Objective: Aggressive behaviour is highly prevalent in long-term psychiatric inpatient care. We aimed to estimate the overall incidence of aggression, the time staff took to handle aggression incidents, and the weighted average financial costs thereof. Methods: A random sampling procedure was conducted at long-term psychiatric inpatient care facilities. Nurses were asked to recall all incidents (i.e., verbal, physical towards objects, self, or others) of their shift. For the time spent on each type of incident, staff were monitored in real-time. Estimated costs were calculated by the time spent multiplied by hourly wages in addition to material-related costs. Results: Incidence rates were 90 incidents per patient year. The average time spent per incident was 125 min but differed for each type of incident. Almost 80% of this time was consumed by nursing staff. The average cost per aggression incident was e78; extrapolated per patient year, the total costs were approximately e7000. Conclusions: The current study found a high rate of aggression incidents in closed long-stay psychiatric wards. Reports of aggression on these types of wards are scarce. Nevertheless, aggression seems to have a severe impact on invested time and related costs, which suggests a need for aggression-prevention and de-escalating programs. KEY POINTS Aggression incidents are highly prevalent and are accompanied by high costs. The effect of aggression incidents on the workload for staff members is high, especially for nursing staff. Studies across countries on the incidence and the costs of aggression among psychiatric inpatients are needed to help model the effects of (new) strategies for aggression reduction.
Objective: To examine the naturalistic response to and cardiovascular side effects of stimulant medication in older adults with ADHD. Methods: Electronic Health Record (EHR) data of adult patients with ADHD (≥55 years) at the specialized PsyQ outpatient clinic for adult ADHD ( n = 113, 55-79 years) were collected. Response, cardiovascular status, side effects, and provided medical care before and after the first ADHD medication dose have been recorded. Results: A total of 65% of the patients reported positive response to the medication, and 42% of the patients quit their medication due to side effects or nonresponse. There was a small but significant decrease in weight and increase in heart rate before and after methylphenidate use. Conclusion: Our results indicate that the use of stimulants may be a relatively safe and effective treatment for older adults with ADHD, under the condition that the cardiovascular parameters are monitored before and during pharmacological treatment. Randomized controlled trials (RCTs) are needed to confirm these findings.
Background. Sleep disturbances are a key feature of major depression. Electroconvulsive treatment (ECT) may improve polysomnography-assessed sleep characteristics, but its short-term effects on actigraphy-assessed and subjective sleep characteristics are unknown. We therefore aimed to assess the effects of ECT on subjective and objective sleep parameters in a proof-of-principle study. Methods. We assessed subjective and objective sleep parameters in 12 severely depressed patients up to 5 consecutive days during their ECT course, corresponding to a total of 43 nights (including 19 ECT sessions). The 12 patients were 83% female and on average 62 (standard deviation (SD) 14) years old and had an average MADRS score of 40 at baseline (SD 21). Results. Subjective and objective sleep parameters were not directly affected by ECT. The subjective sleep efficiency parameter was similar on the day after ECT and other days. ECT did not affect the number of errors in the Sustained Attention to Response Task. Patients subjectively underestimated their total sleep time by 1.4 hours (P < 0.001) compared to actigraphy-assessed sleep duration. Conclusion. ECT did not affect subjective and actigraphy-assessed sleep in the short term. Depressed patients profoundly underestimated their sleep duration.
Background : Aggressive behaviour (i.e. verbal, physical towards objects, self, or others) is highly prevalent in long-term psychiatric inpatient care. We aimed to estimate the overall incidence of aggression, the time staff took to handle aggression incidents, and the weighted average financial costs thereof. Methods : A random sampling procedure was conducted at three long-term psychiatric inpatient care facilities, covering all weekdays and work shifts (day, evening, and night). Psychiatric nurses were asked to recall all incidents of their shift. For the time spent on each type of incident, members of staff were monitored in real-time for a period of one week. Estimated costs were calculated by the time spent multiplied by hourly wages in addition to any material-related costs. Results : The incidence rates were 90 incidents per patient year: 63 for verbal aggression, 8 for physical aggression towards objects, 7 for self-harm, and 12 for physical aggression towards others. The average time spent per incident was 125 minutes but differed for each type of incident. Almost 80% of this time was consumed by nursing staff. The average cost per aggression incident was €78; extrapolated per patient year, the total costs were approximately €7000. Conclusions : The current study found a high rate of aggression incidents in closed long-stay psychiatric wards, particularly when accounting for verbal aggression. Reports of aggression on these types of wards are scarce. Nevertheless, aggression seems to have a severe impact on invested time and related costs, which suggests a need for aggression-prevention and de-escalating programs.
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