scholarly journals Care Programme Approach – documentation of past risk-related behaviour

2003 ◽  
Vol 27 (8) ◽  
pp. 298-300 ◽  
Author(s):  
Peter Dick ◽  
Tessa Durham ◽  
Mitchell Stewart ◽  
Scott Kane ◽  
Jim Duffy
Keyword(s):  
Clinical Information ◽  
Relevant Information ◽  
Risk Category ◽  
Clinical Implications ◽  
Routine Practice ◽  
Care Programme ◽  
Related Information ◽  
History Of ◽  
Self Harm ◽  
History Of Violence

Aims and MethodThe aim of the study was to assess the practicality of extracting past risk-related information from case records and to assess how this process might be cost-effectively incorporated in routine practice. Case records of 43 patients referred to the Care Programme Approach in Dundee were examined.ResultsOur study yielded relevant information – 39% of patients had a history of violence, 58% of self-harm or suicide, 58% of severe self-neglect and 72% of non-compliance with medication. However, it took an average of 5 hours to conduct a thorough review of each case because the notes were bulky and poorly organised.Clinical ImplicationsRetrospective review of conventional case records in routine practice is likely to be incomplete and misleading. Prospective recording should be practicable if used selectively, but requires a standardised approach to clinical recording and case note maintenance. The risk recording system we developed, incorporating a dated index of incidents by risk category, followed by brief summaries of each incident, provides key clinical information not available from a simple check list while not sacrificing brevity.

scholarly journals Care Programme Approach – documentation of past risk-related behaviour

2003 ◽  
Vol 27 (08) ◽  
pp. 298-300
Author(s):  
Peter Dick ◽  
Tessa Durham ◽  
Mitchell Stewart ◽  
Scott Kane ◽  
Jim Duffy
Keyword(s):  
Clinical Information ◽  
Relevant Information ◽  
Risk Category ◽  
Clinical Implications ◽  
Routine Practice ◽  
Care Programme ◽  
Related Information ◽  
History Of ◽  
Self Harm ◽  
History Of Violence

Aims and Method The aim of the study was to assess the practicality of extracting past risk-related information from case records and to assess how this process might be cost-effectively incorporated in routine practice. Case records of 43 patients referred to the Care Programme Approach in Dundee were examined. Results Our study yielded relevant information – 39% of patients had a history of violence, 58% of self-harm or suicide, 58% of severe self-neglect and 72% of non-compliance with medication. However, it took an average of 5 hours to conduct a thorough review of each case because the notes were bulky and poorly organised. Clinical Implications Retrospective review of conventional case records in routine practice is likely to be incomplete and misleading. Prospective recording should be practicable if used selectively, but requires a standardised approach to clinical recording and case note maintenance. The risk recording system we developed, incorporating a dated index of incidents by risk category, followed by brief summaries of each incident, provides key clinical information not available from a simple check list while not sacrificing brevity.

Correlates and predictors of self-harm in a prospective sample of sexually assaulted adolescents

2020 ◽  
Vol 25 (4) ◽  
pp. 847-859
Author(s):  
Fatima Valencia-Agudo ◽  
Tami Kramer ◽  
Venetia Clarke ◽  
Andrea Goddard ◽  
Sophie Khadr
Keyword(s):  
Depressive Symptoms ◽  
Sexual Assault ◽  
Bivariate Analysis ◽  
Clinical Implications ◽  
Future Studies ◽  
Stress Symptoms ◽  
History Of ◽  
Self Harm ◽  
Logistic Regressions ◽  
Larger Sample

Background: Sexual assault of adolescents is associated with negative mental health outcomes, including self-harm. Little is known about correlates and predictors of self-harm after sexual assault. We hypothesized that pre-assault vulnerabilities and post-assault psychological distress would be associated with self-harm after experiencing a recent sexual assault. Methods: The sample was recruited from adolescents aged 13 to 17 years accessing sexual assault centers and it included 98 females. Longitudinal data were collected at T0 (3.9 weeks on average post-assault) and T1 (21.8 weeks on average post-assault). Bivariate analysis and hierarchical binary logistic regressions were performed. Results: The rate of self-harm was 38.1% before the assault and 37.8% after the assault ( T1). History of family dysfunction ( OR 3.60 (1.30, 10.01)), depressive symptoms at T0 ( OR 5.83 (2.35, 14.43)) or T1 ( OR 2.79 (1.20, 6.50), and posttraumatic stress symptoms at T1 ( OR 3.21 (1.36, 7.58)) predicted self-harm at T1. These effects were attenuated when adjusting for confounders, except for depressive symptoms at T0 ( OR 4.21 (1.57, 11.28)). Discussion: Clinical implications for the prevention of onset or continuation of self-harm following adolescent sexual assault are discussed. Future studies should replicate these findings in a larger sample and consider different trajectories of self-harm.

scholarly journals The Debt and Mental Health Evidence Form

2010 ◽  
Vol 34 (3) ◽  
pp. 95-100 ◽  
Author(s):  
Chris Fitch ◽  
Robert Chaplin ◽  
Simon Tulloch
Keyword(s):  
Mental Health ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Qualitative Data ◽  
Mental Health Problems ◽  
Clinical Information ◽  
Relevant Information ◽  
Clinical Implications ◽  
Stakeholder Groups ◽  
Question Form

Aims and methodTo develop a standardised clinical information form which helps health professionals provide clear and relevant information about individuals who believe mental disorders affect their ability to repay debt and have consented to creditor organisations or money advisors approaching professionals for evidence. The six-question form was evaluated by three stakeholder groups.ResultsOverall, 35 responses were received from creditors/money advisors, 28 from mental health professionals and 29 from service users/carers. All questions scored acceptable levels of clarity and three questions scored acceptable relevance levels. Qualitative data were used to revise questions on the basis of concerns expressed by stakeholders about sharing diagnostic data, providing prognoses, and the risk of creditor misunderstanding.Clinical implicationsThe form is likely to be an acceptable standardised means by which health professionals can elicit information on debt from individuals with mental health problems, for use by creditor organisations or money advisors. The results of a pilot study are awaited.

scholarly journals Assessing whether psychiatric trainees feel safe in the workplace

2012 ◽  
Vol 36 (3) ◽  
pp. 93-96 ◽  
Author(s):  
Catia Acosta ◽  
James Warner ◽  
Michael Kopelman ◽  
Ramin Nilforooshan
Keyword(s):  
Clinical Practice ◽  
Annual Meeting ◽  
Physical Assault ◽  
Clinical Implications ◽  
Training Course ◽  
History Of ◽  
History Of Violence ◽  
Level Of Training ◽  
Verbal Assault

Aims and methodPrevious studies have shown that 17 to 60% of psychiatric trainees have been physically or verbally assaulted. To measure the frequency of assaults and the trainees' reactions, we conducted a retrospective self-reported survey of attendees at MRCPsych teaching courses in south London and at an annual meeting of psychiatric trainees.ResultsOverall, 64% of the questionnaires distributed were returned completed. Of the trainees who responded, 41% had been physically assaulted at least once and 89% had been verbally assaulted. As a result of the assault, 34% of trainees were subsequently more risk aware and 11% were now hesitant to assess patients with a history of violence. There was no association between the level of training or attendance at a breakaway training course and having been subject to physical assault.Clinical implicationsOur study showed unacceptable levels of physical and verbal assault on psychiatric trainees and an important effect of those incidents on clinical practice.

Childhood exposure to interpersonal violence is associated with greater transdiagnostic integration of psychiatric symptoms

2020 ◽  
pp. 1-9
Author(s):  
Justin D. Russell ◽  
Taylor J. Keding ◽  
Quanfa He ◽  
James J. Li ◽  
Ryan J. Herringa
Keyword(s):  
Interpersonal Violence ◽  
Psychiatric Comorbidity ◽  
Psychiatric Symptoms ◽  
Treatment Resistance ◽  
Clinical Implications ◽  
Treatment Resistant ◽  
Childhood Exposure ◽  
Resistant Population ◽  
History Of ◽  
History Of Violence

Abstract Background Childhood exposure to interpersonal violence (IPV) may be linked to distinct manifestations of mental illness, yet the nature of this change remains poorly understood. Network analysis can provide unique insights by contrasting the interrelatedness of symptoms underlying psychopathology across exposed and non-exposed youth, with potential clinical implications for a treatment-resistant population. We anticipated marked differences in symptom associations among IPV-exposed youth, particularly in terms of ‘hub’ symptoms holding outsized influence over the network, as well as formation and influence of communities of highly interconnected symptoms. Methods Participants from a population-representative sample of youth (n = 4433; ages 11–18 years) completed a comprehensive structured clinical interview assessing mental health symptoms, diagnostic status, and history of violence exposure. Network analytic methods were used to model the pattern of associations between symptoms, quantify differences across diagnosed youth with (IPV+) and without (IPV–) IPV exposure, and identify transdiagnostic ‘bridge’ symptoms linking multiple disorders. Results Symptoms organized into six ‘disorder’ communities (e.g. Intrusive Thoughts/Sensations, Depression, Anxiety), that exhibited considerably greater interconnectivity in IPV+ youth. Five symptoms emerged in IPV+ youth as highly trafficked ‘bridges’ between symptom communities (11 in IPV– youth). Conclusion IPV exposure may alter mutually reinforcing symptom co-occurrence in youth, thus contributing to greater psychiatric comorbidity and treatment resistance. The presence of a condensed and unique set of bridge symptoms suggests trauma-enriched nodes which could be therapeutically targeted to improve outcomes in violence-exposed youth.

Violence and self-harm in severe mental illness: inpatient study of associations with ethnicity, cannabis and alcohol

2016 ◽  
Vol 25 (1) ◽  
pp. 28-31 ◽  
Author(s):  
Vajira Dharmawardene ◽  
David B Menkes
Keyword(s):  
Substance Use ◽  
Alcohol Use ◽  
Specific Treatment ◽  
Female Gender ◽  
Cannabis Use ◽  
Severely Mentally Ill ◽  
Identification Test ◽  
History Of ◽  
Self Harm ◽  
History Of Violence

Objective: We examined the extent to which ethnicity, cannabis and alcohol use could predict prevalence of violence and self-harm in an inpatient psychiatric sample. Method: We collected demographic and clinical data in a series of 141 adult psychiatric inpatients in Hamilton, New Zealand. The Alcohol Use Disorders Identification Test (AUDIT) and Cannabis Use Disorders Identification Test, Revised (CUDIT-R) were used to measure substance use. Clinical assessment and file review were used to verify histories of self-harm and violence. Results: It was found that 66% had a history of violence, 54% of self-harm, and 40% of both; only 20% had neither. Cannabis use was found to significantly predict lifetime history of violence ( p = 0.02); other independent variables (gender, age, ethnicity, alcohol use, psychiatric diagnosis) did not. Self-harm was strikingly predicted by female gender ( p < 0.001), as well as by measures both of cannabis ( p = 0.025) and alcohol use ( p = 0.036); age, ethnicity and diagnosis did not reach significance. Less than 10% of patients were engaged with drug or alcohol services. Conclusions: Cannabis use is a significant predictor of lifetime violence among the severely mentally ill, while both alcohol and cannabis use predict self-harm. Few affected patients receive specific treatment for substance use comorbidity.

Optimizing the assessment of suicide attempters with a decision tree

2016 ◽  
Vol 33 (S1) ◽  
pp. S602-S603
Author(s):  
J. Lopez-Castroman ◽  
D. Delgado-Gomez ◽  
P. Courtet ◽  
E. Baca-Garcia
Keyword(s):  
Decision Tree ◽  
Suicide Attempts ◽  
Clinical Information ◽  
Relevant Information ◽  
Test Set ◽  
Adaptive Tests ◽  
Suicide Attempters ◽  
History Of ◽  
Competing Interest ◽  
Set Up

BackgroundOptimizing psychiatric assessments could help to standardize the use of structured instruments in clinical practice. In recent years, several research groups have applied Computerized Adaptive Tests (CATs) to simplify assessments in depression, anxiety and also suicidal behaviors. We aimed to construct a shortened test to classify suicide attempters using a decision tree methodology that allows the integration of relevant clinical information, namely the history of past suicide attempts, in the construction of the test.MethodsThe sample was composed of 902 adult participants in three subsamples: first-time suicide attempters, psychiatric inpatients that never attempted suicide and healthy controls. The performance of a decision tree built using the items of a previously developed scale for suicidal risk was examined. The history of past suicide attempts was used to separate patients in the decision tree. The data was randomly divided in a training set and a test set. The test set, that contained 25% of the data, was used to determine the accuracy of the decision tree. Twenty-five cross-validations of this set up were conducted.ResultsThe first four items of the decision tree classified correctly 81.4% of the patients.ConclusionAs a result of a methodology based on decision trees that, contrary to CATs, can incorporate relevant information in building the test we were able to create a shortened test capable of separating suicidal and non-suicidal patients. Using all the information that is available improves the precision and utility of instruments adapted for psychiatric assessments.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Management of self-harm in older people

2009 ◽  
Vol 33 (11) ◽  
pp. 423-425
Author(s):  
Nikki D. Toms ◽  
Craig W. Ritchie
Keyword(s):  
Older People ◽  
Healthcare Professionals ◽  
Working Party ◽  
Clinical Information ◽  
Clinical Implications ◽  
Current Management ◽  
Self Harm ◽  
Consistent Method ◽  
Low Incidence ◽  
Regional Surveillance

Aims and MethodThe epidemiology of self-harm in older people is poorly understood and a low incidence rate hampers research efforts. Regional surveillance for this may assist with research and improve clinical services accordingly. This study involved undertaking a scoping exercise to explore current management of self-harm in elderly people in selected North London hospitals, by interviewing healthcare professionals directly involved in their treatment.ResultsThe study showed varied methods of coding clinical information across trusts, with no consistent method of surveillance.Clinical ImplicationsImplications of this exercise involve generation of a summary document that will educate stage two of the project, which is the convention of a working party to implement a surveillance system across the region.

scholarly journals Violence, stigma and psychiatric diagnosis: the effects of a history of violence on psychiatric diagnosis

2006 ◽  
Vol 30 (7) ◽  
pp. 254-256 ◽  
Author(s):  
Tom Clark ◽  
Renarta Rowe
Keyword(s):  
Bipolar Disorder ◽  
Psychiatric Diagnosis ◽  
Bipolar Affective Disorder ◽  
Clinical Implications ◽  
Clinical Vignettes ◽  
Diagnostic Decision ◽  
History Of ◽  
History Of Violence ◽  
The Uk ◽  
Diagnostic Decision Making

Aims and MethodThe aim of the study was to investigate whether psychiatrists consider that patients with schizophrenia present a greater risk of violence than patients with other forms of mental illness. Two pairs of clinical vignettes were devised. In each pair, one contained a history of violence and one did not. One vignette was mailed to each of 2000 consultant psychiatrists in the UK. Respondents were asked to give a preferred diagnosis. Rates of diagnosis of bipolar disorder, schizoaffective disorder and schizophrenia were compared within vignette pairs.ResultsFor each pair of vignettes, the rate of diagnosis of schizophrenia was higher (33 v. 21.5%, P=0.008 and 44.4 v. 32.1%, P=0.011), and the rate of diagnosis of bipolar disorder was lower (44.2 v. 62.6%, P<0.0005 and 34.9 v. 49.3%, P=0.004), among those who received the vignette containing a history of violence.Clinical ImplicationsA history of violence may lead to an increased likelihood of receiving a diagnosis of schizophrenia as opposed to bipolar affective disorder. This bias in diagnostic decision-making may affect the treatment received by a patient and may perpetuate and exacerbate the stigma associated with a diagnosis of schizophrenia.

Self-Harm and Homeless Adults

Crisis ◽  
2013 ◽  
Vol 34 (5) ◽  
pp. 363-366 ◽  
Author(s):  
Graham Pluck ◽  
Kwang-Hyuk Lee ◽  
Randolph W. Parks
Keyword(s):  
Mental Health ◽  
Psychiatric Admission ◽  
Homeless Adults ◽  
Related Information ◽  
Health History ◽  
Self Injury ◽  
Mental Health History ◽  
History Of ◽  
Self Harm

Background: Homelessness is associated with an increased incidence of mental illness and risk of self-harm, including suicide. Aims: To assess the prevalence of self-harm (including nonsuicidal self-injury and attempted suicide) among a UK sample of homeless adults and to compare demographic, clinical, and homeless-related variables to determine which are linked to self-harm in this population. Method: A sample of 80 homeless adults were interviewed regarding history of self-harm, mental health history, demographic, and homeless-related information. Results: Sixty-eight percent of the sample reported past acts of self-harm. Those with histories of self-harm started using significantly more substances since becoming homeless and were younger when they first became homeless. They were also significantly more likely to have a past psychiatric admission and thoughts of self-harm in the past year. Conclusion: Self-harm is common among homeless adults and linked to long-term and enduring social and mental health concerns.

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