Prevalence, predictors, and patterns of mechanical restraint use for inpatients with dual diagnosis.

PURPOSE: This study examined the prevalence, predictors, and patterns of mechanical restraint in an inpatient dual diagnosis population. DESIGN AND METHODS: Data were longitudinally collected from patients affected by severe mental illness and comorbid substance abuse that were hospitalized in three large wards from 2006 to 2012. FINDINGS: In a sample of 1698 hospitalizations, the use of mechanical restraint ranged between 1% and 4% per year. The diagnosis of schizophrenia (odds ratio [OR], 2.64; 95% confidence interval [CI], 1.29-5.40), the use of stimulant substances (OR, 5.68; 95% CI, 2.78-11.59) and male sex (OR, 3.22; 95% CI, 1.12-9.27) were associated with an increased risk of being exposed to mechanical restraint. PRACTICE IMPLICATIONS: Specialized interventions targeting people at risk of mechanical restraint may further reduce the incidence of restraint and improve treatment outcomes.

Influencia de los trastornos de consumo de sustancias en el curso de la esquizofrenia: un estudio de seguimiento de 15 años / The impact of substance use disorders on the course of schizophrenia—A 15-year follow-up study

Antecedentes. En este estudio de seguimiento se comparó a pacientes con esquizofrenia y un trastorno de consumo de sustancias coexistente con pacientes con esquizofrenia y sin trastorno de consumo de sustancias. Objetivos. Investigar la importancia pronóstica de los efectos de los trastornos de consumo de sustancias sobre el curso de la esquizofrenia. Métodos. Se efectuó un seguimiento de pacientes con esquizofrenia y un trastorno de consumo de sustancias simultáneo (n=107) y de pacientes con esquizofrenia sola (n=119) a lo largo de un periodo de 15 años, mediante el empleo de registros de hospitalización de ámbito nacional, datos relativos al momento y la causa de la muerte y datos de personas sin hogar e internadas. Resultados. La mediana de duración de la hospitalización psiquiátrica fue de 12 días para un paciente con doble diagnóstico y de 21 días para los pacientes con esquizofrenia sola. Los pacientes con el diagnóstico doble presentaron un uso significativamente elevado de todos los tipos de contactos hospitalarios, excepto el tratamiento en régimen de hospitalización por trastornos no psiquiátricos. En tres de los tipos de contacto hospitalario, los pacientes con un consumo de sustancias simultáneo tuvieron aproximadamente de dos a tres veces el número de hospitalizaciones de los pacientes con esquizofrenia sola. Las razones de llegar a estar sin hogar y de institucionalización fueron similares en ambos grupos. Los pacientes con un diagnóstico doble presentaron también un riesgo significativamente superior de muerte durante el seguimiento, en comparación con los pacientes con esquizofrenia sola. Conclusiones. Los resultados obtenidos sugieren que el curso de la esquizofrenia a largo plazo es considerablemente más grave en los pacientes que tienen un diagnóstico doble, en comparación con los que presentan esquizofrenia sola. Los trastornos de consumo de sustancias tienen repercusiones importantes en las tasas de hospitalización de los pacientes con esquizofrenia, así como en la esperanza de vida. Los pacientes con una comorbilidad de abuso de sustancias tienen una mayor probabilidad de ser ingresados para tratamiento a lo largo del periodo de un determinado año, aunque su contacto con el tratamiento es más breve (AU)

Background. This follow-up study compared patients with schizophrenia with co-occurring substance use disorder to patients with schizophrenia and no substance use disorder. Aims. To investigate the prognostic significance of the effects of substance use disorders on the course of schizophrenia. Method. Patients with schizophrenia and co-occurring substance use disorder (n=107), and patients with schizophrenia only (n=119) were followed over a 15-year period through the use of national hospitalization registers, data for time and cause of death, and data for homelessness or institutionalization. Results. The median length of psychiatric hospitalization was 12 days for a patient with dual diagnosis, and 21 days for patients with schizophrenia only. Patients with dual diagnosis displayed a significantly elevated usage of all types of hospital contacts except inpatient treatment for non-psychiatric disorders. In three types of hospital contacts, patients with co-occurring substance use had approximately two to three times as many hospitalizations as did patients with schizophrenia only. Rates for homelessness and institutionalization were similar in both groups. Patients with a dual diagnosis were also significantly more at risk of dying during follow-up than were patients with schizophrenia only. Conclusions. The findings suggest that the long-term course of schizophrenia is considerably more severe in patients who have a dual diagnosis compared to patients with schizophrenia only substance use disorders have a substantial impact on the hospitalization rates of patients with schizophrenia, as well as on life expectancy. Patients with co-morbid substance abuse are more likely to be admitted for treatment during a given year although they have briefer contact with treatment (AU)

The impact of substance use disorders on the course of schizophrenia--a 15-year follow-up study: dual diagnosis over 15 years.

BACKGROUND: This follow-up study compared patients with schizophrenia with co-occurring substance use disorder to patients with schizophrenia and no substance use disorder. AIMS: To investigate the prognostic significance of the effects of substance use disorders on the course of schizophrenia. METHOD: Patients with schizophrenia and co-occurring substance use disorder (n=107), and patients with schizophrenia only (n=119) were followed over a 15-year period through the use of national hospitalization registers, data for time and cause of death, and data for homelessness or institutionalization. RESULTS: The median length of psychiatric hospitalization was 12 days for a patient with dual diagnosis, and 21 days for patients with schizophrenia only. Patients with dual diagnosis displayed a significantly elevated usage of all types of hospital contacts except inpatient treatment for non-psychiatric disorders. In three types of hospital contacts, patients with co-occurring substance use had approximately two to three times as many hospitalizations as did patients with schizophrenia only. Rates for homelessness and institutionalization were similar in both groups. Patients with a dual diagnosis were also significantly more at risk of dying during follow-up than were patients with schizophrenia only. CONCLUSIONS: The findings suggest that the long-term course of schizophrenia is considerably more severe in patients who have a dual diagnosis compared to patients with schizophrenia only Substance use disorders have a substantial impact on the hospitalization rates of patients with schizophrenia, as well as on life expectancy. Patients with co-morbid substance abuse are more likely to be admitted for treatment during a given year although they have briefer contact with treatment.

Treating panic symptoms within everyday clinical settings: the feasibility of a group cognitive behavioural intervention.

Panic disorder is a common and debilitating disorder that has a prevalence rate of 3-5% in the general population. Cognitive-behavioural interventions have been shown to be an efficacious treatment for panic, although a limited number of studies have examined the effectiveness of such interventions implemented in everyday clinical settings. The aim of the following pilot study was to examine the feasibility of a brief group cognitive-behavioural intervention carried out in a clinical setting. Salient issues in determining feasibility include: representativeness of patient group treated, amount of significant clinical change displayed and resources required to carry out the intervention. A small sample of GP-referred patients displaying panic symptoms completed a 2-week intensive cognitive-behavioural intervention. Results collected post-intervention revealed significant clinical reductions in panic, anxiety and depressive symptoms and marked improvement in mobility. These improvements were maintained at 12-month follow-up. Outcomes supported the feasibility of a brief group cognitive-behavioural intervention for GP-referred patients. Implications of these results are discussed in terms of implementing effective treatments in everyday clinical practice and developing a stepped care approach to treating panic symptoms.

[Cognitive milieu therapy and restraint within dual diagnosis populations]. / Kognitiv miljøterapi og tvang i behandling af dobbeltdiagnose.

INTRODUCTION: The use of restraint is common practice within psychiatry and is most frequently used with patients with a co-occurring serious mental illness and substance abuse or dual diagnosis. Furthermore restraint has being shown to have a negative impact on treatment outcomes and on the psychological wellbeing of patients. Cognitive behavioural therapy has been shown to contribute to positive treatment outcomes for a range of mental health problems, including schizophrenia and substance abuse. MATERIALS AND METHODS: The following study examined the incidence of restraint within a dual diagnosis inpatient ward before and after the implementation of cognitive milieu therapy. RESULTS: Data collected over a four-year period showed that the incidence of physical restraint was significantly reduced after the introduction of cognitive milieu therapy, and that this reduction was not offset by increases in other forms of restraint. CONCLUSION: The implications of these results are discussed regarding the use of restraint on dual diagnosis populations within psychiatric settings.

Validity of the BPRS, the BDI and the BAI in dual diagnosis patients.

AIM: The psychometric properties of the Brief Psychiatric Rating Scale, the Beck Anxiety Inventory (BAI), and the Beck Depression Inventory (BDI) were tested in a sample of 134 patients with a substance use disorder and a non-substance related psychiatric disorder in a special inpatient dual diagnosis treatment unit. METHODS: Subjects were assessed at baseline. At discharge on average 6 months post-intake, 78% of patients were re-assessed using the same instruments. All instruments were tested in (1) their ability to discriminate patients with different diagnoses at baseline and follow-up using comparison of area under the curves, and (2) their temporal stability. Moderator regression was used to test whether thought disorder at baseline had any effect on the test-retest rank-order stability of other instruments. FINDINGS: The BPRS Thought Disorder scale was able to discriminate between patients with and without schizophrenia spectrum diagnoses, and the BDI was able to discriminate between patients with and without mood disorders and schizoaffective disorders at intake to treatment, and each instrument was significantly better than the other at discriminating relevant diagnostic groups. Discriminant correlations between the BDI and the BAI were high and statistically significant. Moderator regression analyses showed no indication that any of the scales were less stable at higher levels of thought disorder. CONCLUSIONS: It is concluded that dual diagnosis patients can be reliably assessed for symptoms using the BDI and some subscales of the BPRS.