Continuous special observation (CSO) is used in inpatient psychiatry, for patients who are at risk of suicide and self-harm. This article reviews the evidence for the practice and recent innovation in CSO. The findings highlight the lack of evidence to support the practice and discusses the recent developments that show promise for a more dynamic and patient-centred approach. These include using a standardised algorithm for assessment and use of CSO, using an observation checklist at the end of each shift, and using patient-agreement to increase autonomy and trust.
There is an association between childhood trauma and the development of psychosis in adulthood and a treatment recommended to reduce the symptoms of trauma is Eye Movement Desensitisation and Reprocessing (EMDR). Studies of EMDR in adults with psychotic experiences and a history of trauma have shown encouraging results. As psychosis is a core feature of schizophrenia, and many persons with schizophrenia will have experienced childhood trauma, we review the evidence that EMDR may be a safe and effective adjunctive treatment for schizophrenia. We conclude that the evidence base supports well-designed and adequately powered randomised controlled studies of EMDR in schizophrenia with careful consideration given to inclusion criteria, participant acceptability and selection of clinically relevant outcome measures. Mechanism of action and potential effects on cognitive functioning should also be explored.
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