A Pilot Study to Explore the Effect of Long Acting Injectable Antipsychotics on Aggression.

Objectives: To explore the effect of switching from an oral antipsychotic to a long-acting injectable (LAI) antipsychotic on aggression, in terms of the changes of verbal and physical aggression, interventions required, self-injurious behavior, use of seclusion or restraint, antipsychotic medication refusal, and use of antipsychotics as needed (PRN). Methods: This was a retrospective chart review at a long-term state forensic psychiatric facility. Patients treated with an oral antipsychotic for at least 6 months and then switched to a LAI antipsychotic for an additional 6 months during an 80-month period were included. Results: Out of 70 patients evaluated, 18 were the study subjects. The median age of the cohort was 38 years with a majority being male. Of the seven patients who had an incident of aggression, two had an increase in aggressive incidents following the switch, three had a decrease, and two had no change. Thirty-six interventions occurred while patients were on an oral antipsychotic, which decreased by 30.6% to 25 interventions after the switch. Three patients had an incident of self-injurious behavior, and 6 patients required restraints/seclusions. Of the eight patients who had retrievable medication refusal and antipsychotic PRN use information, five had a decrease in antipsychotic medication refusals and five had an increase in PRN antipsychotic use after the switch. Conclusion: The switch from an oral antipsychotic to a LAI antipsychotic did not appear to significantly increase or decrease incidents of aggression or self-injurious behavior, but seemed to decrease the number of restraints/seclusions required.

Impact of COVID-19 quarantines on clozapine-induced constipation: Experience of utilizing a clozapine-induced constipation protocol at a state forensic psychiatric facility.

Objective: Since 2017, Fulton State Hospital (FSH) has implemented a clozapine-induced constipation protocol. In March 2020, FSH initiated unit quarantines to minimize the spread of coronavirus disease (COVID-19). The objective of this study was to evaluate the impact of these quarantines on medical referrals for constipation, the Bristol Stool Chart ratings, utilization of as-needed (PRN) laxatives, and adherence rates with scheduled constipation medication regimens. Methods: Patients on the clozapine-induced constipation protocol from May 1, 2019 to December 31, 2020, were included, with 10-month pre- and mid-quarantine implementation. Data collected included patient demographics, primary psychiatric diagnosis, and outcome variables. Descriptive statistics and paired t-tests were performed. Results: A total of 31 patients were included. Most were male (93.5%), with a median age of 40 years. The most common primary diagnosis was schizophrenia. Compared with the pre-quarantine implementation period, there were fewer medical referral contacts per person, less use of PRN laxatives, and slightly lower adherence rates to scheduled constipation medication regimens during the mid-quarantine implementation period. Conclusion: Compared with the pre-quarantine implementation period, there were fewer medical referrals per person during the mid-quarantine implementation period.

Differences in Symptom Severity and Independent Living Skills Between Re-hospitalized and Not Re-hospitalized Individuals with Schizophrenia: A Longitudinal Study.

This study determined if schizophrenia symptom severity and independent living skills at discharge, or while residing in the community, predicted re-hospitalization for discharged patients with schizophrenia. A total of 60 patients were discharged from a state psychiatric hospital and had completed assessments at discharge, 6 months, and 1 year post discharge. There were 12 patients who were re-hospitalized. There were no differences between the re-hospitalized and not re-hospitalized groups based on third-party ratings of schizophrenia symptom severity and independent living skills. However, the patients' self-report and third party ratings of deteriorating general mental health symptoms 6 months after discharge predicted re-hospitalization.

Highly Aggressive Women in a Forensic Psychiatric Hospital.

In this study, we compared three groups of women admitted to a public forensic inpatient facility over the course of a two-year period. Detailed and systematic examination of social and psychiatric histories revealed that the group with the most persistent levels of aggression differed from the other two groups with respect to frequency of self-harming behavior, intellectual impairment, hypothyroidism, a childhood diagnosis of attention deficit-hyperactivity disorder (ADHD), and age of onset of psychiatric and behavioral symptoms. The high-aggression group also had the highest rate of childhood physical and sexual abuse, but the difference between that group and the two lower aggression groups did not achieve statistical significance. From the standpoint of childhood adversity, 94 percent of those in the high-aggression group had been placed outside of the original home by age 11. Eighty-nine percent were intellectually impaired. At admission, physical examinations revealed that 50 percent had a history of hypothyroidism and two-thirds were obese. Before admission, most had manifested severe aggression and emotional dysregulation, as evinced by high levels of self-harm, suicide attempts, and aggressive behavior in previous institutional settings that was both frequent and intense. Patients who share these characteristics are currently placed on a ward at the hospital with a milieu and individual therapy programs that are based on a dialectical behavior therapy approach that targets key symptoms of emotional and behavioral dysregulation.

A comparison of the combined-use of alcohol & energy drinks to alcohol-only on high-risk drinking and driving behaviors.

BACKGROUND: The combined-use of alcohol and energy drinks is an emerging public health issue. This investigation examined differences in drinking and driving behaviors among combined-users (CU) and participants who consumed alcohol-only (AO). OBJECTIVES: This study was specifically designed to investigate potential differences in drinker's perceptions of (a) what it means to them to drive over the .08 Blood Alcohol Content (BAC) driving limit and (b) what it means to drive after knowing they have had too much to drink to drive safely. METHODS: College students (N = 355) were surveyed to assess differences in drinking and driving-related behaviors between the AO (n = 174) and CU (n = 107) groups. RESULTS: CU were more likely than AO to drive over the .08 BAC driving limit (53% vs. 38%; p = .009) and after knowing they were too drunk to drive (57% vs. 44%; p = .025). CU were also more likely (56% vs. 35%; p = .000) to ride with an intoxicated driver while knowing it was unsafe. Conclusions/Importance: Combined-users are more likely to drive after drinking, drive while knowingly drunk, and participate in other high-risk behaviors such as heavy drinking that increase the potential for injury. Public policy makers and health professionals should focus prevention efforts to reduce high-risk combined-use behavior.

Frequency of energy drink use predicts illicit prescription stimulant use.

BACKGROUND: The purpose of this study was to examine energy drink (ED) usage patterns and to investigate the illicit use of prescription stimulants among college students. METHODS: A sample of 267 undergraduate and graduate students (mean age of 22.48 among stimulant users) from a large midwestern university and its branch campus locations voluntarily participated in the study. RESULTS: Among prescription stimulant users without a valid medical prescription, Mann-Whitney U tests and logistic regression analysis revealed that the frequency of ED use was a significant predictor of the illicit use of prescription stimulants. Moreover, frequency of ED consumption was a significant predictor of the illicit use of prescription stimulant medications, with the odds for using increasing by .06 with each additional day of ED use past 0 day (odds for use = 1.06, P =.008). CONCLUSIONS: Results indicate that the frequency of ED use is a significant predictor of the illicit use of prescription stimulants. All prescription stimulant users with or without a valid script also used EDs. This finding is important to practitioners because of the harmful interactions (eg, serotonin syndrome) that can occur when ED ingredients (eg, ginseng, yohimbine, evodamine, etc) are mixed with prescription stimulants.

The relationship between seclusion and restraint use and childhood abuse among psychiatric inpatients.

Seclusion and restraint (S/R) is a controversial topic in the field of psychiatry, due in part to the high rates of childhood physical and sexual abuse found among psychiatric inpatients. The trauma-informed care perspective suggests that the use of S/R with previously abused inpatients may result in retraumatization due to mental associations between childhood trauma and the experience during S/R. Thus, though one would expect to see efforts on the part of inpatient psychiatric facilities to limit S/R of previously abused inpatients, research suggests that trauma victims may be more likely to experience S/R. The current study sought to clarify this possibility by examining whether presence or absence and chronicity of childhood sexual and physical abuse differed among three groups of adult inpatients (N = 622) residing at a mid-Western state psychiatric hospital. These groups are empirically derived on the basis of dramatic differences in the patterning of their exposure to S/R over the course of hospitalization. Results of Chi-square and Kruskal-Wallis tests suggest that the classes did not significantly differ in presence or absence and chronicity of childhood sexual or physical abuse when male and female inpatients were analyzed separately. However, among the class of inpatients who experienced the most instances of S/R, 70% of the members have histories of childhood abuse. Implications for inpatients, clinicians, and policy makers are discussed.

The efficacy of a targeted personalized drinking feedback intervention among intercollegiate athletes: a randomized controlled trial.

College athletes are an at-risk population for excessive alcohol use and subsequent alcohol-related harms. The purpose of this study was to test the efficacy of an electronically delivered personalized drinking feedback (PDF) intervention targeted specifically to college athletes, both in comparison with a standard (i.e., nontargeted) PDF intervention and an education-only (EO) condition that also included targeted information. Data were collected on 263 intercollegiate athletes from three colleges (76% women, 86% White) who were randomly assigned to one of the conditions. Results provided partial support for the efficacy of the targeted PDF intervention. Students in the targeted PDF condition reported a lower peak blood alcohol concentration (BAC) at the 6-month follow-up than those in the other conditions. Heavy drinking students in the targeted PDF condition reported a lower peak BAC than those in the other conditions at the 1-month follow-up and a lower peak BAC than those in the EO condition at the 6-month follow-up. Finally, in-season athletes in the targeted PDF condition reported fewer drinks per week than those in the PDF-standard condition at the 1-month follow-up. These findings provide preliminary support for the use of targeted PDF interventions with at-risk alcohol users, such as college athletes.

Trajectories of seclusion and restraint use at a state psychiatric hospital.

OBJECTIVE: This study investigated patterns of seclusion and restraint among patients hospitalized at a psychiatric facility with a large number of forensic psychiatric beds. METHODS: Seclusion and restraint records were examined for 622 patients who were admitted during a five-year period (September 2001 to September 2006) and had a stay of at least 60 days. Seclusion and restraint episodes were recorded as bimonthly counts over the first two years after the initial admission. Latent class analysis was used to investigate the hypothesis that discrete seclusion and restraint trajectories exist. RESULTS: Indices of model fit strongly supported the existence of three highly discrete trajectories. The low-trajectory class (71%) consisted of individuals who averaged less than .15 seclusion or restraint incidents per month over the course of their hospitalizations. Patients in the medium-trajectory class (22%) averaged approximately two incidents per month during the first two months, and rates declined to an average of about one incident per month by the end of the study period. Patients in the high-trajectory class (7%) averaged six incidents per month during the first two months, followed by a gradual decline in rates, where they then averaged two to three incidents per month by the end of the study period. The three groups differed significantly with respect to a number of diagnostic and demographic characteristics. While hospitalized, patients in the high-trajectory class were almost 30 times more likely to be named as perpetrators in incident and injury reports and 75 times more likely to be physically abused than patients in the low-trajectory class. CONCLUSIONS: These findings have implications for clinical and administrative decision makers with regard to assigning new admissions to appropriate security levels, targeting patients with specialized treatment interventions, and moving low-risk patients into less restrictive treatment environments.

A systematic review of college student-athlete drinking: Prevalence rates, sport-related factors, and interventions.

Alcohol use among college students has become a considerable public health problem. Among this group, intercollegiate athletes are at a particularly high risk for excessive alcohol consumption and resulting negative alcohol-related consequences. The purpose of our review was to systematically examine three main issues related to alcohol consumption among intercollegiate athletes: (a) the prevalence rates and alcohol consumption patterns of this group, especially in comparison with those of collegiate nonathletes; (b) the various factors that might motivate or encourage alcohol use among intercollegiate athletes, primarily sport-related individual and environmental variables; and (c) considerations for conducting alcohol-related interventions with intercollegiate athletes.

The use of logistic regression to enhance risk assessment and decision making by mental health administrators.

Development of policies and procedures to contend with the risks presented by elopement, aggression, and suicidal behaviors are long-standing challenges for mental health administrators. Guidance in making such judgments can be obtained through the use of a multivariate statistical technique known as logistic regression. This procedure can be used to develop a predictive equation that is mathematically formulated to use the best combination of predictors, rather than considering just one factor at a time. This paper presents an overview of logistic regression and its utility in mental health administrative decision making. A case example of its application is presented using data on elopements from Missouri's long-term state psychiatric hospitals. Ultimately, the use of statistical prediction analyses tempered with differential qualitative weighting of classification errors can augment decision-making processes in a manner that provides guidance and flexibility while wrestling with the complex problem of risk assessment and decision making.

Development of the athlete drinking scale.

Prior research has found that intercollegiate athletes consume more alcohol and experience more negative alcohol-related consequences than nonathletes, but no measure of sport-related reasons for alcohol use currently exists. The purpose of this study was to develop such a measure, which the authors termed the Athlete Drinking Scale (ADS). An exploratory factor analysis supported the existence of 3 subscales: Positive Reinforcement, Team/Group, and Sport-Related Stress. Additional analyses supported the internal consistency and construct validity of the subscales, and hierarchical multiple regression analyses indicated that the ADS accounted for a significant amount of variance in both alcohol consumption and alcohol-related problems among intercollegiate athletes. The ADS appears to be a promising tool for measuring sport-related reasons for intercollegiate athlete alcohol use.

Nutrient intakes of men and women collegiate athletes with disordered eating.

The objective of this study was to assess the macro- and micronutrient intakes of men and women collegiate athletes with disordered eating behaviors and to compare the nutrient intakes of athletes with restrictive- versus binge-eating behaviors. National Collegiate Athletic Association (NCAA) Division I University athletes (n = 232) were administered an anonymous, written questionnaire to compare nutrient intakes, desired weight change, and weight control behaviors in athletes with restrictive- (R) and binge- (B) eating behaviors to those in asymptomatic (A) athletes. T-tests, χ(2) statistic, and ANOVA were used to test for differences among disordered eating groups within genders (p < 0.05). Data are means ± standard error of the mean. Among men athletes, those with disordered eating consumed a smaller percentage of energy from carbohydrate compared to controls (R = 49.7 ± 1.5; B = 48.7 ± 2.3; A = 53.4 ± 0.7%). Among female athletes, those with disordered eating wanted to lose a greater percentage of their current body weight than did asymptomatic athletes (B = -6.1 ± 1.4; R = -6.7 ± 1.1; A = -3.7 ± 0.4%). Women who were classified with binge eating consumed significantly more alcohol than did controls (B = 6.8 ± 1.3; A = 3.9 ± 0.4 g alcohol per day). Athletes with disordered eating were more likely to report restricting their intake of carbohydrate and fat and using supplements to control their weight than asymptomatic athletes. Disordered eating was not associated with greater frequencies of inadequate micronutrient intake in either gender. Athletes with disordered eating may be at significantly greater risk for nutritional inadequacies than athletes who are asymptomatic due to macronutrient restriction and greater alcohol consumption. Key PointsAthletes with disordered eating were more likely to report restricting their intake of carbohydrate and fat and using supplements to control their weight than asymptomatic athletesAmong female athletes, those with disordered eating wanted to lose a greater percentage of their current body weight than did asymptomatic athletesDisordered eating was not associated with greater frequencies of inadequate micronutrient intake in either genderAthletes with disordered eating may be at significantly greater risk for nutritional inadequacies than athletes who are asymptomatic due to macronutrient restriction and greater alcohol consumption.

Nutrient intakes and dietary behaviors of male and female collegiate athletes.

The purpose of this study was to assess the dietary intakes and behaviors of male and female collegiate athletes. Athletes (n =345) at a NCAA Division I university completed an anonymous questionnaire. T-tests, chi(2) statistic, and ANOVA were used to assess gender and sport differences. Multiple linear regression was used to assess gender differences in nutrient intakes, controlling for energy intake and to examine the relationships between desired weight change, dietary behaviors, and nutrient intakes. Only 15 % and 26 % of athletes had adequate intakes of carbohydrate and protein, respectively, based on recommendations for athletes. Males were more likely to exceed the Dietary Guidelines for fat, saturated fat, cholesterol, and sodium than females. Sixty-two percent of female athletes wanted to lose at least 5 lbs compared to 23 % of males. The desire to lose weight was associated with decreased energy and macronutrient consumption, but not with inadequate micronutrient intakes.

Measuring motivations for intercollegiate athlete alcohol use: a confirmatory factor analysis of the drinking motives measure.

This study examined the psychometric properties of the Drinking Motives Measure (DMM) on a sample of 227 collegiate athletes. Confirmatory factor analyses indicated that the 4-factor structure of the DMM provided a better fit than either 2- or 1-factor models, but the overall fit of the 4-factor model was moderate at best. A revised 3-factor model consistent with prior research (M. L. Cooper, M. Russell, J. B. Skinner, & M. Windle, 1992) provided the best fit. Hierarchical multiple regression analyses indicated that the 3 DMM factors included in the revised model accounted for 17%-21% of the unique variance on alcohol consumption variables. Results provide preliminary evidence supporting the internal consistency, construct validity, and convergent validity of the revised 3-factor DMM with collegiate athletes.

Negative consequences of intercollegiate athlete drinking: the role of drinking motives.

OBJECTIVE: Intercollegiate athletes consume more alcohol and experience more negative alcohol-related consequences than nonathletes. The purpose of this study was to determine if drinking motives accounted for variability among intercollegiate athletes in experiencing negative alcohol-related consequences, and to analyze how the strength and patterns of the relationship between individual drinking motives and negative consequences varied among the different consequences. METHOD: Self-report data were analyzed on 206 National Collegiate Athletic Association Division I athletes (55% female), selected from a large, midwestern university, who reported drinking alcohol in the past year. Participants completed the Drinking Motives Measure and the Core Alcohol and Drug Survey. RESULTS: Drinking motives accounted for variability in experiencing negative alcohol-related consequences. Drinking for coping reasons displayed the strongest relationship with most of the negative consequences, but for some consequences social and enhancement motives displayed relationships with the consequences that were either similar to or stronger than those of the coping motives. CONCLUSIONS: This research demonstrated that drinking motives in general are useful predictors of negative alcohol-related consequences among a yet unstudied population, intercollegiate athletes. The findings suggest that drinking for negatively reinforcing reasons (i.e., coping motives) is generally the strongest motivational predictor of alcohol-related consequences, although the relative strength of individual motives in predicting consequences can vary depending upon the content of an individual consequence.

Pain behavior predictors among fibromyalgia patients.

This study was designed to assess the reliability and validity of a Pain Behavior Observation method with fibromyalgia syndrome (FS) subjects and to determine the factors which predict pain behavior among FS subjects. Fifty-eight female FS subjects participated in the videotaped Pain Behavior Observation method. Subjects also completed the McGill Pain Questionnaire (MPQ), the Arthritis Impact Measurement Scale (AIMS), and the Symptoms Checklist-90-Revised (SCL-90-R). Pain behavior totals were derived using the Pain Behavior Observation method of McDaniel et al. (1986). Results indicated that the scoring method of Keefe and Block (1982) developed for use with back pain patients was more generalizable to this FS sample. Total pain behavior score using the Keefe and Block scoring method was correlated with self-report pain. Interrater reliability ranged from 0.9 to 0.99. Hierarchical multiple regression analyses revealed that age and physical disability predicted the total pain behaviors. The Pain Behavior Observation method appears a valid pain measurement technique independent of depression among FS patients. Directions for future research are discussed.