The first step in the validation of a new screen for violence risk in acute psychiatry: The inpatient context.

BACKGROUND: Instruments for evaluating the risk of violence towards others have mostly been developed for assessment of risk for recidivism into violent crime in forensic psychiatry. In general psychiatry there is a considerable need for specialised, brief and structured assessment tools to inform risk decisions. METHOD: The study aimed to validate a brief structured clinical risk assessment screen of inpatient violence (V-RISK-10), a 10-item structured clinical checklist with a good vignette-based interrater reliability (ICC=0.87). In this study it was used for risk assessment of a one-year sample of patients (N=1.017) admitted to two acute psychiatric units. Risk assessments at admission were compared to prospective records of aggressive and violent acts during the hospital stay. RESULTS: Results showed a base rate for aggression of 9%. The predictive validity of the V-RISK-10 was estimated by Receiver Operating Characteristics (ROC). It yielded an area under the curve (AUC) of 0.83, with sensitivity/specificity of 0.81/0.73 and corresponding positive and negative predictive values (PPV/NPV) of 0.24/0.97. The screen was easy-to-use and showed a short completion time. CONCLUSION: Despite promising results further validation studies are required before the V-RISK-10 is adopted into routine clinical practise.

V-RISK-10: validation of a screen for risk of violence after discharge from acute psychiatry.

BACKGROUND: Current violence risk assessment instruments are time-consuming and mainly developed for forensic psychiatry. A paucity of violence screens for acute psychiatry instigated the development and validation of the V-RISK-10. The aim of this prospective naturalistic study was to test the predictive validity of the V-RISK-10 as a screen of violence risk after discharge from two acute psychiatric wards. METHODS: Patients were screened with V-RISK-10 before discharge, and incidents of violence were recorded 3, 6, 9 and 12 months after discharge. A total of 381 of the 1017 patients that were screened completed the follow up. RESULTS: The ROC-AUC values for any violent behaviour were 0.80 and 0.75 (p<0.001) for the 3 and 12 months follow-up periods, respectively, and significant for both genders. The most accurate risk estimates were obtained for severe violence. For persons without a known history of violence prior to the screening, AUCs were 0.74 (p=0.004) and 0.68 (p=0.002). CONCLUSIONS: Results indicate that the V-RISK-10 is a valid and clinically useful screen for violence risk after discharge from acute psychiatry, and even significant for patients without a known previous history of violence.

[Quality assurance of psychiatric consultations in somatic hospitals]. / Kvalitetsforbedring av psykiatriske konsultasjoner i somatiske sykehus.

Research has shown great variety in the clinical practice of consultation-liaison psychiatry in and between different countries. This paper presents the Norwegian experiences from a European collaborative study of quality management in consultation-liaison psychiatry. We describe a dynamic model for total quality management based on regular registration of some clinical data and the subsequent feed-back on changes of these. We discuss our experiences with this model and obstacles met in everyday work. Finally we point to different ways of implementing this method on a broader base in consultation-liaison psychiatry.

[Treatment of patients with psychogenic amnesia with the help of therapeutic anamnesis]. / Behandling av pasienter med psykogen amnesi ved hjelp av terapeutisk anamnese.

Psychogenic (dissociative) amnesia is a psychiatric disorder characterised by a sudden loss of memory which is too extensive to be explained by ordinary forgetfulness, but which has no organic disease or explanation. Psychogenic amnesia is categorised among the dissociative disorders in DSM-IV and ICD-10 and begins suddenly, usually after severe psychosocial stress. The prognosis is good with complete recovery, and there is seldom relapse. This article describes a man, 45 years of age, who developed severe depression and amnesia following a very troublesome divorce. He did not talk, he communicated by signs and gestures, and he isolated himself in his mother's home. After being admitted to a psychiatric ward he became anorectic and developed erosive eoesophagitis/gastroduodenitis. Initially he was given perfenazin (Trilafon) 24 mg/day. The psychiatric treatment produced no results for the first three weeks, but the patient gradually recovered when the therapist and the patient recapitulated the conflicts associated with the divorce, using documents from the patient's lawyer as a guide. This method is called "therapeutic anamnesis" and is similar in many ways to psychiatric treatment of post-traumatic stress reactions.

[Psychiatric consultations at a somatic central hospital. Review of 383 referrals over 3 years]. / Psykiatrisk tilsyn ved et somatisk sentralsykehus. En gjennomgang av 383 henvisninger over tre år.

We present an analysis of all psychiatric consultations with inpatients in the somatic wards at the Central Hospital in Alesund over a period of three years. About 1% of the patients were referred for psychiatric consultation. Most of these patients had no previous experience of psychiatry. Mean age was 45 years (range 16-90), and 56% were females. The reasons for referral were assessment of suicidal behaviour (47%), depression (16%) and psychosis (11%). The most common psychiatric diagnoses were personality disorders (16%), affective disorders (14%) and alcohol and drug abuse and dependence (14%). About 10% were admitted to psychiatric wards, and 21% were referred to psychiatric outpatient clinics. The referring physicians were satisfied with the psychiatric consultation service.