Prevalence and Risk Factors of Violence by Psychiatric Acute Inpatients: A Systematic Review and Meta-Analysis

Background

Violence in acute psychiatric wards affects the safety of other patients and the effectiveness of treatment. However, there is a wide variation in reported rates of violence in acute psychiatric wards.

Objectives

To use meta-analysis to estimate the pooled rate of violence in published studies, and examine the characteristics of the participants, and aspects of the studies themselves that might explain the variation in the reported rates of violence (moderators).

Method

Systematic meta-analysis of studies published between January 1995 and December 2014, which reported rates of violence in acute psychiatric wards of general or psychiatric hospitals in high-income countries.

Results

Of the 23,972 inpatients described in 35 studies, the pooled proportion of patients who committed at least one act of violence was 17% (95% confidence interval (CI) 14–20%). Studies with higher proportions of male patients, involuntary patients, patients with schizophrenia and patients with alcohol use disorder reported higher rates of inpatient violence.

Conclusion

The findings of this study suggest that almost 1 in 5 patients admitted to acute psychiatric units may commit an act of violence. Factors associated with levels of violence in psychiatric units are similar to factors that are associated with violence among individual patients (male gender, diagnosis of schizophrenia, substance use and lifetime history of violence).     

Psychiatric Inpatients from an Urban Community, 1968-72

The psychiatric inpatient population from Salford was analysed in five successive annual censuses, from 1 January 1968 to 1 January 1972. Short-stay and medium-stay patients (under one year) remained constant. Long-stay patients reduced only slowly, and the length of stay increased. Over 200 patients (60%) had been in for 20 years or more at 1 January 1972. Analysis showed that the 1968 long-stay cohort diminished by 122 patients (29%) in four years, while 54 new long-stay patients accumulated. There seems little prospect of emptying large psychiatric hospitals of their long-stay population.     

Toxocara Infection in Psychiatric Inpatients: A Case Control Seroprevalence Study

Background

There is poor knowledge about the epidemiology of toxocariasis in psychiatric patients.

Aims

Determine the seroepidemiology of Toxocara infection in psychiatric patients.

Methods

Through a case-control seroprevalence study, 128 psychiatric inpatients and 276 control subjects were compared for the presence of anti-Toxocara IgG antibodies in Durango, Mexico. Socio-demographic, clinical, and behavioral characteristics of inpatients associated with toxocariasis were also investigated.

Results

Six of the 128 (4.7%) psychiatric inpatients, and 3 (1.1%) of the 276 controls were positive for anti-Toxocara IgG antibodies (P = 0.03). Stratification by age showed that Toxocara seroprevalence was significantly (P = 0.02) higher in patients aged ≤50 years old (6/90∶6.7%) than controls of the same age (2/163∶1.2%). While Toxocara seroprevalence was similar in patients and controls aged >50 years old. Stratification by gender showed that Toxocara seroprevalence was significantly (P = 0.03) higher in female patients (2/37∶5.4%) than in female controls (0/166∶0%). No statistically significant associations between Toxocara seropositivity and clinical characteristics were found. In contrast, Toxocara seropositivity was associated with consumption of goat meat and raw sea snail.

Conclusions

This is the first report of toxocariasis in psychiatric inpatients in Mexico. Further studies with larger sample sizes are needed to elucidate the association of toxocariasis with psychiatric diseases. The role of the consumption of goat meat and raw sea snail in the transmission of Toxocara deserve further investigation.     

Association of Trauma-Related Disorders and Dissociation with Four Idioms of Distress Among Latino Psychiatric Outpatients

Past research on idioms of distress among U.S. Latinos has revealed that ataque de nervios and altered perceptions, such as hearing and seeing things when alone, are independent markers of higher morbidity and mental health utilization despite having no one-to-one relationships with any single psychiatric diagnosis. It has been proposed that the idioms exert this effect because they are signs of distressing dissociative capacity associated with traumatic exposure. This study examines the relationships in an ethnically diverse Latino psychiatric outpatient sample (N = 230) among interpersonal trauma, posttraumatic stress disorder (PTSD), major depressive disorder, dissociative capacity and four cultural idioms of distress associated with the popular overall category of nervios. We particularly explore how these relationships change with varied measures of traumatic exposure, including trauma severity and timing or persistence of trauma. A series of adjusted bivariate regressions assessed the matrix of associations between the idioms and the clinical variables. In this highly traumatized population, we identified a strong ‘nexus’ of associations between dissociation and three of the idioms: currently being ill with nerves, ataque de nervios and altered perceptions. These idioms were largely independent from PTSD and depression and were associated with trauma persistence and severity. A fourth idiom, being nervous since childhood, was not associated with any other variable and may represent a personality trait rather than a diagnosable condition. Our results validate the clinical utility of the construct of nervios as a set of specific idioms associated with dissociation that are useful markers of mental health need among Latinos independently of their association with clinical diagnoses.     

A Force-Activated Trip Switch Triggers Rapid Dissociation of a Colicin from Its Immunity Protein

Colicins are protein antibiotics synthesised by Escherichia coli strains to target and kill related bacteria. To prevent host suicide, colicins are inactivated by binding to immunity proteins. Despite their high avidity (K_d≈fM, lifetime ≈4 days), immunity protein release is a pre-requisite of colicin intoxication, which occurs on a timescale of minutes. Here, by measuring the dynamic force spectrum of the dissociation of the DNase domain of colicin E9 (E9) and immunity protein 9 (Im9) complex using an atomic force microscope we show that application of low forces (<20 pN) increases the rate of complex dissociation 10⁶-fold, to a timescale (lifetime ≈10 ms) compatible with intoxication. We term this catastrophic force-triggered increase in off-rate a trip bond. Using mutational analysis, we elucidate the mechanism of this switch in affinity. We show that the N-terminal region of E9, which has sparse contacts with the hydrophobic core, is linked to an allosteric activator region in E9 (residues 21–30) whose remodelling triggers immunity protein release. Diversion of the force transduction pathway by the introduction of appropriately positioned disulfide bridges yields a force resistant complex with a lifetime identical to that measured by ensemble techniques. A trip switch within E9 is ideal for its function as it allows bipartite complex affinity, whereby the stable colicin:immunity protein complex required for host protection can be readily converted to a kinetically unstable complex whose dissociation is necessary for cellular invasion and competitor death. More generally, the observation of two force phenotypes for the E9:Im9 complex demonstrates that force can re-sculpt the underlying energy landscape, providing new opportunities to modulate biological reactions in vivo; this rationalises the commonly observed discrepancy between off-rates measured by dynamic force spectroscopy and ensemble methods.     

兔急性肠系膜上静脉血栓形成模型建立及其病理学观察

目的 建立稳定的兔急性肠系膜上静脉血栓形成模型,观察其病理学变化.方法 采用扎闭静脉、损伤血管壁、激活凝血因子等方法建立模型,分期观察病理学改变.结果 成模后可见血管腔内明显血栓形成;肠道粘膜上皮细胞水肿至坏死脱落伴大量炎性细胞浸润;血管内皮细胞从凹陷到局部坏死脱落,直至大面积坏死脱落,内皮下基质暴露.结论 本实验可成功建立兔肠系膜上静脉血栓形成模型,病理学改变符合临床,模型稳定可靠.     

Predictive Validity of the Suicide Trigger Scale (STS-3) for Post-Discharge Suicide Attempt in High-Risk Psychiatric Inpatients

Background

The greatly increased risk of suicide after psychiatric hospitalization is a critical problem, yet we are unable to identify individuals who would attempt suicide upon discharge. The Suicide Trigger Scale v.3 (STS-3), was designed to measure the construct of an affective ‘suicide trigger state’ hypothesized to precede a suicide attempt (SA). This study aims to test the predictive validity of the STS-3 for post-discharge SA on a high-risk psychiatric-inpatient sample.

Methods

The STS-3, and a psychological test battery measuring suicidality, mood, impulsivity, trauma history, and attachment style were administered to 161 adult psychiatric patients hospitalized following suicidal ideation (SI) or SA. Receiver Operator Characteristic and logistic regression analyses were used to assess prediction of SA in the 6-month period following discharge from hospitalization.

Results

STS-3 scores for the patients who made post-discharge SA followed a bimodal distribution skewed to high and low scores, thus a distance from median transform was applied to the scores. The transformed score was a significant predictor of post-discharge SA (AUC 0.731), and a subset of six STS-3 scale items was identified that produced improved prediction of post-discharge SA (AUC 0.814). Scores on C-SSRS and BSS were not predictive. Patients with ultra-high (90^th percentile) STS-3 scores differed significantly from ultra-low (10^th percentile) scorers on measures of affective intensity, depression, impulsiveness, abuse history, and attachment security.

Conclusion

STS-3 transformed scores at admission to the psychiatric hospital predict suicide attempts following discharge among the high-risk group of suicidal inpatients. Patients with high transformed scores appear to comprise two clinically distinct groups; an impulsive, affectively intense, fearfully attached group with high raw STS-3 scores and a low-impulsivity, low affect and low trauma-reporting group with low raw STS-3 scores. These groups may correspond to low-plan and planned suicide attempts, respectively, but this remains to be established by future research.     

慢性阻塞性肺病大鼠模型的肺功能及肺组织病理学变化评估

目的:探讨被动吸烟的时间长短与慢性阻塞性肺病(COPD)大鼠模型的肺功能及肺组织病理学的变化之间的关系.方法:采用被动吸烟法建立COPD大鼠模型,随机分为被动吸烟4周组、6周组、8周组和对照组,分别测定和评估不同时间段的各组大鼠模型的肺功能和气道肺组织的病理变化.结果:6周组及8周组大鼠模型的呼气峰流速(PEF)显著降低、气道内压上升坡度(IP-slope)显著增高,与对照组比较P＜0.01.以PEF值小于对照组的大鼠80%PEF值为存在气流受限的界线,则4周组、6周组、8周组出现气流受限的鼠分别为0只(0)、6只(75%)及8只(100%),6周组及8周组的大鼠气流受限发生率显著高于4周组(P＜0.01).8周组大鼠出现明显气道壁增厚、气道狭窄及显著肺气肿改变,其气道壁炎细胞浸润、杯状细胞化生、气道壁坏死糜烂、纤维结缔组织及平滑肌增生等评分均显著高于对照组(P＜0.01),气道坏死糜烂、小气道阻塞发生率及气道平滑肌增生等指标显著高于6周组(P＜0.01).6周组中有6只大鼠出现气道狭窄及肺气肿改变,气道壁炎细胞浸润、杯状细胞化生、气道壁坏死糜烂、纤维结缔组织及平滑肌增生等评分均显著高于对照组(P＜0.01).6周组及8周组大鼠PEF值与气道壁纤维组织和平滑肌增生呈显著负相关(P＜0.05);而4周组大鼠未出现典型肺气肿及气道狭窄.结论:COPD的形成与吸烟时间有关,在吸烟量相同条件下,吸烟时间越长,气道和肺组织病变越重,气流受限的发生率越高.     

A Systematic Review of Music Therapy Practice and Outcomes with Acute Adult Psychiatric In-Patients

Background and Objectives

There is an emerging evidence base for the use of music therapy in the treatment of severe mental illness. Whilst different models of music therapy have been developed in mental health care, none have specifically accounted for the features and context of acute in-patient settings. This review aimed to identify how music therapy is provided for acute adult psychiatric in-patients and what outcomes have been reported.

Review Methods

A systematic review using medical, psychological and music therapy databases. Papers describing music therapy with acute adult psychiatric in-patients were included. Analysis utilised narrative synthesis.

Results

98 papers were identified, of which 35 reported research findings. Open group work and active music making for nonverbal expression alongside verbal reflection was emphasised. Aims were engagement, communication and interpersonal relationships focusing upon immediate areas of need rather than longer term insight. The short stay, patient diversity and institutional structure influenced delivery and resulted in a focus on single sessions, high session frequency, more therapist direction, flexible use of musical activities, predictable musical structures, and clear realistic goals. Outcome studies suggested effectiveness in addressing a range of symptoms, but were limited by methodological shortcomings and small sample sizes. Studies with significant positive effects all used active musical participation with a degree of structure and were delivered in four or more sessions.

Conclusions

No single clearly defined model exists for music therapy with adults in acute psychiatric in-patient settings, and described models are not conclusive. Greater frequency of therapy, active structured music making with verbal discussion, consistency of contact and boundaries, an emphasis on building a therapeutic relationship and building patient resources may be of particular importance. Further research is required to develop specific music therapy models for this patient group that can be tested in experimental studies.     

The Formation and Function of the Children's Psychiatric Research Institute,London, Ont

The Children''s Psychiatric Research Institute was established in February 1960 by the Mental Health Branch of the Ontario Department of Health. Its formation was the result of co-operative efforts by the Ontario Association for Retarded Children, the University of Western Ontario and the senior members of the Mental Health Division of the Ontario Department of Health. It was established in London, Ontario, because of the interest in research in this area of medicine on the part of the University of Western Ontario Faculty of Medicine.Children suspected of being mentally retarded are accepted on referral by physicians or social agencies in southwestern Ontario. A multi-discipline team examines these patients for causal pathology, levels of function at intellectual, social and emotional parameters, and family relationships and reactions. In-patient facilities are available if required for additional investigation. The opportunity provided by the Institute and its patients for research and teaching is utilized through its close relationship with the University of Western Ontario. A postgraduate course in problems of mental retardation is offered to interested physicians.     

Dopamine Metabolism and Receptor Function After Acute and Chronic Ethanol

Abstract: Acute ethanol treatment in rats elicits a selective increase in dihydroxyphenylacetic acid (DOPAC) content in striatum. In contrast, striatal DOPAC concentration does not differ from normal values after chronic ethanol treatment. Chronic administration of ethanol however causes a selective increase of specific [3H]spiroperidol binding and met-enkephalin content in the striatum. Kinetic analysis of [3H]spiroperidol binding data shows that after chronic ethanol treatment there is a significant increase in the affinity constant rather than in the number of binding sites for the ligand. Our results support the hypothesis that dopaminergic mechanisms at both pre- and postsynaptic level may be involved in the mediation of some of the central effects observed after ethanol consumption.     

A Calmodulin C-Lobe Ca2+-Dependent Switch Governs Kv7 Channel Function

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Inpatients in an accident unit.

A one-year prospective study was undertaken in the 79-bed accident unit of the Bristol Royal Infirmary to define reasons for continuing inpatient care. This showed that, of a consecutive series of 466 patients staying in hospital for over two weeks, 35% lengthened their stay beyond that needed for acute nursing or continued medical care. A combination of factors usually led to total social dependence, the major problem being the absence of a caring relative. Other factors included pre-existing locomotor disorder or mental infirmity, unmanageable incontinence of urine after catheterisation, and institutional disorientation. If the pattern of management of elderly patients after injury is not changed and beds are to be kept available for the newly injured the unit will need about 50 new long-stay beds each year.     

Dexrazoxane Diminishes Doxorubicin-Induced Acute Ovarian Damage and Preserves Ovarian Function and Fecundity in Mice

Advances in cancer treatment utilizing multiple chemotherapies have dramatically increased cancer survivorship. Female cancer survivors treated with doxorubicin (DXR) chemotherapy often suffer from an acute impairment of ovarian function, which can persist as long-term, permanent ovarian insufficiency. Dexrazoxane (Dexra) pretreatment reduces DXR-induced insult in the heart, and protects in vitro cultured murine and non-human primate ovaries, demonstrating a drug-based shield to prevent DXR insult. The present study tested the ability of Dexra pretreatment to mitigate acute DXR chemotherapy ovarian toxicity in mice through the first 24 hours post-treatment, and improve subsequent long-term fertility throughout the reproductive lifespan. Adolescent CD-1 mice were treated with Dexra 1 hour prior to DXR treatment in a 1:1 mg or 10:1 mg Dexra:DXR ratio. During the acute injury period (2–24 hours post-injection), Dexra pretreatment at a 1:1 mg ratio decreased the extent of double strand DNA breaks, diminished γH2FAX activation, and reduced subsequent follicular cellular demise caused by DXR. In fertility and fecundity studies, dams pretreated with either Dexra:DXR dose ratio exhibited litter sizes larger than DXR-treated dams, and mice treated with a 1:1 mg Dexra:DXR ratio delivered pups with birth weights greater than DXR-treated females. While DXR significantly increased the “infertility index” (quantifying the percentage of dams failing to achieve pregnancy) through 6 gestations following treatment, Dexra pretreatment significantly reduced the infertility index following DXR treatment, improving fecundity. Low dose Dexra not only protected the ovaries, but also bestowed a considerable survival advantage following exposure to DXR chemotherapy. Mouse survivorship increased from 25% post-DXR treatment to over 80% with Dexra pretreatment. These data demonstrate that Dexra provides acute ovarian protection from DXR toxicity, improving reproductive health in a mouse model, suggesting this clinically available drug may provide ovarian protection for cancer patients.     

Study of Development of Function of Kidneys and Their Regulation on the Background of Pathological Process

By the example of reabsorption of sodium ions in kidney, it is shown that this process, alongside with establishment of the system of osmotic concentration, plays the key role in evolution of renal function. There is shown a similarity of tendencies of changes of the total sodium ion reabsorption in children’s kidney in the process of development and in a series of representatives of various vertebrate classes. An opposite tendency is revealed during the kidney dysfunction produced by chronic renal failure. At all stages of postnatal ontogenesis in healthy children and in adults, kidney maintains the same parameters of the blood serum ion composition and osmolality. A new approach to study evolution of functions is proposed, which is based on a combination of two L.A. Orbeli’s methods—ontogenetic and clinical, by the example of study of renal function and its regulation during development of a pathological process on the background of formation of function in postnatal ontogenesis. When using such approach in children with nocturnal enuresis, significance of autacoids in regulation of urine formation is established. In the case of acute pneumonia in children, a possibility of extrapituitary production of vasopressin-like substances in lungs is shown. In norm, in postnatal ontogenesis of healthy children, in regulation of renal functions and of diuresis system, effects of efferent nerves and hormones (vasopressin) dominate, while significance of autacoids is minimal. But at a dysfunction produced by a pathological process, a change of ratio of activities of these regulatory systems is revealed. The obtained data indicate importance of the clinical and experimental methods proposed by L.A. Orbeli in analysis of evolution of renal functions and study of the nature of regulations. A combination of several methods of evolutionary physiology in one study allows revealing new mechanisms underlying regulation of function and promotes formation of concepts about regularities of evolution of functions.__________Translated from Zhurnal Evolyutsionnoi Biokhimii i Fiziologii, Vol. 41, No. 3, 2005, pp. 277–284.Original Russian Text Copyright © 2005 by Kuznetsova, Natochin.