Sleep at night and association to aggressive behaviour; Patients in a Psychiatric Intensive Care Unit

Langsrud, Knut; Kallestad, Håvard; Vaaler, Arne; Almvik, Roger; Palmstierna, Tom; Morken, Gunnar

doi:10.1016/j.psychres.2018.03.012

Cited by 24 publications

(14 citation statements)

References 30 publications

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“…Sleep irregularities are a well-known comorbidity of patients with psychiatric diagnoses and amongst others associated with worsening of symptom severity in schizophrenia (52–54) and an increase in mania symptoms (55, 56). Consistent with previous studies, there is evidence for an association of poor sleep and aggressive behavior in psychiatric patients (57, 58). Despite this evidence for an association between sleep irregularities and coercive measures, which is corroborated by the current study's results, sleep disturbance has received little attention in previous studies analyzing antecedents of seclusion.…”

Section: Discussionsupporting

confidence: 89%

Narrative Case Notes Have the Potential to Predict Seclusion 3 Days in Advance: A Mixed-Method Analysis

Stepanow

Walter

et al. 2019

Front. Psychiatry

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Objectives: Current risk assessment tools can predict problematic behavior and the need for coercive measures, but only with a moderate level of accuracy. The aim of this study was to assess antecedents and triggers of seclusion. Methods: Narrative notes of health care professionals on psychiatric inpatients were analyzed daily starting 3 days prior to seclusion in the case group ( n = 26) and compared to a matched control group without seclusion ( n = 26) by use of quantitative and qualitative research methods, based on qualitative content analysis. Results: Quantitative measures showed more aggression in the case group with highly significant differences between the groups ( p < 0.001) at all measurement times. Seclusion was significantly associated with the total word count of the narrative notes. Subjective emotional expressions by staff were more apparent before seclusion ( p = 0.003). Most frequently, subjective expressions regarding “arduous/provocative” ( p < 0.001) and “anxious” ( p = 0.010) sentiments could be identified in the case group. Description of patients' behavior in the case group included more negatively assessed terms ( p = 0.001). Moreover, sleep loss, refusing medication, high contact frequency, demanding behavior and denied requests were present in a significantly higher frequency before seclusion. Expressions like “threatening” ( p = 0.001) were found only before seclusion and appeared to have the function of personal risk assessment. The expression “manageable” ( p = 0.035) appeared often in difficult situations that could still be handled. Conclusion: Several factors preceding seclusion could be identified. Narrative notes of staff already showed differences 3 days before the escalation. Particularly the word count, the analysis of terms describing patients' behavior, subjective expressions of staff, and terms used as a function of personal risk assessment could help to provide better predictions of aggressive incidents and to prevent coercive measures.

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Section: Discussionsupporting

confidence: 89%

Narrative Case Notes Have the Potential to Predict Seclusion 3 Days in Advance: A Mixed-Method Analysis

Stepanow

Walter

et al. 2019

Front. Psychiatry

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“…12 Also, short sleep duration and night-to-night variation in sleep duration are both associated with increased risk of aggression in psychiatric intensive care units. 13 Treatment of insomnia has been shown to lessen psychosis 14 as well as mania 15 and depression. 16 A pilot randomised controlled trial (RCT) of cognitive-behavioral therapy (CBT) for insomnia conducted on our ward showed a significant effect on insomnia and length of stay.…”

Section: Introductionmentioning

confidence: 99%

Introducing artificial intelligence in acute psychiatric inpatient care: qualitative study of its use to conduct nursing observations

Barrera

Gee

Wood

et al. 2020

Evid Based Mental Health

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BackgroundAll patients admitted to an acute inpatient mental health unit must have nursing observations carried out at night either hourly or every 15 minutes, to ascertain that they are safe and breathing. However, while this practice ensures patient safety, it can also disturb patients’ sleep, which in turn can impact negatively on their recovery.ObjectiveThis article describes the process of introducing artificial intelligence (‘digitally assisted nursing observations’) in an acute mental health inpatient ward, to enable staff to carry out the hourly and the 15 minutes observations, minimising disruption of patients’ sleep while maintaining their safety.FindingsThe preliminary data obtained indicate that the digitally assisted nursing observations agreed with the observations without sensors when both were carried out in parallel and that over an estimated 755 patient nights, the new system has not been associated with any untoward incidents. Preliminary qualitative data suggest that the new technology improves patients’ and staff’s experience at night.DiscussionThis project suggests that the digitally assisted nursing observations could maintain patients’ safety while potentially improving patients’ and staff’s experience in an acute psychiatric ward. The limitations of this study, namely, its narrative character and the fact that patients were not randomised to the new technology, suggest taking the reported findings as qualitative and preliminary.Clinical implicationsThese results suggest that the care provided at night in acute inpatient psychiatric units could be substantially improved with this technology. This warrants a more thorough and stringent evaluation.

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“…For instance, sleep abnormalities may be prodromal symptoms heralding the onset of a major mental disorder, sleep-wake cycle disruptions are criterion symptoms for diagnosing unipolar and bipolar disorders and circadian dysrhythmias may exacerbate suicidal behaviours (5). Evidence from our research demonstrates that day-to-day variability in sleep-wake cycles is associated with longer duration of acute psychiatric admissions and frequency of aggression or violent incidents (6,7). Lastly, sleep problems are often the last symptoms to resolve during recovery from an acute episode of a mood or psychotic disorder (8,9).…”

Section: Introductionmentioning

confidence: 75%

A pragmatic effectiveness randomized controlled trial of duration of psychiatric hospitalization in a trans-diagnostic sample of patients with acute mental illness admitted to a ward with either blue depleted evening lighting or normal lighting conditions

Scott¹,

Langsrud

Kjørstad³

et al. 2019

Preprint

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Introduction There is increasing recognition of the need to stabilize sleep-wake cycles in individuals with major mental disorders. As such, clinicians and researchers advocate for the use of interventions targeted at sleep and circadian dysrhythmias as an adjunct to the standard treatments offered for acute illness episodes of a broad range of diagnoses. To determine the trans-diagnostic generalizability of chronotherapy, we explore the benefits of admitting individuals with an acute illness episode to a psychiatric inpatient unit where changes in light exposure are integrated into the therapeutic environment. Methods A two-arm pragmatic effectiveness randomized controlled treatment trial, where individuals admitted for acute inpatient psychiatric care will be allocated to a ward with blue depleted evening light or to a ward with the same layout and facilities but lacking the new lighting technology. The trial will test whether the experimental lighting conditions offer any additional benefits beyond those associated with usual treatment in an acute psychiatric inpatient unit. The main objectives are to examine any differences between groups in the mean duration of hospitalization in days. Additional analyses will compare group differences in symptoms, functioning, medication usage, and side-effects and whether length of stay is associated with stability of sleep-wake cycles and circadian rhythms. Ancillary investigations will determine any benefits according to diagnostic subgroups and potential drawbacks such as any adverse effects on the well-being of professionals working across both wards. Discussion This unit offers a unique opportunity to explore how exposure to different lighting conditions may modify sleep-wake cycles and how any changes in sleep-wake cycle may impact on the clinical and functional outcomes of individuals experiencing an acute episode of a severe mental disorder that requires inpatient care. The findings could influence the future design of hospital units offering care to patients with mental or physical disorders. Trial registration Clinicaltrials.gov NCT03788993, retrospectively registered Dec 28th 2018. https://clinicaltrials.gov/ct2/show/NCT03788993.

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Sleep at night and association to aggressive behaviour; Patients in a Psychiatric Intensive Care Unit

Cited by 24 publications

References 30 publications

Narrative Case Notes Have the Potential to Predict Seclusion 3 Days in Advance: A Mixed-Method Analysis

Narrative Case Notes Have the Potential to Predict Seclusion 3 Days in Advance: A Mixed-Method Analysis

Introducing artificial intelligence in acute psychiatric inpatient care: qualitative study of its use to conduct nursing observations

A pragmatic effectiveness randomized controlled trial of duration of psychiatric hospitalization in a trans-diagnostic sample of patients with acute mental illness admitted to a ward with either blue depleted evening lighting or normal lighting conditions

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