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Abstract Background Psychiatric sleep research has attempted to identify diagnostically sensitive and specific sleep patterns associated with particular disorders. Both schizophrenia and alcoholism are typically characterized by a severe sleep disturbance associated with decreased amounts of slow wave sleep, the physiologically significant, refreshing part of the sleep. Antisocial behaviour with severe aggression, on the contrary, has been reported to associate with increased deep sleep reflecting either specific brain pathology or a delay in the normal development of sleep patterns. The authors are not aware of previous sleep studies in patients with both schizophrenia and antisocial personality disorder. Case presentation The aim of the present case-study was to characterize the sleep architecture of a violent, medication-free and detoxified female offender with schizophrenia, alcoholism and features of antisocial personality disorder using polysomnography. The controls consisted of three healthy, age-matched women with no history of physical violence. The offender's sleep architecture was otherwise very typical for patients with schizophrenia and/or alcoholism, but an extremely high amount of deep sleep was observed in her sleep recording. Conclusions The finding strengthens the view that severe aggression is related to an abnormal sleep pattern with increased deep sleep. The authors were able to observe this phenomenon in an antisocially behaving, violent female offender with schizophrenia and alcohol dependence, the latter disorders previously reported to be associated with low levels of slow wave sleep. New studies are, however, needed to confirm and explain this preliminary finding.

PURPOSE The purpose of this study is to describe the therapeutic approach to a patient's criminal offense in a forensic mental health nurse-patient relationship from the nurse's perspective. DESIGN AND METHODS Eight nurses in a Finnish forensic psychiatric hospital were interviewed, and the resultant research material was analyzed by inductive content analysis. FINDINGS The results revealed the process of the therapeutic approach to a patient's offense, which comprises numerous steps and various phases. PRACTICE IMPLICATIONS For the nurse, the process of working through the offense can be divided into stages in which an attempt is made to respond to the patient's behavior and interaction in a manner that leads to working through the criminal act. [ABSTRACT FROM AUTHOR]

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 samplest-test. Between-group comparisons were analysed by the independent samplest-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. [ABSTRACT FROM PUBLISHER]

Background: Little is known of the use of mechanical restraint in adolescent psychiatry. Aims: To investigate the frequency and features of mechanical restraint in the field of Finnish adolescent psychiatry. Methods: The data were collected in the metropolitan area of Helsinki, Finland, with seven closed and eight open wards for Finnish-speaking 13-17-year-old adolescents. The official restraint reports and the hospital files of the restraint patients from January 2009 to December 2009 were collected and analyzed. Results: Among adolescents hospitalized in closed wards, the 1-year prevalence of mechanical restraint was 9.5%. Among all hospitalized adolescents, the prevalence was 6.9%. The number of mechanically restrained individuals per 100 000 13 to17-year -old Finnish-speaking inhabitants was 57.1. The median duration of the restraint episode was 4 h and 50 min, but almost half of the mechanical restraint episodes lasted 8 h or more. A quarter of restraint episodes were not based on reasons mentioned in the Finnish Mental Health Act. The most frequent diagnostic categories of mechanically restrained adolescents were mood disorders followed by schizophrenia-related as well as behavioral and emotional disorders. Suicidality preceded 40% and violence 61% of restraint episodes. Boys were restrained during the first days of hospital treatment significantly more often than were girls, whereas one in four girls experienced her first episode of restraint after 1 month of hospitalization. Conclusions: Reducing the number and shortening the length of mechanical restraint episodes requires education of staff as well as projects focusing on reducing coercion. The clinical guidelines must be followed at grassroots level. [ABSTRACT FROM AUTHOR]

Objective: To explore the characteristics of girls displaying frequent aggressive behaviors on an adolescent forensic psychiatric ward.Materials and methods: On an adolescent forensic ward, demographics, family, treatment, crime and victimization histories, diagnoses, and symptoms of all adolescents are collected in a cumulative database. Regarding these, girls displaying excessive aggressive behaviors were compared with other girls, all the boys, and boys displaying frequent aggressive behaviors. Their case histories were further qualitatively explored to find characteristics associated with female violence in the literature.Results: The studied girls were the most severely ill among adolescents admitted, and had suffered most the unfortunate backgrounds with parental mental disorders, poor parental management, early caregiver disruption, community disorganization, lack of social support, and being victims of sexual abuse. They displayed a wide range of psychiatric symptoms on different symptom dimensions.Conclusion: Treatment cannot focus solely on aggression management. Extensive psychiatric needs have to be met. [ABSTRACT FROM AUTHOR]

The article presents a study which highlighted the long-term effects of orlistat, a lipase inhibitor, in adult clozapine- or olanzapine-treated patients with "Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition" (DSM-IV)-diagnosed schizophrenia. The study showed that continued treatment with orlistat has no additional advantages as compared to short treatment. It also revealed that orlistat appeared to modestly decrease lipid levels.

Background: Psychiatric sleep research has attempted to identify diagnostically sensitive and specific sleep patterns associated with particular disorders. Both schizophrenia and alcoholism are typically characterized by a severe sleep disturbance associated with decreased amounts of slow wave sleep, the physiologically significant, refreshing part of the sleep. Antisocial behaviour with severe aggression, on the contrary, has been reported to associate with increased deep sleep reflecting either specific brain pathology or a delay in the normal development of sleep patterns. The authors are not aware of previous sleep studies in patients with both schizophrenia and antisocial personality disorder. Case presentation: The aim of the present case-study was to characterize the sleep architecture of a violent, medication-free and detoxified female offender with schizophrenia, alcoholism and features of antisocial personality disorder using polysomnography. The controls consisted of three healthy, age-matched women with no history of physical violence. The offender's sleep architecture was otherwise very typical for patients with schizophrenia and/or alcoholism, but an extremely high amount of deep sleep was observed in her sleep recording. Conclusions: The finding strengthens the view that severe aggression is related to an abnormal sleep pattern with increased deep sleep. The authors were able to observe this phenomenon in an antisocially behaving, violent female offender with schizophrenia and alcohol dependence, the latter disorders previously reported to be associated with low levels of slow wave sleep. New studies are, however, needed to confirm and explain this preliminary finding. [ABSTRACT FROM AUTHOR]