Incidence and risk factors of venous thromboembolism: Peculiarities in psychiatric institutions

Gærtner, S.; Piémont, A.; Faller, Alix-Marie; Bertschy, Gilles; Hallouche, N.; Mirea, C.; Ray, Isabelle Le; Cordeanu, Elena-Mihaela; Stephan, Dominique

doi:10.1016/j.ijcard.2017.07.092

Cited by 7 publications

(9 citation statements)

References 32 publications

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“…A few studies did not find harm in the context of the coercive measures they investigated (17, 18, 24, 29, 35, 38).…”

Section: Resultsmentioning

confidence: 99%

“…The second most frequently analyzed harm was VTE in 14 studies: deep vein thrombosis of the leg (DVT) in 8 studies (18, 22, 38, 39, 41, 51, 70, 72) and pulmonary embolism (PE) in 12 studies (38, 39, 41, 42, 49, 51, 64, 68, 70–72, 74), with the consequence of death in 8 studies (41, 42, 49, 51, 64, 68, 71, 74). Gaertner et al (38) retrospectively found out that among the analyzed patients with VTE, the restrained patients were not more frequently affected by this harm than the unrestrained. As stated above, this finding is also supported by de Hert et al (18).…”

Section: Resultsmentioning

confidence: 99%

“…Seclusion was included in six studies (18, 25, 31, 32, 38, 78). Four of them report of seclusion together with other coercive measures, especially restraint measures.…”

Section: Resultsmentioning

confidence: 99%

“…Thirty studies (18, 21, 22, 25, 27, 29, 31, 32, 38–43, 51, 57, 58, 60–62, 64, 65, 67, 68, 70–72, 74, 78, 80) reported coercive measures in patients with schizophrenia or psychosis, 18 studies (22, 26, 29, 30, 32, 34, 38, 40, 43, 45, 46, 49, 53, 56, 69, 75–77) included dementia in their population, and affective disorders (mostly manic episodes) were diagnoses in 15 studies (16, 20–22, 25, 27, 29, 31, 32, 38, 39, 41, 49, 51, 79). States of excitation and excited delirium (ED) with no direct correlate to the ICD-10 were mentioned in 12 studies (17, 19, 33, 44, 47, 48, 52, 54, 59, 63, 66, 73), substance abuse disorders in 7 studies (21, 22, 27, 31, 38, 58, 73), delirium in 6 studies (28, 29, 36, 40, 43, 45), and personality disorders in 5 studies (21, 22, 25, 27, 38). Seventeen studies were subsumed to “others” (16, 20–24, …”

Section: Resultsmentioning

confidence: 99%

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Physical Harm and Death in the Context of Coercive Measures in Psychiatric Patients: A Systematic Review

2019

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Background: For centuries coercive measures in psychiatry have been means of averting acute danger. It has been known for almost as long that these measures can lead to harm or even death to those affected. Over the past two decades the topic has increasingly been the subject of scientific discussion and research. While the legal and ethical preconditions for coercive measures in psychiatry as well as epidemiological studies on their incidence and patients’ subjective experiences have increasingly come into focus, research on possible adverse events has lagged behind. To our knowledge there is no systematic review on the harmful or even fatal physical adverse effects of coercive interventions in psychiatry. Methods: We searched the databases PubMed and CINAHL for primary literature with a search string based on the PICO framework including key words describing different psychiatric diagnoses, coercive measures, and harms. Results: In total, 67 eligible studies (mainly case reports and case series) of very heterogeneous quality were included. Two RCTs were found reporting position-dependent cardiac deterioration, but were, however, carried out with healthy people and were characterized by a small number of cases. Death was the most frequently reported harm: cardiac arrest by chest compression in 14 studies, cardiac arrest by strangulation in 9, and pulmonary embolism in 8 studies. Further harms were, among others, venous thromboembolism and injuries. Injuries during physical restraint were reported in 0.8–4% of cases. For other kinds of coercive interventions, there are no sufficient data. Venous thromboembolism occurred in a considerable percentage of cases during mechanical restraint, also under prophylaxis. The most commonly reported coercive measure was restraint, distinguishing in mechanical restraint (43 studies), physical restraint (22 studies), bedrails (eight studies), vest restraint (7 studies), and chair restraint (6 studies). Forced medication was explicitly mentioned only in two, but seems to have occurred in nine studies. Six studies included seclusion. Conclusion: Coercive measures can lead to physical harm or even death. However, there is a significant lack of data on the incidence of such adverse events related to coercive interventions. Though reported anecdotally, physical adverse events during seclusion appear to be highly underresearched.

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“…A few studies did not find harm in the context of the coercive measures they investigated (17, 18, 24, 29, 35, 38).…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Seclusion was included in six studies (18, 25, 31, 32, 38, 78). Four of them report of seclusion together with other coercive measures, especially restraint measures.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Physical Harm and Death in the Context of Coercive Measures in Psychiatric Patients: A Systematic Review

2019

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“…[24][25][26][27][28] Moreover, there is a large degree of comorbidity between schizophrenia and other psychiatric (e.g., anxiety and affective disorders, addiction) or complex somatic disorders (e.g., diabetes, cardio-vascular diseases). [29][30][31][32][33][34] The lack of specificity of RF and comorbidity is not incompatible with RF models, however, such models fail to predict and explain the existence of these phenomena.…”

Section: Box 1 Schizophrenia-clinical Features and Etiologymentioning

confidence: 99%

Schizophrenia: Developmental Variability Interacts with Risk Factors to Cause the Disorder

et al. 2020

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A new etiological model is proposed for schizophrenia that combines variability-enhancing nonspecific factors acting during development with more specific risk factors. This model is better suited than the current etiological models of schizophrenia, based on the risk factors paradigm, for predicting and/or explaining several important findings about schizophrenia: high co-morbidity rates, low specificity of many risk factors, and persistence in the population of the associated genetic polymorphisms. Compared with similar models, e.g., de-canalization, common psychopathology factor, sexual-selection, or differential sensitivity to the environment, this proposal is more general and integrative. Recently developed research methods have proven the existence of genetic and environmental factors that enhance developmental variability. Applying such methods to newly collected or already available data can allow for testing the hypotheses upon which this model is built. If validated, this model may change the understanding of the etiology of schizophrenia, the research models, and preventionbrk paradigms.

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Isolement et contention mécanique dans les soins psychiatriques : modalités de prescription, prise en charge et surveillance

et al. 2018

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Incidence and risk factors of venous thromboembolism: Peculiarities in psychiatric institutions

Cited by 7 publications

References 32 publications

Physical Harm and Death in the Context of Coercive Measures in Psychiatric Patients: A Systematic Review

Physical Harm and Death in the Context of Coercive Measures in Psychiatric Patients: A Systematic Review

Schizophrenia: Developmental Variability Interacts with Risk Factors to Cause the Disorder

Isolement et contention mécanique dans les soins psychiatriques : modalités de prescription, prise en charge et surveillance

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