as a habit pattern. Morgan et al (1976) reported that up to 40% of their DSH patients either did not attend any appointment or failed to complete their treatment. Two possible explanations for this were that they either felt that they did not need psychiatric treatment, or else believed that psychiatric treatment was not an answer to their problems. Kessel and Lee (1962), probably in line with much psychiatric practice, did not give a follow-up appointment to 40% of their self-poisoners; this was for two reasons. Firstly, these patients did not have a problem for which psychiatric treatment was appropriate and secondly, many of these patients had an entrenched personality disorder, which made it unlikely that psychiatric intervention would be beneficial.

Risk Factors Associated With Inpatient Violence During Medium Security Treatment

2016 ◽  
Vol 34 (17) ◽  
pp. 3711-3736 ◽  
Author(s):  
Inge Jeandarme ◽  
Ciska Wittouck ◽  
Freya Vander Laenen ◽  
Claudia Pouls ◽  
T. I. Oei ◽  
...  
Keyword(s):  
Risk Factors ◽  
Physical Violence ◽  
Violent Behavior ◽  
Binary Logistic Regression ◽  
Warning Signs ◽  
Assessment Tools ◽  
Individual Risk ◽  
Factors Associated ◽  
Medium Security ◽  
Forensic Psychiatric

Violence is a common phenomenon both in regular and forensic psychiatric settings, and has a profound impact on staff and other patients. Insight into the individual risk factors associated with violence in forensic psychiatric settings is rare and is therefore the subject of this research. A retrospective file study in three medium security units in Flanders was conducted to compare non-violent inpatients with inpatients who engaged in (verbal and physical) violent behavior. Binary logistic regression analyses were used to examine which variables contributed independently to the risk of violence. The results showed that absconding during treatment was independently associated with physical violence. A personality disorder diagnosis and general non-compliance with treatment were associated with verbal violence. Both types of violence predicted early termination of treatment. Contrary to previous research, the results from the risk assessment tools were not associated with inpatient violence. Clinical implications are discussed and include, among others, that clinicians should remain vigilant for early warning signs of non-compliance during treatment.

Emotion-Oriented Coping Style Predicts Self-Harm in Response to Acute Psychiatric Hospitalization

Crisis ◽  
2020 ◽  
pp. 1-7
Author(s):  
Jacqueline M. Frei ◽  
Vladimir Sazhin ◽  
Melissa Fick ◽  
Keong Yap
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Psychiatric Hospitalization ◽  
Coping Styles ◽  
Psychiatric Inpatients ◽  
Borderline Personality ◽  
Self Report ◽  
Therapeutic Interventions ◽  
Coping Behaviors ◽  
Self Harm

Abstract. Psychiatric hospitalization can cause significant distress for patients. Research has shown that to cope with the stress, patients sometimes resort to self-harm. Given the paucity of research on self-harm among psychiatric inpatients, a better understanding of transdiagnostic processes as predictors of self-harm during psychiatric hospitalization is needed. The current study examined whether coping styles predicted self-harm after controlling for commonly associated factors, such as age, gender, and borderline personality disorder. Participants were 72 patients (mean age = 39.32 years, SD = 12.29, 64% male) admitted for inpatient treatment at a public psychiatric hospital in Sydney, Australia. Participants completed self-report measures of coping styles and ward-specific coping behaviors, including self-harm, in relation to coping with the stress of acute hospitalization. Results showed that younger age, diagnosis of borderline personality disorder, and higher emotion-oriented coping were associated with self-harm. After controlling for age and borderline personality disorder, higher levels of emotion-oriented coping were found to be a significant predictor of self-harm. Findings were partially consistent with hypotheses; emotion-oriented but not avoidance-oriented coping significantly predicted self-harm. This finding may help to identify and provide psychiatric inpatients who are at risk of self-harm with appropriate therapeutic interventions.

Rumination in Borderline Personality Disorder: Meta-Analysis

2018 ◽  
Author(s):  
Mara J. Richman ◽  
Zsolt Unoka ◽  
Robert Dudas ◽  
Zsolt Demetrovics
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Emotion Dysregulation ◽  
Meta Analysis ◽  
Borderline Personality ◽  
Therapeutic Interventions ◽  
Sample Type ◽  
Moderator Variables ◽  
Analytic Review ◽  
Self Harm

Borderline personality disorder (BPD) is characterized by deficits in emotion regulation and affective liability. Of this domain, ruminative behaviors have been considered a core feature of emotion dysregulation difficulties. Despite this, inconsistencies have existed in the literature regarding which rumination type is most prominent in those with BPD symptoms. Moreover, no meta-analytic review has been performed to date on rumination in BPD. Taking this into consideration, a meta-analysis was performed to assess how BPD symptoms correlate with rumination, while also considering clinical moderator variables (i.e., BPD symptom domain, co-morbidities, GAF score) and demographic moderator variables (i.e., age, gender, sample type, and education level). Analysis of correlation across rumination domains for the entire sample revealed a medium overall correlation between BPD symptoms and rumination. When assessing types of rumination, the largest correlation was among pain rumination followed by anger, depressive, and anxious rumination. Among BPD symptom domain, affective instability had the strongest correlation with increased rumination, followed by unstable relationships, identity disturbance, and self-harm/ impulsivity, respectively. Demographic variables showed no significance. Clinical implications are considered and further therapeutic interventions are discussed in the context of rumination.

scholarly journals Patients with first versus multiple episodes of self-harm: how do their profiles differ?

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Philippe Golay ◽  
Louise Ostertag ◽  
Alessandra Costanza ◽  
Bénédicte Van der Vaeren ◽  
Yves Dorogi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Personality Disorder ◽  
Suicide Attempt ◽  
Professional Activity ◽  
Suicidal Risk ◽  
Factors Influencing ◽  
Several Variables ◽  
French Speaking ◽  
Self Harm ◽  
Multiple Episodes

Abstract Background Self-harm (SH) is among the strongest predictors of further episodes of SH, suicide attempt, and death by suicide. People who repeteadly harm themselves are at even higher risk for suicide. Factors influencing the repetition are important to identify when assessing suicidal risk and thereafter to offer specific interventions. Therefore, this study aimed to compare first versus multiple episodes characteristics in a large sample of patients in french-speaking Switzerland. Method We used the database from the French-speaking Swiss program for monitoring SH. Data of the psychiatric assessment of all adults admitted for SH were collected in the emergency department of four Swiss city hospitals between December 2016 and October 2019. Results 1730 episodes of SH were included. Several variables were significantly associated with multiple episodes, including diagnosis (over representation of personality disorders and under representation of anxiety disorders), professional activity (Invalidity insurance more frequent) and prior psychiatry care. Conclusions Patients suffering from a personality disorder and those with invalidity insurance are at risk for multiple episodes of SH and should be targeted with specific interventions.

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