Restraint Episodes Research Articles

Clinical review of clozapine treatment in a state hospital.

Medical records of the first 37 patients to begin clozapine treatment at a state hospital in Oregon were reviewed for six months before clozapine treatment and six months after. Patients had a long history of schizophrenia and had responded poorly to antipsychotic medication. Clozapine treatment was generally well tolerated, although the rate of seizures (8 percent) was slightly higher than expected. Psychotic symptoms decreased as measured by the Brief Psychiatric Rating Scale, as did symptoms of tardive dyskinesia as measured by the Abnormal Involuntary Movement Scale. Thirty-four patients remained hospitalized after six months of treatment. However, indicators of social function (hospital privilege level, community passes, violent episodes, and episodes of seclusion and restraint) all showed that patients improved markedly after receiving clozapine.

Can a "Credit Crunch" Be Efficient?

Two observations have sometimes been viewed as evidence that the equilibrium allocations of intermediated credit markets are inefficient. First, low-income households' marginal propensity to consume is close to unity. Second, even high-income households seem to face nonprice constraints during recessions. This paper presents a model that possesses both of these features. (A recession is modeled as an economy in which the equilibrium level of investment is at its lowest possible level.) However, contrary to the conventional view, the equilibrium of this model is ex ante efficient. The model also sheds light on some historical episodes of credit restraint.

Cellular and learned tolerances to pentobarbital ataxia

Pentobarbital was administered to 4 groups of rats: 1) intermittently before testing on the rotarod (RR) (experienced, EXP), 2) chronically (CHR) before testing on the RR (EXP), 3) intermittently (INT) after being tested on the RR (NONEXP), and 4) chronically (CHR) after being tested on the RR (NONEXP). On postchronic testing, Group 1 (INT/EXP) failed to show tolerance to the RR decrement, related to prechronic scores, while Group 3 (INT/NONEXP) actually showed an enhanced RR decrement. Group 2 (CHR/EXP) and Group 4 (CHR/EXP) both exhibited prominent tolerance to RR impairment at the postchronic test, with a nonsignificant trend for greater tolerance in Group 2. The lack of an expressed behavioral tolerance in INT/EXP rats and the enhanced RR decrement in INT/NONEXP subjects at the postchronic test was attributed to repeated use of a towel wrap restraint during the chronic treatment period. When the prechronic tests for INT/EXP animals were separated into the first 3 and last 3 days, pentobarbital impairment of RR during days 4–6 was significantly less than during days 1–3. This tolerance in INT/EXP rats was lost at the postchronic testing, while INT/NONEXP subjects had by then developed an enhanced RR impairment to pentobarbital. Following postchronic testing, chronic pentobarbital (CHR/EXP and CHR/NONEXP groups) and chronic vehicle (INT/EXP and INT/NONEXP groups) were discounted for 9 days (withdrawal), after which an intermediate dose of the drug was tested on RR performance. Next, 9 days of extinction training involved vehicle injection daily before testing RR performance, after which the intermediate drug dose was again tested. INT/EXP and INT/NONEXP groups showed no change in RR impairment at the postwithdrawal and postextinction tests. However, in CHR/EXP rats pentobarbital tolerance was partly lost at the postwithdrawal test, with a significantly greater loss at the postextinction test. group showed a prominent loss of tolerance at the postwithdrawal test and no significantly greater loss at the postextinction test. Analysis of serum and brain concentrations of drug in other rats identically treated up to the postchronic period yielded evidence of metabolic and cellular tolerances in the chronically treated groups (2 and 4). Additionally, behavioral tolerance appeared to form as a function of drug experience in the CHR/EXP group. INT/EXP subjects (Group 1) failed to express behavioral tolerance during the postchronic test despite drug experience and the INT/NONEXP (Group 3) showed enhanced RR decrement, probably as the result of an interfering factor of repeated episodes of towel wrap restraint.

Precipitants of Violence in a Psychiatric Inpatient Setting

Data gathered from the medical record and in interviews with staff and patients in an inpatient psychiatric setting at a Veterans Affairs medical center were used to examine events preceding 73 episodes in which patients were placed in four-point restraints. The behaviors leading to restraint included physical aggression, verbal threats, and threats with an object as a weapon. These behaviors were more likely to relate to external situations than to the patient's internal psychiatric symptoms. Staff were most frequently the target of patients' aggression, and patients were more likely to view the events leading to restraint as conflict with staff. No differences in the subsequent number of restraint episodes or hours in restraints were found between patients with positive and negative responses to the index restraint episode.

Impact of therapeutic management on use of seclusion and restraint with disruptive adolescent inpatients.

Use of seclusion and restraint on three inpatient adolescent psychiatric units was examined during two five-month periods before and after implementation of a "therapeutic management" protocol. Under the protocol, staff classified disruptive behaviors into four stages and provided verbal and behavioral interventions to control behavior at each stage. Patients who required seclusion and restraint had significant latitude to determine the timing of their release from the interventions and met with staff one hour and 24 hours after their release to explore alternatives to aggression. The number of episodes of seclusion and restraint fell by 64 percent after the protocol was adopted, and the number of patients who required those interventions dropped by 39 percent. The mean duration of episodes of seclusion and restraint was reduced by 59 percent. Therapeutic management provides a corrective experience by addressing the developmental needs, deficient cognitive skills, and poor internalized controls of disruptive adolescents.

Involuntary and voluntary psychiatric patients: a pilot study of resource consumption.

This pilot study compares the resources utilized caring for "voluntary" and "involuntary" patients in a community hospital inpatient psychiatric unit. "Voluntary" patients committed less episodes of violence. "Emergency involuntaries" experienced more episodes of restraint and were involved in more violent episodes than "other involuntaries". A critical predictor of behavior was whether patients were brought to the hospital by police. Implications for public policy and psychiatric DRGs (diagnosis related groups) are discussed.

Signs and Symptoms in Psychiatry

Signs and Symptoms in Psychiatry

The experimental production of resistance to stress-induced stomach lesions in the rat

A significant degree of stress-specific protection against the ulcerogenic effects of either restraint or enforced running can be produced in rats by exposing them to several brief, daily episodes of either restraint or enforced running. The specificity of the protection suggests that somewhat different physiological factors are involved in the production of stress ulcers by these two procedures. Further research is planned to determine whether generalized immunity can be produced by non-pharmacological non-surginal techniques.

Clinical course and prevalence of coercive measures: an observational study among involuntarily hospitalised psychiatric patients.

In daily clinical work, coercion continues to be highly prevalent, with rates differing between countries and sometimes even within countries or between wards of the same hospital. Previous research found inconsistent characteristics of individuals who underwent coercive measures during psychiatric treatment. Furthermore, there continues to be a lack of knowledge on the clinical course of people after being involuntarily committed. This study aimed to describe the rate and duration of different coercive measures and characterise a cohort of involuntarily committed patients regarding sociodemographic and clinical variables. In this observational cohort study, we analysed clinical data from the patients' medical files, the use of coercive measures (seclusion, restraint, coercive medication) and other procedural aspects in involuntarily hospitalised patients (n = 612) at the University Hospital of Psychiatry Zurich. For analysis, we used cross-tabulation with chi-square tests for categorical variables and, owing to a non-normal distribution, the Mann-Whitney U-test for interval variables. Coercive measures were documented in 170 patients (28% of those who were involuntarily hospitalised). The total number of seclusions was 344, with a mean duration of 9 hours per seclusion. A total of 89 patients (15%) received 159 episodes of coercive medication (oral and intramuscular). Also, 11 episodes of restraint were recorded in 7 patients (1%) with a mean duration of 12 hours per restraint. Patients subjected to coercion were significantly more often male, violent prior to admission, diagnosed with psychosis or personality disorder, and had a history of frequent hospitalisations with long durations of hospitalisation. The prevalence of coercive measures is still high in involuntarily hospitalised patients. Seclusion was the most frequently used coercive measure, which may be based on cultural and clinical aspects and differs from findings in other countries where restraint is more frequently used. Some sociodemographic and clinical characteristics were associated with the use of coercion. This underlines the importance of developing treatment strategies for patients at risk to prevent situations in which the use of coercion is necessary. To enable comparison between different study sites, standardised protocols should be used to document frequency and duration of coercive measures.