COERCIVE MEASURESIN PANDEMIC PSYCHIATRIC CARE — RETROSPECTIVE STUDY

Coercion raises serious ethical and legal issues in psychiatric care. Coercive medical measures are applied in psychiatric institutions for protective purposes. Alcoholism is a social and medical problem because it especially affects the behavior of the individual. Alcohol consumption can catalyze exacerbations of mental illness and predispose to behaviors with an increased risk of violence. Aim: The purpose of this study is to illustrate medical and legal issues related to coercive measures in emergency psychiatric care during the pandemic. Methods: The study is retrospective, and the data were taken from the observation sheets of patients in the period between March 1, 2020–March 31, 2021, in acute section II in the Institute of Psychiatry "Socola" Iasi. Results: Of those who required coercive measures during hospitalization, most were restraint for symptoms such as: self-aggression and aggression towards others. Mechanical restraint measures were also necessary in cases with hallucinatory-delusional symptoms, associated with self-aggression and aggression towards others. The share of hospitalized patients for alcohol abuse, who required coercive measures, was significantly higher during the pandemic. Conclusion: Manifestations of violence among patients with major mental disorders are rare. Mechanical restraint was necessary especially in those who had self-aggression and aggression towards others, symptoms secondary to alcohol consumption. Alcohol consumption amplifies the psychological imbalance in the context of the COVID-19 pandemic.

Evaluation of coercive measures in different psychiatric hospitals: the impact of institutional characteristics

Background Epidemiological studies have demonstrated considerable differences in the use of coercive measures among psychiatric hospitals; however, the underlying reasons for these differences are largely unclear. We investigated to what extent these differences could be explained by institutional factors. Methods Four psychiatric hospitals with identical responsibilities within the mental health care system, but with different inpatient care organizations, participated in this prospective observational study. We included all patients admitted over a period of 24 months who were affected by mechanical restraint, seclusion, or compulsory medication. In addition to the patterns of coercive measures, we investigated the effect of each hospital on the frequency of compulsory medication and the cumulative duration of mechanical restraint and seclusion, using multivariate binary logistic regression. To compare the two outcomes between hospitals, odds ratios (OR) with corresponding 95% confidence intervals (CI) were calculated. Results Altogether, coercive measures were applied in 1542 cases, corresponding to an overall prevalence of 8%. The frequency and patterns of the modalities of coercive measures were different between hospitals, and the differences could be at least partially related to institutional characteristics. For the two hospitals that had no permanently locked wards, certain findings were particularly noticeable. In one of these hospitals, the probability of receiving compulsory medication was significantly higher compared with the other institutions (OR 1.9, CI 1.1–3.0 for patients < 65 years; OR 8.0, CI 3.1–20.7 for patients ≥65 years); in the other hospital, in patients younger than 65 years, the cumulative duration of restraint and seclusion was significantly longer compared with the other institutions (OR 2.6, CI 1.7–3.9). Conclusions The findings are compatible with the hypothesis that more open settings are associated with a more extensive use of coercion. However, due to numerous influencing factors, these results should be interpreted with caution. In view of the relevance of this issue, further research is needed for a deeper understanding of the reasons underlying the differences among hospitals.

Sociodemographic, Circumstantial, and Psychopathological Predictors of Involuntary Admission of Patients with Acute Psychosis

Studies have consistently determined that patients with acute psychosis are more likely to be involuntarily admitted, although few studies examine specific risk factors of involuntary admission (IA) among this patient group. Data from all patients presenting in the psychiatric emergency department (PED) over a period of one year were extracted. Acute psychosis was identified using specific diagnostic criteria. Predictors of IA were determined using logistic regression analysis. Out of 2533 emergency consultations, 597 patients presented with symptoms of acute psychosis, of whom 118 were involuntarily admitted (19.8%). Involuntarily admitted patients were more likely to arrive via police escort (odds ratio (OR) 10.94) or ambulance (OR 2.95), live in a psychiatric residency/nursing home (OR 2.76), report non-adherence to medication (OR 2.39), and were less likely to suffer from (comorbid) substance abuse (OR 0.53). Use of mechanical restraint was significantly associated with IA (OR 13.31). Among psychopathological aspects, aggressiveness was related to the highest risk of IA (OR 6.18), followed by suicidal intent (OR 5.54), disorientation (OR 4.66), tangential thinking (OR 3.95), and suspiciousness (OR 2.80). Patients stating fears were less likely to be involuntarily admitted (OR 0.25). By understanding the surrounding influencing factors, patient care can be improved with the aim of reducing the use of coercion.

Effect of Cu Nanoparticles on the Properties of PP-g-PHMG/PE Monofilament and Its Antifouling Application

The modified polyethylene monofilament was prepared by melt blending and spinning using polyethylene (PE), polypropylene-grafted poly(hexamethylene guanidine) (PP-g-PHMG), and Cu nanoparticles (CuNPs). The effect of CuNP content on the structure, mechanical properties, and antimicrobial properties of the monofilaments was studied. In addition, the antifouling property of fishing nets using the modified polyethylene monofilaments was evaluated. The results showed that CuNPs were dispersed homogeneously in the monofilament matrix as microaggregates. The initial increase in the tensile strength of monofilament was attributed to the mechanical restraint, whereas a decrease in the tensile properties at 1.0 wt% CuNP content was due to the predominant effect of a decrease in the total crystallinity. A bacteriostatic test showed that the monofilament had an obvious inhibitory effect on Staphylococcus aureus. Furthermore, coupon test results showed that PP-g-PHMG/PE/CuNP nanocomposite netting had lower weight gain than PP-g-PHMG/PE netting (23.6% reduction) because of the combined antibacterial effect of both PHMG and CuNP. Therefore, PP-g-PHMG/PE/CuNP monofilament has the potential to produce green and efficient antifouling fishing nets.