Antipsychotics in Inpatient Children and Adolescents with Seclusion and Restraint: A Preliminary Exploratory Retrospective Chart Review.

Objective: This study is a retrospective review of patients 5-17 years of age experiencing seclusion and/or restraint (S&R) in a pediatric psychiatric inpatient setting and an exploratory analysis of antipsychotic use on S&R duration. We examined whether administration of antipsychotics would possibly decrease the time spent in S&R. Methods: Reports of patients who underwent S&R in an acute care inpatient child and adolescent psychiatric unit from 2012 to 2014 were reviewed. Demographic information related to age, gender, and race as well as information on diagnosis, current medications (including antipsychotics) were obtained. Independent samples t-tests were used to determine whether there were differences in how much time patients spent in S&R based on whether they were administered antipsychotics or not. Odds ratios (ORs) of being administered antipsychotics during S&R were computed for factors such as gender, race, and diagnosis group. Results: Ninety-six patients (68 males, age range 5-17 years) were involved in 232 S&R events that occurred between 2012 and 2014. Results indicate that patients who were administered antipsychotics during S&R still spent significantly more time in S&R compared with those who were given medications other than antipsychotics (e.g., Benadryl) (t = 3.161; p = 0.002) and those who were not administered any medication (t = 3.54; p = 0.001). Binary logistic regression showed that female patients were at more than two times (OR(adjusted) = 2.86; 95% confidence interval = 1.234-6.655) higher risk of being administered antipsychotics while in S&R compared with their male counterparts within this particular sample. Conclusions: The results of our study indicate that, contrary to our hypothesis, antipsychotic administration did not appear to reduce the time spent in S&R compared with groups that were administered medications other than antipsychotics and those that were not administered any medication during S&R. We also found an increased risk of antipsychotic administration in female patients compared with male patients in S&R events, indicating the need for larger studies examining these effects in greater detail.

Association Between Sleep Times and Seclusion and Restraint Events in an Inpatient Pediatric Psychiatric Hospital: A Retrospective Chart Review.

OBJECTIVE: To examine demographic characteristics of patients who experience seclusion and restraint (S&R) events in a pediatric psychiatric inpatient setting and assess whether sleep time 24 hours prior and after the occurrence of an S&R event was different from average sleep time during hospitalization. METHODS: Charts from an acute care inpatient child and adolescent psychiatric unit from 2012 to 2014 were reviewed. A paired samples t test was performed to look for significant differences in sleep time 24 hours prior to S&R versus average sleep times for the same patients during hospitalization. RESULTS: A total of 232 S&R events occurred between 2012 and 2014. Of the incidents, 172 involved children who were ≤ 12 years old, and 178 incidents involved male patients. A paired sample t test revealed a significant mean (SD) decrease in sleep time prior to S&R (9.5 [2.24]) compared to average sleep time during hospitalization (10.07 [1.08], t205 = -3.722, P < .01). CONCLUSIONS: The study results reveal a statistically significant reduction in sleep time 24 hours prior to an S&R event compared to average sleep duration during hospitalization. The association between sleep times and subsequent problem behaviors in an inpatient setting require further evaluation.

Effect of osmolality and selected ions on retraction of the distome body into the cercaria tail chamber of Proterometra macrostoma (Trematoda: Azygiidae).

The furcocystocercous cercariae of the digenetic trematode, Proterometra macrostoma , possess a tail chamber into which their distome body withdraws prior to emergence from their snail intermediate host. The process of distome retraction and the conditions that trigger it in this species are not clear. The objectives of the present study were (1) to describe the retraction process in P. macrostoma; (2) to assess whether osmolality affects cercarial retraction; (3) to evaluate the effect of selected ions on retraction; and (4) to compare the swimming effectiveness of naturally ( =  in vivo) retracted versus in vitro retracted cercariae. Retraction of the cercaria body into its tail chamber required only 2 min or less once initiated. The process began with the development of a chamber within the anterior end of the worm's tail. The chamber's lip advanced in a pulsating motion over the stationary distome. Retraction was completed with the constriction and fusion of the chamber lip once it passed over the anterior end of the distome, sealing the latter within the tail chamber. There was a significant difference in the proportions of cercariae with bodies retracted into tails, bodies not retracted, and bodies separated from tails in artificial pond water (APW) versus artificial snail water (ASW). A greater number of cercariae withdrew into their tail chambers in ASW (59/124; 47.6%) than in APW (21/124; 16.9%). In APW, more bodies separated from their tails (24/124; 19.4%) than in ASW (3/124; 2.4%). In both solutions (APW: 63.7%  =  79/124; ASW: 50%  =  62/124), a majority of cercariae never retracted. In APW, 76.2% of distomes retracting into their tails did so within the first 5 min compared to only 30.5% in ASW. There was no significant difference in the proportions of cercariae with bodies retracted into tails, bodies not retracted, and bodies separated from tails based on isosmotic replacement of individual ions, i.e., Na(+), K(+), Ca(++), or Mg(++), in ASW with Li(+). There was also no significant difference in the vertical swimming burst distance in cercariae whose bodies were initially retracted into their tails in vitro versus in vivo.