Drug-free after basal exposure therapy. / Medisinfri etter basal eksponeringsterapi.

BAKGRUNN: Vestre Viken tilbyr basal eksponeringsterapi til døgnpasienter med alvorlige sammensatte psykiske lidelser og lavt funksjonsnivå. I behandlingen kan de som ønsker det få hjelp til å bli medisinfrie. Det sentrale behandlingselementet er eksponering for uønskede indre opplevelser, betegnet som eksistensiell katastrofeangst. Vi undersøkte pasientenes psykososiale fungering etter minst to år etter avsluttet døgnbehandling. MATERIALE OG METODE: Det var tilgjengelige data for 33 av 36 utskrevne pasienter. Vi registrerte psykofarmakabruk, symptom- og funksjonsnivå (Global Assessment of Functioning, GAF), utdanningsnivå, arbeidsevne og boevne ved inntaks- og oppfølgingstidspunktet samt innleggelser året før inntak og oppfølging. Grad av eksponering ble skåret ved utskrivning. RESULTATER: Ved oppfølgingstidspunktet (i gjennomsnitt 5,3 år) var 16 personer medisinfrie, mens 17 fremdeles brukte psykofarmaka. Gjennomsnittlig GAF-skår i den medisinfrie gruppen var ca. 65, noe som tilsvarer milde symptomer og lettere sosiale utfordringer. I psykofarmakagruppen var gjennomgjennomsnittlig GAF-skår ca. 41, noe som indikerer alvorlige problemer og behandlingsbehov. Fire av de medisinfrie og 13 av dem som brukte psykofarmaka, var blitt reinnlagt året før oppfølgingen, og henholdsvis ni og én var i minst 50 % arbeid. Medisinfrie pasienter med høy grad av eksponering hadde best psykososial fungering. De syv som oppnådde full tilfriskning, var alle medisinfrie. FORTOLKNING: De pasientene som i basal eksponeringsterapi valgte å eksponere seg, trappet ned psykofarmakabruken og etter hvert ble medisinfrie, viste ved langtidsoppfølgingen bedre psykososial fungering enn de som fortsatt brukte psykofarmaka.

Predictors of suicide in the patient population admitted to a locked-door psychiatric acute ward.

OBJECTIVE: No prior study appears to have focused on predictors of suicide in the general patient population admitted to psychiatric acute wards. We used a case-control design to investigate the association between suicide risk factors assessed systematically at admission to a locked-door psychiatric acute ward in Norway and subsequent death by suicide. METHOD: From 2008 to 2013, patients were routinely assessed for suicide risk upon admission to the acute ward with a 17-item check list based on recommendations from the Norwegian Directorate of Health and Social Affairs. Among 1976 patients admitted to the ward, 40 patients, 22 men and 18 women, completed suicide within December 2014. RESULTS: Compared to a matched control group (n = 120), after correction for multiple tests, suicide completers scored significantly higher on two items on the check list: presence of suicidal thoughts and wishing to be dead. An additional four items were significant in non-corrected tests: previous suicide attempts, continuity of suicidal thoughts, having a suicide plan, and feelings of hopelessness, indifference, and/or aggression. A brief scale based on these six items was the only variable associated with suicide in multivariate regression analysis, but its predictive value was poor. CONCLUSION: Suicide specific ideations may be the most central risk markers for suicide in the general patient population admitted to psychiatric acute wards. However, a low predictive value may question the utility of assessing suicide risk.

Evaluation of Exhaust Emissions from Three Diesel-Hybrid Cars and Simulation of After-Treatment Systems for Ultralow Real-World NOx Emissions.

Hybridization offers great potential for decreasing pollutant and carbon dioxide emissions of diesel cars. However, an assessment of the real-world emissions performance of modern diesel hybrids is missing. Here, we test three diesel-hybrid cars on the road and benchmark our findings with two cars against tests on the chassis dynamometer and model simulations. The pollutant emissions of the two cars tested on the chassis dynamometer were in compliance with the relevant Euro standards over the New European Driving Cycle and Worldwide harmonized Light vehicles Test Procedure. On the road, all three diesel-hybrids exceeded the regulatory NOx limits (average exceedance for all trips: +150% for the Volvo, +510% for the Peugeot, and +550% for the Mercedes-Benz) and also showed elevated on-road CO2 emissions (average exceedance of certification values: +178, +77, and +52%, respectively). These findings point to a wide discrepancy between certified and on-road CO2 and suggest that hybridization alone is insufficient to achieve low-NOx emissions of diesel powertrains. Instead, our simulation suggests that properly calibrated selective catalytic reduction filter and lean-NOx trap after-treatment technologies can reduce the on-road NOx emissions to 0.023 and 0.068 g/km on average, respectively, well below the Euro 6 limit (0.080 g/km).

Basal Exposure Therapy: A New Approach for Treatment-Resistant Patients with Severe and Composite Mental Disorders.

New treatment approaches are needed for patients with severe and composite mental disorders who are resistant to conventional treatments. Such treatment-resistant patients often have diagnoses of psychotic or bipolar disorders or severe personality disorders and comorbid conditions. In this study, we evaluate basal exposure therapy (BET), a novel ward-integrated psychotherapeutic approach for these patients. Central to BET is the conceptualization of undifferentiated existential fear as basic to the patients' problem, exposure to this fear, and the therapeutic platform complementary external regulation, which integrates and governs the totality of interventions throughout the treatment process. BET is administered at a locked-door ward with 6 patient beds and 13.5 full-time employees, including a psychiatrist and 2 psychologists. Thirty-eight patients who had completed BET were included, all but two being female, mean age 29.9 years. Fourteen patients had a diagnosis of schizophrenia or schizoaffective disorder (F20/25), eight had bipolar disorder or recurrent depressive disorder (F31/33), eight had diagnoses in the F40-48 domain (neurotic, stress-related, and somatoform disorders), five were diagnosed with emotionally unstable personality disorder (F60.3), and three patients had other diagnoses. Twenty of the patients (53%) had more than one ICD-10 diagnosis. Average treatment time in BET was 13 months, ranging from 2 to 72 months. Time-series data show significant improvements in symptoms and functioning from enrollment to discharge, with effect sizes at 0.76 for the Dissociation Experience Scale, 0.93 for the Brief Symptom Inventory, 1.47 for the Avoidance and Action Questionnaire, and 1.42 and 1.56, respectively, for the functioning and symptom subscales of the Global Assessment of Functioning Scale. In addition, the patients used significantly less antiepileptic, antipsychotic, anxiolytic, and antidepressant medications at discharge than at treatment enrollment. Patient improvement across treatment was associated with the following duration of time in BET, the successful completions of the exposure component of BET, positive changes in experiential avoidance as measured with the Acceptance and Action Questionnaire, and high symptom levels and low levels of functioning at treatment start. The findings indicate that BET may be a promising inpatient psychotherapeutic approach for previously treatment-resistant patients with severe and comorbid conditions.

Infusion therapy: a multifaceted approach to teaching in nursing.

A multifaceted method of instruction for infusion therapy is presented in this article. The traditional use of mannequin arms is included and virtual reality is incorporated. The union of these methods, both of which use a hands-on approach, complements the use of text and laboratory demonstration for teaching infusion therapy. This study shows that with increased use of the virtual reality system, the student has increased probability of success at the first attempt during the return demonstration of the skill of initiating infusion therapy. With the emphasis on enhancing student preparedness for this advanced skill, the authors have found that the inclusion of all methods will better meet students' learning needs and their preferred methods of learning.