One-year incidence and prevalence of seclusion: Dutch findings in an international perspective

Noorthoorn, Eric; Lepping, Peter; Janssen, W; Hoogendoorn, Adriaan W.; Nijman, Henk; Widdershoven, Guy; Steinert, Tilman

doi:10.1007/s00127-015-1094-2

Cited by 55 publications

(74 citation statements)

References 59 publications

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“…In contrast to other large studies (Keski-Valkama et al 2010;Noorthoorn et al 2015), patient diagnosis was largely unrelated to either PICU transfer or seclusion with the exception that patients with bipolar disorder were twice as likely to be transferred to PICU compared with patients with schizophrenia. The fact that we adjusted for behaviours and traits commonly associated with this diagnosis (i.e., manic, agitated, demanding and irritable behaviour), implies that bipolar disorder patients may present with other behaviours which cause them to be viewed by clinical staff as needing PICU treatment.…”

Section: Demographic and Clinical Predictors Of Treatmentcontrasting

confidence: 73%

Factors associated with use of psychiatric intensive care and seclusion in adult inpatient mental health services

Cullen

Bowers

Khondoker

et al. 2016

Epidemiol Psychiatr Sci

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Aims. Within acute psychiatric inpatient services, patients exhibiting severely disturbed behaviour can be transferred to a psychiatric intensive care unit (PICU) and/or secluded in order to manage the risks posed to the patient and others. However, whether specific patient groups are more likely to be subjected to these coercive measures is unclear. Using robust methodological and statistical techniques, we aimed to determine the demographic, clinical and behavioural predictors of both PICU and seclusion.Methods. Data were extracted from an anonymised database comprising the electronic medical records of patients within a large South London mental health trust. Two cohorts were derived, (1) a PICU cohort comprising all patients transferred from general adult acute wards to a non-forensic PICU ward between April 2008 and April 2013 (N = 986) and a randomly selected group of patients admitted to general adult wards within this period who were not transferred to PICU (N = 994), and (2) a seclusion cohort comprising all seclusion episodes occurring in non-forensic PICU wards within the study period (N = 990) and a randomly selected group of patients treated in these wards who were not secluded (N = 1032). Demographic and clinical factors (age, sex, ethnicity, diagnosis, admission status and time since admission) and behavioural precursors (potentially relevant behaviours occurring in the 3 days preceding PICU transfer/seclusion or random sample date) were extracted from electronic medical records. Mixed effects, multivariable logistic regression analyses were performed with all variables included as predictors.Results. PICU cases were significantly more likely to be younger in age, have a diagnosis of bipolar disorder and to be held on a formal section compared with patients who were not transferred to PICU; female sex and longer time since admission were associated with lower odds of transfer. With regard to behavioural precursors, the strongest predictors of PICU transfer were incidents of physical aggression towards others or objects and absconding or attempts to abscond. Secluded patients were also more likely to be younger and legally detained relative to non-secluded patients; however, female sex increased the odds of seclusion. Likelihood of seclusion also decreased with time since admission. Seclusion was significantly associated with a range of behavioural precursors with the strongest associations observed for incidents involving restraint or shouting.Conclusions. Whilst recent behaviour is an important determinant, patient age, sex, admission status and time since admission also contribute to risk of PICU transfer and seclusion. Alternative, less coercive strategies must meet the needs of patients with these characteristics.

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Section: Demographic and Clinical Predictors Of Treatmentcontrasting

confidence: 73%

Factors associated with use of psychiatric intensive care and seclusion in adult inpatient mental health services

Cullen

Bowers

Khondoker

et al. 2016

Epidemiol Psychiatr Sci

View full text Add to dashboard Cite

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“…In an international study comparing factors associated with the use of the three main coercive measures seclusion, restraint, and enforced medication (McLaughlin et al 2016)it was found that seclusion was associated with a longer admission duration, regardless of the severity of symptoms at admission. This finding is in line with nationwide Dutch data, also suggesting that the added use of enforced medication could substantially reduce seclusion duration (Noorthoorn et al 2015) and restraint overall (Verlinde et al 2017).…”

Section: Risk Factors Associated With Seclusionsupporting

confidence: 89%

“…This finding is in line with nationwide Dutch data, also suggesting that the added use of enforced medication could substantially reduce seclusion duration (Noorthoorn et al . ) and restraint overall (Verlinde et al . ).…”

Section: Introductionmentioning

confidence: 99%

Associations between psychiatric symptoms and seclusion use: Clinical implications for care planning

Sande

Noorthoorn

Nijman

et al. 2017

Int J Mental Health Nurs

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Findings from an increasing number of studies suggest that incorporating systematic short-term risk assessments in treatment planning could lead to safer practice on psychiatric admissions wards. The aim of the present study was to investigate the associations between the scores of three structured observation tools - the Kennedy Axis V (K-Axis-V), the Brief Psychiatric Rating Scale (BPRS), and the Social Dysfunction and Aggression Scale (SDAS) - and seclusion. In total, 1840 weekly risk assessments with these observation scales were collected over 2342 admission weeks. These assessment scores related to 370 acutely-admitted psychiatric patients and were subjected to a multilevel analysis. It was found that several dynamic and static factors were related to seclusion. Dynamic factors included violent behaviour, current substance abuse, suspiciousness, and negativism. Static factors included ethnicity and having been diagnosed with a substance abuse disorder. The findings suggest that the incorporation of the Kennedy-Axis V, the BPRS, and the SDAS into standard practice might be helpful in identifying patients at high risk of seclusion, and could be supportive to treatment planning and clinical decision-making in the prevention of seclusion use in acute psychiatric settings.

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“…It is debatable to what extent these measures contribute to the reduction of the incidence of aggressive acts. Noorthoorn et al (2015) found positive effects on the duration -not the frequency -of specific coercive measures in psychiatry. A study in British mental health care institutions did not show a reduction in aggressive incidents after staff training programs (Bowers et al, 2006).…”

Section: Aim Of This Studymentioning

confidence: 90%

“…In the past decade, the aims of research on aggressive incidents in mental health care institutions have largely been limited to reducing the use of coercive measures (Noorthoorn et al, 2015;Vruwink et al, 2012;Steinert et al, 2010;Raboch et al, 2010;Bowers et al, 2006).…”

Section: Aggressive Incidentsmentioning

confidence: 99%

The influence of dysfunctional impulsivity and alexithymia on aggressive behavior of psychiatric patients

Schutter¹,

Kramer²,

Franken³

et al. 2016

Psychiatry Research

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Current approaches in Dutch mental health care institutions towards inpatients' aggression have focused predominantly on environmental factors, such as training the staff in aggression management. However, personality traits might be an important factor in patients' aggressionas shown by incidents in the wards. This study explores the influence of dysfunctional impulsivity and alexithymia on psychiatric patients' aggressive behavior, through self-reports and through involvement in aggressive incidents. Personality traits influencing patients' aggression emphasize the importance of a more direct approach to their aggression. Clinical patients at Dutch mental health care institution Emergis (n = 84) filled out questionnaires about their aggressiveness (using Buss and Perry's Aggression Questionnaire Short Form), dysfunctional impulsivity and alexithymia. Multiple regression analyses indicated that dysfunctional impulsivity positively related to self-reported aggressive behavior. The relationship, however, could not be confirmed for inpatients' aggression as reported by the staff on the wards. Unexpectedly affective alexithymia negatively related to hostility. Gender differences in self-reported aggression were found. Female patients showed higher levels of hostility. Regression analyses indicated that the male gender positively related to physical aggression. Findings emphasize the importance of a new approach in Dutch mental health care, in which patients may engage in aggression-regulation training programs.

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One-year incidence and prevalence of seclusion: Dutch findings in an international perspective

Cited by 55 publications

References 59 publications

Factors associated with use of psychiatric intensive care and seclusion in adult inpatient mental health services

Factors associated with use of psychiatric intensive care and seclusion in adult inpatient mental health services

Associations between psychiatric symptoms and seclusion use: Clinical implications for care planning

The influence of dysfunctional impulsivity and alexithymia on aggressive behavior of psychiatric patients

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