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2.
J Patient Saf ; 17(3): e228-e233, 2021 04 01.
Article in English | MEDLINE | ID: mdl-29112030

ABSTRACT

BACKGROUND: Although forensic nurses work with the most challenging psychiatric patients and manifest a safety culture in their interactions with patients, there have been few studies on patient safety culture in forensic psychiatric nursing. OBJECTIVES: The aim of this qualitative study was to describe nurses' views of patient safety culture in their working unit and daily hospital work in 2 forensic hospitals in Finland. METHODS: Data were collected over a period of 1 month by inviting nurses to answer an open-ended question in an anonymous Web-based questionnaire. A qualitative inductive analysis was performed on nurses' (n = 72) written descriptions of patient safety culture in state-owned forensic hospitals where most Finnish forensic patients are treated. RESULTS: Six main themes were identified: "systematization of an open and trusting communication culture," "visible and close interaction between managers and staff," "nonpunitive responses to errors, learning and developing," "balancing staff and patient perspectives on safety culture," "operational safety guidelines," and "adequate human resources to ensure safety." CONCLUSIONS: The findings highlight the influence of the prevailing culture on safety behaviors and outcomes for both healthcare workers and patients. Additionally, they underline the importance of an open culture with open communication and protocols.


Subject(s)
Nurses , Nursing Staff, Hospital , Attitude of Health Personnel , Communication , Forensic Psychiatry , Humans , Patient Safety , Safety Management
3.
J Nurs Manag ; 27(4): 848-857, 2019 May.
Article in English | MEDLINE | ID: mdl-30784144

ABSTRACT

AIM: To evaluate how a 3-year patient safety intervention, more specifically, the implementation of a patient safety incident reporting system, influences patient safety culture. BACKGROUND: Positive patient safety culture improves both the quality of health care and patient safety. Nevertheless, nursing managers need tools that can help them develop and evaluate patient safety culture. METHODS: The Hospital Survey on Patient Safety Culture was used to evaluate patient safety culture at two Finnish forensic psychiatric hospitals (study and control) over two periods, baseline and follow-up. Data were analysed using Z-score and T test statistics. RESULTS: The follow-up results from the study hospital showed that five patient safety culture dimensions exhibited a significantly (p < 0.05) positive change in positive response rates over the 3-year period. Furthermore, nine out of twelve patient safety culture dimensions at the study hospital showed a significant improvement in mean score. At the control hospital, only the dimension of frequency of reporting events showed a significantly positive change (p < 0.05) in mean score. CONCLUSION: This research shows that the studied patient safety intervention (implementation of the patient safety incident reporting system) significantly influences patient safety culture. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers should utilize a variety of patient safety interventions to improve patient safety and focus on leveraging information from patient safety incidents to advance patient safety culture.


Subject(s)
Forensic Psychiatry/standards , Nursing Staff, Hospital/psychology , Patient Safety/standards , Safety Management/standards , Finland , Forensic Psychiatry/methods , Humans , Nursing Staff, Hospital/statistics & numerical data , Organizational Culture , Surveys and Questionnaires
4.
Crim Behav Ment Health ; 29(1): 57-68, 2019 Feb.
Article in English | MEDLINE | ID: mdl-30632230

ABSTRACT

BACKGROUND: Identification of the risk factors underlying impulsivity related to violent acts is an essential component of risk assessment and management to reduce violent offending. AIMS: Our aim was to develop a clinically useful measure for assessing impulsivity related to violence. Our research questions were which items in the newly developed measure are associated with later violent recidivism and what is the measure's predictive validity? METHODS: A new scale, the impulsivity measure related to violence (IMP-V), was studied by completing the scale, blind to outcome, from information in the forensic psychiatric examination reports of 63 of a 1-year referral cohort of 181 Finnish offenders. Data on reoffending for up to 15 years after release were collected from official criminal records. RESULTS: The predictive accuracy of the IMP-V continuous ratings was 78% and for the categorical summary risk ratings 77%. Univariate analyses of categorical summary risk ratings of the risk factors revealed that, with two exceptions, each additional score on the IMP-V was associated with a significant increase in violence recidivism. CONCLUSIONS: These preliminary results indicate that the IMP-V is a promising decision-enhancing guide for assessing the risk of violence in impulsive people and that the measure is worth developing for use with impulsivity-prone offenders and forensic psychiatric patients. The IMP-V organises information on the nature of impulsivity in violence-prone persons and thus also creates opportunities for more effective risk management.


Subject(s)
Criminals/psychology , Impulsive Behavior/physiology , Judgment/ethics , Adult , Finland , Follow-Up Studies , Humans , Male , Risk Factors
5.
Nord J Psychiatry ; 70(3): 190-4, 2016.
Article in English | MEDLINE | ID: mdl-26450657

ABSTRACT

BACKGROUND: Increased body weight and hyperlipidemia caused by antipsychotics may be associated with improved antipsychotic efficacy in schizophrenia. If this association has a causal interrelationship via a genuine pathophysiological mechanism, then body weight loss in antipsychotic-treated patients would be accompanied by worsened psychopathology. This could have clinical implications. AIM: To explore whether the decreased body weight in these patients is associated with a worsened psychopathology. METHODS: In our previously published study, a 16 week treatment period with add-on orlistat (but not placebo) resulted in body weight loss in male (but not female) clozapine- or olanzapine-treated overweight or obese patients. In the current study, we investigated whether body weight loss in those male patients could worsen psychosis. Changes in the Positive and Negative Syndrome Scale (PANSS) scores within groups and body weight changes and lipid profiles over the treatment period were analysed by the paired samples t-test. Between-group comparisons were analysed by the independent samples t-test. RESULTS: Over the treatment period body weight decreased by 2.56 ± 3.25 kg from initial 106.02 ± 12.61 kg (p = 0.04) for the orlistat group, with no statistically significant changes for the placebo group. Lipid levels did not change in either group. The orlistat-induced weight decrease was not associated with worsening in the PANSS scores. CONCLUSIONS: Weight loss was not associated with a worsening of psychosis. The interrelationship between the antipsychotic-induced weigh gain and improved schizophrenia psychopathology observed in earlier studies appears to be indirect. Orlistat treatment in our study did not worsen psychopathology in this population.


Subject(s)
Anti-Obesity Agents/adverse effects , Antipsychotic Agents/adverse effects , Lactones/adverse effects , Lipid Metabolism/drug effects , Obesity/drug therapy , Schizophrenia/drug therapy , Adult , Anti-Obesity Agents/therapeutic use , Antipsychotic Agents/therapeutic use , Benzodiazepines/adverse effects , Benzodiazepines/therapeutic use , Clozapine/adverse effects , Clozapine/therapeutic use , Double-Blind Method , Female , Humans , Lactones/therapeutic use , Lipid Metabolism/physiology , Male , Middle Aged , Obesity/chemically induced , Olanzapine , Orlistat , Psychiatric Status Rating Scales , Psychopathology , Schizophrenia/metabolism , Schizophrenia/physiopathology , Weight Loss/drug effects , Weight Loss/physiology
6.
Duodecim ; 131(7): 649-55, 2015.
Article in Finnish | MEDLINE | ID: mdl-26233982

ABSTRACT

Sexually offending behavior by adolescents may be directed towards children, age-mates and adults. Neurocognitive and psychiatric disorders and the associated inability to age-related interpersonal relationships and inability to control the sexual desires activated during adolescence may lead a young person to seek inappropriate sexual satisfaction from children. Sometimes the offenses are part of antisocial development. Interventions should be focused on the distorted cognitions and attitudes maintaining the injurious sexual behavior, and on the risk of criminal behavior in general. Pharmacological therapy, mainly with SSRI drugs, has also been tested in adolescents.


Subject(s)
Adolescent Behavior , Psychology, Adolescent , Sex Offenses/prevention & control , Sex Offenses/psychology , Adolescent , Adult , Antisocial Personality Disorder/therapy , Child , Female , Humans , Interpersonal Relations , Male
7.
Crim Behav Ment Health ; 25(3): 192-206, 2015 Jul.
Article in English | MEDLINE | ID: mdl-25042997

ABSTRACT

BACKGROUND: Structured violence risk assessment is an essential part of treatment planning for violent young people. The Structured Assessment of Violence Risk in Youth (SAVRY) has been shown to have good reliability and validity in a range of settings but has hardly been studied in adolescent mental health services. AIMS: This study aimed to evaluate the long-term predictive validity of the SAVRY in adolescent psychiatry settings. METHODS: In a prospective study, 200 SAVRY assessments of adolescents were acquired from psychiatric, forensic and correctional settings. Re-offending records from the Finnish National Crime Register were collected. Receiver operating curve statistics were applied. RESULTS: High SAVRY total and individual subscale scores and low values on the protective factor subscale were significantly associated with subsequent adverse outcomes, but the predictive value of the total score was weak. At the risk item level, those indicating antisocial lifestyle, absence of social support and pro-social involvement were strong indicators of subsequent criminal convictions, with or without violence. The SAVRY summary risk rating was the best indicator of likelihood of being convicted of a violent crime. After allowing for sex, age, psychiatric diagnosis and treatment setting, for example, conviction for a violent crime was over nine times more likely among those young people given high SAVRY summary risk ratings. CONCLUSIONS: The SAVRY is a valid and useful method for assessing both short-term and long-term risks of violent and non-violent crime by young people in psychiatric as well as criminal justice settings, adding to a traditional risk-centred assessment approach by also indicating where future preventive treatment efforts should be targeted. The next steps should be to evaluate its role in everyday clinical practice when using the knowledge generated to inform and monitor management and treatment strategies.


Subject(s)
Criminals/psychology , Juvenile Delinquency/psychology , Personality Assessment/standards , Psychiatric Status Rating Scales/standards , Violence/psychology , Adolescent , Antisocial Personality Disorder , Crime/psychology , Female , Follow-Up Studies , Forensic Psychiatry/methods , Humans , Male , Mental Disorders , Mental Health Services , Personality Assessment/statistics & numerical data , Predictive Value of Tests , Prospective Studies , Reproducibility of Results , Risk Assessment/methods
8.
J Forensic Nurs ; 9(4): 207-16, 2013.
Article in English | MEDLINE | ID: mdl-24256983

ABSTRACT

Safety culture refers to the way patient safety is regarded and implemented within an organization and the structures and procedures in place to support this. The aim of this study was to evaluate patient safety culture, identify areas for improvement, and establish a baseline for improving state hospitals in Finland. Cross-sectional design data were collected from two state-run forensic hospitals in Finland using an anonymous, Web-based survey targeted to hospital staff based on the Hospital Survey on Patient Safety Culture questionnaire. The response rate was 43% (n = 283). The overall patient safety level was rated as excellent or very good by 58% of respondents. The highest positive grade was for "teamwork within units" (72%). The lowest rating was for "nonpunitive response to errors" (26% positive). Good opportunities for supplementary education had a statistically significant (p ≤ 0.05) effect on 9 of 12 Hospital Survey on Patient Safety Culture dimensions. Statistically significant (p ≤ 0.05) differences in patient safety culture were also found in the staff's educational background, manager status, and between the two hospitals. These findings suggest there are a number of patient safety problems related to cultural dimensions. Supplementary education was shown to be a highly significant factor in transforming patient safety culture and should therefore be taken into account alongside sufficient resources.


Subject(s)
Attitude of Health Personnel , Hospitals, Psychiatric/organization & administration , Hospitals, Public/organization & administration , Organizational Culture , Patient Safety , Analysis of Variance , Communication , Cross-Sectional Studies , Educational Status , Feedback , Female , Finland , Hospital Administrators , Humans , Interdisciplinary Communication , Male , Medical Staff, Hospital , Needs Assessment , Nursing Staff, Hospital , Physician-Nurse Relations , Surveys and Questionnaires
9.
Int Clin Psychopharmacol ; 28(2): 67-70, 2013 Mar.
Article in English | MEDLINE | ID: mdl-23187856

ABSTRACT

Constipation is a common and potentially fatal side effect of clozapine treatment. Another important side effect of clozapine may also be significant weight gain. Orlistat is a weight-control medication that is known to induce loose stools as a common side effect. This study aimed to explore whether orlistat used to control clozapine-induced weight gain can simultaneously tackle clozapine-related constipation. In this 16-week randomized-controlled study, clozapine-treated patients received add-on orlistat (n=30) or add-on placebo (n=24). Colonic function was measured using the Bristol Stool Form Scale. There was a significant (P=0.039) difference in the prevalence of constipation in favor of orlistat over placebo in completers (n=40) at the endpoint. A decrease in the prevalence of constipation within the orlistat group (P=0.035) was observed (vs. no statistically significant changes in the placebo group). In clozapine-treated patients, orlistat may be beneficial not only for weight control but also as a laxative. As no established treatments for clozapine-induced constipation exist, orlistat can be considered for this population, although more studies are required.


Subject(s)
Anti-Obesity Agents/therapeutic use , Antipsychotic Agents/adverse effects , Clozapine/adverse effects , Constipation/prevention & control , Lactones/therapeutic use , Obesity/drug therapy , Overweight/drug therapy , Anti-Obesity Agents/adverse effects , Antipsychotic Agents/therapeutic use , Benzodiazepines/adverse effects , Benzodiazepines/therapeutic use , Clozapine/therapeutic use , Colon/drug effects , Colon/physiopathology , Constipation/chemically induced , Constipation/physiopathology , Cross-Sectional Studies , Diarrhea/chemically induced , Double-Blind Method , Finland/epidemiology , Humans , Incidence , Lactones/adverse effects , Laxatives/adverse effects , Laxatives/therapeutic use , Obesity/psychology , Olanzapine , Orlistat , Overweight/psychology , Patient Dropouts , Prevalence , Psychotic Disorders/complications , Psychotic Disorders/drug therapy , Schizophrenia/complications , Schizophrenia/drug therapy , Severity of Illness Index , Weight Loss/drug effects
10.
Arch Womens Ment Health ; 15(3): 167-74, 2012 Jun.
Article in English | MEDLINE | ID: mdl-22426944

ABSTRACT

This study aims to evaluate the psychosocial factors of neonaticide, especially the circumstances before delivery, the relationships of the pregnant women, and their social environment awareness of women's pregnancy. This nationwide study was register-based, comprising all known neonaticides in Austria and Finland between 1995 and 2005. Cases (n = 28) were obtained by screening the death certificates from coroner's departments and by analyzing them along with all further available reports. Few women (17.9 %, 5/28) admitted their pregnancy to others. Although most (16/28) offenders were in a relationship, the partner had knowledge of the pregnancy in only three cases. The main motive for negation of the pregnancy (named in 60.8 % of cases) was fear of abandonment/negative response from others. The fertility rate among the women was high, but half of those with children had lost the custody of them. In neonaticide, the lack of awareness surrounding offenders' pregnancy, as well as the awareness of social environment, is more relevant than any other social variable.


Subject(s)
Child Abuse/psychology , Depression, Postpartum/psychology , Infanticide/psychology , Mental Competency , Mothers/psychology , Pregnancy/psychology , Adult , Austria , Female , Finland , Humans , Infant, Newborn , Mother-Child Relations , Prognosis , Retrospective Studies , Risk Factors , Socioeconomic Factors , Spouses/psychology , Young Adult
12.
J Interpers Violence ; 27(8): 1519-39, 2012 May.
Article in English | MEDLINE | ID: mdl-22080577

ABSTRACT

The present study examined gender differences in intimate partner homicide (IPH) and offender characteristics with the focus on putative gender-specific risk factors in a nationwide consecutive sample of homicide offenders. Data on all offenders (N = 642; 91 females, 551 males) convicted of homicide and subjected to a forensic psychiatric examination in Finland were obtained for the years 1995 and 2004. IPH offenders, 39 female and 106 male, were compared for risk factors with female and male offenders whose victims were not spouses. The forensic psychiatric examination reports were retrospectively analyzed, and the Hare Psychopathy Checklist-Revised (PCL-R) was rated. Significant gender differences were found in four risk factors: employment, intoxication of victim, self-defense, and quarrel, mostly related to alcohol as a factor of the offense. The findings support the notion that female IPH is linked to defensive reactions resulting from prior abuse, and that IPH offenders resemble the general population more than offenders of other types of homicide.


Subject(s)
Homicide/trends , Registries , Sexual Partners , Adolescent , Adult , Aged , Aged, 80 and over , Female , Finland , Humans , Male , Middle Aged , Retrospective Studies , Risk Assessment , Risk Factors , Young Adult
13.
Int Psychiatry ; 9(4): 91-93, 2012 Nov.
Article in English | MEDLINE | ID: mdl-31508140

ABSTRACT

A tradition of Romano-Germanic or civil law defines the legal system in Finland. Laws of relevance to psychiatry are the 1990 Mental Health Act and, insofar as it pertains to forensic psychiatry, the Criminal Law (1889) and the Law on State Mental Hospitals (1987, revised 1997). These are outlined in the present paper.

14.
Child Abuse Negl ; 35(5): 319-28, 2011 May.
Article in English | MEDLINE | ID: mdl-21620158

ABSTRACT

OBJECTIVE: This study searched for gender differences in filicidal offense characteristics and associated variables. METHODS: In this bi-national register-based study all filicide perpetrators (75 mothers and 45 fathers) and their crimes in Austria and Finland 1995-2005 were examined for putative gender differences. The assessed variables were associated with the offense characteristics, the offenders' socioeconomic and criminal history, and related stressful events. RESULTS: Mothers had previously committed violent offenses less often than fathers (5% vs. 28%, p<0.001) and they were less often employed (27% vs. 49%, p<0.05). Mothers' victims were on average younger than those of fathers; median ages of the victims were 3.4 and 6.1 years, respectively (p<0.001). Fathers were more often intoxicated during the offense (11% vs. 42%, p<0.001) and also used shooting as the method of operation more often than mothers (5% vs. 27%, p<0.001). Mothers used drowning, criminal negligence, and poisoning more often than fathers. Fathers' motives were more impulsive in nature (13% vs. 41%, p<0.001). After the killing, mothers tried to get rid of the body more often than fathers (25% vs. 7%, p<0.05). CONCLUSIONS: Fathers who commit filicide may represent at least two subgroups, the one not unlike the common homicide offender; the other, the overloaded, working and suicidal father. Mothers may include several types of offenders, one of which is the neonaticide offender. More detailed descriptions and, therefore, more research are needed. PRACTICE IMPLICATIONS: Distressed parents and families need support and health care personnel, social work and other officials need to be alert to notice fatigued parents' signs of despair, especially when several stressful experiences amass. Straightforward enquiry to the situation and even practical and psychological help may be needed for enhanced protection of children. The role of employers should also be discussed in relation to the welfare of working parents.


Subject(s)
Fathers/psychology , Fathers/statistics & numerical data , Homicide/psychology , Homicide/statistics & numerical data , Mothers/psychology , Mothers/statistics & numerical data , Adolescent , Alcohol Drinking/epidemiology , Alcohol Drinking/psychology , Austria/epidemiology , Child , Child Abuse/psychology , Child Abuse/statistics & numerical data , Child, Preschool , Criminals , Father-Child Relations , Female , Finland/epidemiology , Humans , Infant , Infant, Newborn , Male , Mother-Child Relations , Registries , Risk Factors , Sex Distribution , Sex Factors , Socioeconomic Factors , Stress, Psychological , Violence
15.
J Clin Psychiatry ; 72(3): 326-30, 2011 Mar.
Article in English | MEDLINE | ID: mdl-20816037

ABSTRACT

OBJECTIVE: To explore long-term effects of orlistat in adult clozapine- or olanzapine-treated patients with DSM-IV-diagnosed schizophrenia and overweight or obesity who tolerate orlistat. METHOD: Orlistat or placebo was added to clozapine or olanzapine in stable doses in a 16-week randomized controlled trial. Open-label orlistat was added to the antipsychotics during a 16-week extension phase for those completing the double-blind phase. No low-calorie diet or participation in behavioral programs was required. Body weight (primary outcome) and some metabolic parameters were measured prospectively. Analyses were performed for those completing both phases (ie, population differing from that reported earlier). The study was conducted from 2004 through 2005. RESULTS: During the open-label phase, the 44 patients experienced mean ± SD body weight loss of -1.29 ± 3.04 kg, P = .007. During both phases, men (but not women) showed a weight loss of -2.39 ± 5.45 kg, P = .023. Some subgroups showed desirable changes in several metabolic parameters. Prolonged (32 weeks) orlistat treatment yielded no additional benefits as compared to short (16 weeks) treatment. CONCLUSIONS: In clozapine- or olanzapine-treated overweight or obese patients able to take orlistat on a long-term basis, the drug, with no concomitant hypocaloric diet or behavioral interventions, caused moderate weight loss only in men. However, some metabolic benefits may be achieved independently of weight changes. In patients who do not respond to orlistat within the first 16 weeks, continuation treatment may provide no additional benefits. TRIAL REGISTRATION: controlled-trials.com Identifier: ISRCTN65731856.


Subject(s)
Anti-Obesity Agents/therapeutic use , Antipyretics/adverse effects , Benzodiazepines/adverse effects , Clozapine/adverse effects , Lactones/therapeutic use , Obesity/drug therapy , Adult , Antipyretics/therapeutic use , Benzodiazepines/therapeutic use , Cholesterol/blood , Cholesterol, LDL/blood , Clozapine/therapeutic use , Double-Blind Method , Female , Humans , Male , Obesity/chemically induced , Olanzapine , Orlistat , Schizophrenia/drug therapy , Sex Factors , Treatment Outcome , Weight Loss/drug effects
16.
J Forensic Sci ; 55(6): 1552-6, 2010 Nov.
Article in English | MEDLINE | ID: mdl-20629908

ABSTRACT

With populations aging there have been some concerns on elderly offending. We compared elderly homicide offenders with a younger comparison group with special emphasis on psychopathy. We analyzed nationwide register-based material on all homicide offenders aged 60 or older who were in a forensic psychiatric examination in Finland 1995-2004 and their gender-matched comparison group of younger homicide offenders. The offenders 60 years or older were diagnosed less often than the younger ones with drug dependence and personality disorders and more often with dementia and physical illnesses. The mean Psychopathy Checklist--Revised total scores as well as factor and facet scores were lower in the 60 or older age group. The group 60 years or older had significantly lower scores on eight individual items of social deviance. The interpersonal/affective factor 1 scores did not differ. Understanding the possible underlying phenomena of violent behavior may provide help for developing services for the elderly.


Subject(s)
Antisocial Personality Disorder/psychology , Homicide/psychology , Adult , Age Distribution , Age Factors , Aged , Aged, 80 and over , Alcoholism/epidemiology , Crime Victims/statistics & numerical data , Female , Forensic Psychiatry , Homicide/statistics & numerical data , Humans , Male , Middle Aged , Personality Assessment , Personality Disorders/epidemiology , Registries
17.
Int J Law Psychiatry ; 33(3): 177-83, 2010.
Article in English | MEDLINE | ID: mdl-20471087

ABSTRACT

The construct of psychopathy is essential in explaining criminal behavior, but unfortunately the empirical research on psychopathy in women has been inconsistent. In this study the underlying structure of psychopathy in women was examined by testing the two-factor model by Hare (2003) and the three-factor solution by Cooke and Michie (2001) using confirmatory factor analysis. We replicated the study by Warren et al. (2003) using a nationwide sample of 97 female homicide offenders in order to facilitate the comparison of results. The prevalence of psychopathy in the present study was 9.3% with a cut-off of >or=30 and 21.6% with a cut-off of >or=25. The best fit for the data out of the tested models was the three-factor model with six testlets. The two-factor model proved to be too simple a model for the female homicide data. The findings regarding comorbidity of psychopathy with personality disorders show that the concept of psychopathy includes diagnostic criteria of several personality disorders, but further research is needed to establish a possible superordinate dimension. Further research on the PCL-R and putative gender differences in the expression of psychopathy in women and men as well as on the putative impact of cultural differences on the instrument is clearly needed.


Subject(s)
Homicide/psychology , Mental Disorders/psychology , Psychiatric Status Rating Scales/standards , Adolescent , Adult , Chi-Square Distribution , Factor Analysis, Statistical , Female , Finland , Humans , Mental Disorders/diagnosis , Middle Aged , Models, Psychological , Personality Disorders/diagnosis , Personality Disorders/psychology , ROC Curve , Sensitivity and Specificity , Sex Factors , Young Adult
18.
Nord J Psychiatry ; 64(2): 136-44, 2010 Apr.
Article in English | MEDLINE | ID: mdl-19883195

ABSTRACT

BACKGROUND: The containment or the prevention of actual violence is the primary justification for the use of restraint and seclusion in psychiatry. The aim of the present study was to determine the grounds for using restraint and seclusion in clinical practice in Finland, and whether these reasons have changed over a 15-year period as a result of legislative changes. METHOD: A structured postal survey concerning the reasons for restraint and seclusion was completed in all the Finnish psychiatric hospitals during a predetermined week in 1990, 1991, 1994, 1998 and 2004. The duration of the episode as well as demographic and clinical information on the restrained and secluded patient were also reported. RESULTS: Agitation/disorientation was the most frequent reason for the use of restraint and seclusion. The duration of the restraint and seclusion episodes was not determined by the reason for using these measures. Some differences in the reasons were found among subgroups of patients. CONCLUSION: Clinical practice deviates from the theoretical and legal grounds established for restraint and seclusion, and is too open to subjective assessment and interpretations.


Subject(s)
Mental Disorders/therapy , Patient Isolation/statistics & numerical data , Restraint, Physical/statistics & numerical data , Adolescent , Adult , Coercion , Data Collection , Female , Finland , Guideline Adherence/statistics & numerical data , Hospitals, Psychiatric/statistics & numerical data , Humans , Male , Mental Disorders/epidemiology , Mental Disorders/psychology , Middle Aged , Patient Isolation/legislation & jurisprudence , Psychomotor Agitation/psychology , Psychomotor Agitation/therapy , Restraint, Physical/legislation & jurisprudence , Safety Management/statistics & numerical data , Utilization Review/statistics & numerical data , Violence/prevention & control , Violence/psychology , Young Adult
19.
Soc Psychiatry Psychiatr Epidemiol ; 45(11): 1087-93, 2010 Nov.
Article in English | MEDLINE | ID: mdl-19844645

ABSTRACT

BACKGROUND: To find interventions for reducing the use of restraint and seclusion, it is necessary to identify who the restrained and secluded patients are. The aim of the present study was to determine which demographic and clinical groups of psychiatric inpatients are at risk of being restrained/secluded, and whether there have been changes in the restrained/secluded patients' profiles over a 15-year period in Finland. METHOD: A structured postal survey concerning the demographic and clinical information of restrained/secluded patients was completed in all Finnish psychiatric hospitals during a predetermined week in 1990, 1991, 1994, 1998, and 2004. The National Hospital Discharge Register was used to gather information on all psychiatric inpatients during the study weeks. RESULTS: Out of the variables studied (age, gender, main diagnosis, phase of hospital stay), only the main diagnosis and the phase of hospital stay were independent risk factors for restraint/seclusion, and remained constant over time. The age profile of the restrained/secluded patients was unstable over time and the risk of being restrained/secluded was not associated with gender. CONCLUSION: Restraint and seclusion is used mainly among the acute and the most disturbed patients. Therefore, in order to reduce the use of restraint and seclusion, resources should be targeted especially to these groups.


Subject(s)
Hospitals, Psychiatric/statistics & numerical data , Mental Disorders/epidemiology , Restraint, Physical/statistics & numerical data , Social Isolation , Adolescent , Adult , Age Distribution , Coercion , Female , Finland/epidemiology , Health Care Surveys , Hospitalization/statistics & numerical data , Humans , International Classification of Diseases , Length of Stay/statistics & numerical data , Longitudinal Studies , Male , Mental Disorders/diagnosis , Mental Disorders/psychology , Middle Aged , Restraint, Physical/methods , Risk Factors , Surveys and Questionnaires
20.
BMC Psychiatry ; 9: 74, 2009 Nov 21.
Article in English | MEDLINE | ID: mdl-19930581

ABSTRACT

BACKGROUND: Filicide is the tragic crime of murdering one's own child. Previous research has found that the offending parents are commonly depressed and that suicide is often associated as an actual act or an intention. Yet, filicide is an underreported crime and previous studies have been strained with methodological problems. No comprehensive international studies on filicide have been presented in the literature until now. METHODS: This was a descriptive, comprehensive, register-based study of all filicides in Austria and Finland during 1995-2005. Filicide-suicide cases were also included. RESULTS: Most of the perpetrators were the biological mothers; in Austria 72%, in Finland 52%. Suicide followed filicide either as an attempt or a fulfilled act in 32% and 54% of the cases in Austria and Finland, respectively. Psychotic mood disorders were diagnosed for 10% of the living perpetrators in Austria, and 12% in Finland. Non-psychotic depression was diagnosed in 9% of surviving perpetrators in Austria, 35% in Finland. CONCLUSION: The data from the two countries demonstrated that filicide is such a multifaceted and rare phenomenon that national data from individual countries seldom offer sufficient scope for its thorough study. Further analyses are needed to produce a complete picture of filicide.


Subject(s)
Crime Victims/statistics & numerical data , Depressive Disorder/epidemiology , Homicide/statistics & numerical data , Mothers/statistics & numerical data , Psychotic Disorders/epidemiology , Adolescent , Adult , Age Distribution , Aged , Austria/epidemiology , Cause of Death , Child , Child of Impaired Parents/statistics & numerical data , Child, Preschool , Chronology as Topic , Female , Finland/epidemiology , Forensic Psychiatry , Humans , Infant , Infanticide , Male , Middle Aged , Mothers/psychology , Sex Factors , Suicide/psychology , Suicide/statistics & numerical data , Suicide, Attempted/statistics & numerical data
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