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While an estimated 8.5% of psychiatric patients treated in emergency departments require physical restraint, the impact of restraint on attendance at post-discharge outpatient psychiatric appointments has not been investigated. This study evaluated two groups of patients aged 18 or over: 1) 67 individuals who presented voluntarily or involuntarily (being brought in by the police) to the emergency department and who were physically restrained in the course of clinical care, and 2) a comparative group of 84 individuals who presented involuntarily but were not restrained. Perception of quality of care, recollection of the restraint episode, and attendance at follow-up outpatient appointments were compared between these two groups. Of the 151 patients, 33% were from minorities, 45% were female, and the median age was 36 years (range of 18 to 77 years). Both minority race and use of physical restraints were related to less frequent attendance at the prescribed outpatient psychiatric appointment, based on multivariate logistic regression (odds ratios of 0.40 and 0.38, respectively). Although physical restraint may sometimes be necessary to manage aggression and agitation in the emergency department, being restrained appears to be associated with decreased likelihood of attending prescribed outpatient follow-up mental health treatment. Clinicians should consider alternatives to physical restraints whenever possible to minimize impact on treatment compliance after discharge from the emergency department.

Objectives. Clinical insomnia is known to affect pain, but mechanisms are unclear. Insomnia can dysregulate inflammatory pathways, and inflammation plays a mediating role in pain. It is unclear whether insomnia-related alterations in inflammation can be modified with insomnia improvement, and if such alterations parallel improvement in pain. The current study objective was to provide proof of concept for the role of insomnia in inflammation and pain by testing whether improving insomnia would reduce pain and related physical function, and, concurrently, modulate inflammatory responses. Methods. Thirty adults with osteoarthritis (OA) knee pain and insomnia (Insomnia Severity Index (ISI) above 10) provided baseline measures of clinical OA and laboratory pain, and serial blood samples for inflammatory biomarkers, interleukin (IL)-6 and tumor necrosis factor (TNF)-α, before and after pain testing. To manipulate insomnia, participants were randomly assigned to 6-week cognitive behavioral therapy for insomnia (n = 16); or wait-list control (n = 14). At 8-weeks (Time 2), all measures were repeated. To directly test insomnia improvement effects, participants were grouped by insomnia status at Time 2 after confirming baseline equivalency on all outcomes. Results. Compared to those maintaining insomnia at Time 2 (ISI ≥ 8; n = 18), those whose insomnia improved at Time 2 (n = 12) had significantly improved physical functioning, decline in knee pain during transfer activities, and attenuated increase in IL-6 and less decrease in TNF-α across the pain testing session. Discussion. These findings suggest further exploration of inflammatory pathways linking clinical insomnia, and its improvement, to chronic pain.