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To evaluate forensic and secure mental health services (FSMHS) staff’s confidence in managing workplace aggression, identify associated factors, and explore their workplace aggression prevention training needs.Through an online survey, staff rated their experience of workplace aggression, perceived effectiveness of current training, and confidence in responding to workplace aggression, and described training needs. Stepwise multiple regression was used to identify associated factors with statistical significance. Thematic analysis was used to generate themes describing their training needs.The staff perceived current training as low-to-medium in effectiveness, mirroring their confidence in managing workplace aggression. Nurses experienced more workplace aggression compared to other professions. Staff working at High Security perceived current training as less effective compared to those working at Medium Security or Low Security. Qualitative findings underscored the necessity for improved training content, methods, and supportive strategies.Recommendations for enhancing training include: tailoring training to FSMHS settings; equally focussing on both non-physical and physical intervention techniques; providing more scenario-based hands-on practice opportunities; delivering training in a reasonable trainer-trainee ratio; prioritising nurses and High Security staff and integrating other professions into the training framework; and implementing strategies that support staff, consumers, and environment to ensure training effectiveness and applicability. [ABSTRACT FROM AUTHOR]

Background: Although clozapine is the most effective antipsychotic for people with treatment-resistant schizophrenia (TRS), only 40% of people with TRS respond, and there is limited evidence for augmentation agents. Cannabidiol (CBD) reduces positive symptoms in individuals with schizophrenia, but no trials have specifically examined its efficacy in those with clozapine-resistant schizophrenia., Aims: To examine the clinical efficacy of CBD augmentation in people with clozapine-resistant schizophrenia., Method: This is a 12-week randomised, placebo-controlled, double-blind, parallel-group trial (registration number: ACTRN12622001112752). We will recruit 88 individuals with clozapine-resistant schizophrenia, randomised (1:1) to 1000 mg daily CBD versus placebo. Eligible individuals will be aged between 18 and 64 years, fulfil DSM-IV criteria for schizophrenia or schizoaffective disorder, have a total PANSS (Positive and Negative Syndrome Scale) score ≥60, have received oral clozapine for at least 18 weeks and have a clozapine level of >350 ng/mL. Interim analyses will be conducted at 25, 50 and 75% recruitment; these will also provide an opportunity to reallocate participants dependent on conditional power. The primary endpoint will be the difference in PANSS positive scores at the end of week 12. Secondary endpoints include depression, anxiety, sleep, quality of life, alcohol consumption, change in weight and metabolic syndrome components, and neurocognitive measures, as well as safety and tolerability., Discussion: Novel treatments for clozapine-resistant schizophrenia are urgently needed. If found to be effective, CBD may have a role as a novel and safe adjunct to clozapine.

Objectives: This 'Realist Review' aimed to investigate the factors associated with length of stay and outcomes of medium secure care to help inform the development of a local secure care pathway., Method: The searches generated a total of 1570 entries across multiple search engines. Following removal of duplicates, application of inclusion/exclusion criteria and selection of articles, a total of 18 were reviewed in detail, including a further five articles obtained from references and the explored grey literature., Results: Several issues influenced not only admission to medium secure units, but also the outcomes. Many articles were retrospective studies relying on administrative data. The realist synthesis provides contextual data to inform program development., Conclusions: The existing literature, though variable in quality, was limited by the varied jurisdictions and contexts. However it may be useful to inform care pathways for the optimal use of medium secure beds., Competing Interests: DisclosureThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The authors declare that research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

The purpose of this study was to compare the accuracy of clinical methods to estimate body fat (%BF) in people who take weight-inducing atypical antipsychotic medications. Forty-seven people (35 males, 12 females) with previously diagnosed psychotic illness who had been taking atypical antipsychotic medications for more than 6 months took part in this study. Percentage body fat was estimated using bioelectrical impedance analysis (BIA) and anthropometry from previously published prediction equations and compared with that measured using the deuterium dilution technique which served as the criterion measure. Bland-Altman analyses were used to assess the agreement between measures. In the males, %BF determined using BIA with the Lukaski equation was the only clinical method with mean differences that were not significant from criterion values. While in the females, %BF determined from BMI was the only method that was significantly different from the criterion values. All of the methods of estimating %BF except Watson equations provided consistent estimates across the weight range. Therefore, this study suggests that in a group of people who predominantly had schizophrenia and were taking atypical antipsychotic medications, BIA using the equation of Lukaski was the best indicator of %BF, although on an individual basis the accuracy was poor. BMI underestimated %BF to a greater significant extent than BIA. The use of BIA rather than BMI may provide a better indicator of adiposity in people who take weight inducing antipsychotic medications.