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Background: Patient aggression and violence against staff members and other patients are common concerns in psychiatric units. Many structured clinical risk assessment tools have recently been developed. Despite their superiority to unaided clinical judgments, staff has shown ambivalent views towards them. A constant worry of staff is that the results of risk assessments would not be used. The aims of the present study were to investigate what were the interventions applied by the staff of a psychiatric admission ward after a high risk patient had been identified, how frequently these interventions were used and how effective they were. Methods: The data were collected in a naturalistic setting during a 6-month period in a Finnish psychiatric admission ward with a total of 331 patients with a mean age of 42.9 years (SD 17.39) suffering mostly from mood, schizophrenia-related and substance use disorders. The total number of treatment days was 2399. The staff assessed the patients daily with the Dynamic Appraisal of Situational Aggression (DASA), which is a structured violence risk assessment considering the upcoming 24 h. The interventions in order to reduce the risk of violence following a high DASA total score (>= 4) were collected from the patients' medical files. Inductive content analysis was used. Results: There were a total of 64 patients with 217 observations of high DASA total score. In 91.2% of cases, at least one intervention aiming to reduce the violence risk was used. Pro re nata (PRN)-medication, seclusion and focused discussions with a nurse were the most frequently used interventions. Non-coercive and non-pharmacological interventions like daily activities associated significantly with the decrease of perceived risk of violence. Conclusion: In most cases, a high score in violence risk assessment led to interventions aiming to reduce the risk. Unfortunately, the most frequently used methods were psychopharmacological or coercive. It is hoped that the f

Ummetus ja närästys ovat häiritseviä ruuansulatuskanavan oireita, jotka kuitenkin usein jäävät huomiotta skitsofrenian somaattisten komorbiditeettien tutkimuksessa. Tässä tutkimuksessa pyrittiin arvioimaan ummetusta ja närästystä ja niitä selittäviä tekijöitä otoksessa avohoidon potilaita, joilla oli skitsofreniaspektrin psykoosisairaus. 275 potilasta kävi kattavassa yleislääkärin tutkimuksessa, hoitajan vastaanotolla, verikokeissa sekä täytti kyselylomakkeen. Monien eri sosioekonomisten, elintapa- ja kliinisten tekijöiden vaikutus ummetukseen ja närästykseen käytiin läpi ja analysoitiin logistisella regressioanalyysillä. Huomioon otettiin myös, josko oireet liittyivät joihinkin laboratorioarvoihin. Ummetusta oli 31,3%:lla ja närästystä 23,6%:lla potilaista. Parasetamolin ja klotsapiinin käyttö, vanhempi ikä sekä tuettu asuminen olivat riskitekijöitä ummetukselle. Närästyksen riksitekijöitä olivat naissukupuoli, tulehduskipulääkkeet ja diabeteslääkitys. Närästyspotilailla oli alhaisempi hemoglobiini ja hematokriitti sekä korkeampi glukoosiarvo ja ummetuspotilailla matalampi trombosyyttiarvo, mutta ne selittyivät näille oireille altistavilla tekijöillä. Klotsapiini lisää suuresti ummetuksen riskiä ja voi johtaa henkeä uhkaaviin seurauksiin. Lisäksi kipu- ja diabeteslääkkeet liittyivät myös ruuansulatuskanavan oireisiin. Näiden lääkkeiden vaikutukset ruuansulatuskanavassa tulisi pitää kirkkaana mielessä, kun hoitaa skitsofreniapotilaita., Background Constipation and dyspepsia are disturbing gastrointestinal symptoms that are often ignored in research on physical comorbidities of schizophrenia. Aims Our aim was to assess dyspepsia and constipation in a sample of outpatients with schizophrenia spectrum psychoses. Methods A general practitioner performed a thorough physical health check for 275 outpatients and diagnosed constipation and dyspepsia. We assessed the possible contribution of several sociodemographic, lifestyle, and clinical variables to constipation and dyspepsia using logistic regression analysis. We also assessed whether these symptoms were associated with abnormal laboratory findings. Results The prevalence of constipation was 31.3%, and of dyspepsia 23.6%. Paracetamol (OR=3.07, 95% CI 1.34–7.02) and clozapine use (OR=5.48, 95% CI 2.75–10.90), older age (OR=1.04, 95% CI 1.01–1.06), and living in sheltered housing (OR=2.49, 95% CI 1.16–5.33) were risk factors for constipation. For dyspepsia the risk factors were female sex (OR=2.10, 95% CI 1.15–3.83), non-steroidal anti-inflammatory drugs (OR=2.47, 95% CI 1.13–5.39), and diabetes medication (OR=2.42, 95% CI 1.12–5.25). Patients with dyspepsia had lower hemoglobin and hematocrit and higher glucose values than those without dyspepsia. Patients with constipation had lower thrombocyte values than patients without constipation. However, these findings were explained by factors predisposing to constipation and dyspepsia. Conclusions Clozapine use markedly increases the risk of constipation and may lead to life-threatening complications. In addition, analgesics and diabetes medication were related to gastrointestinal symptoms. These medications and their association to gastrointestinal symptoms should be kept in mind when treating patients with schizophrenia.

Background: Psychopathy, a severe disorder of personality, is well represented in the criminal and forensic psychiatric population and is significantly associated with increased risk of violence and crime. Fire-setting is a major source of property damage, injury, and death in many Western countries. The primary aim of this study was to evaluate psychopathic traits in a consecutive sample of Finnish male pretrial fire-setting offenders. Further, we wanted to investigate whether fire-setting recidivists show higher traits of psychopathy than one-time firesetters and whether exclusive firesetters show lower traits of psychopathy than those with criminal versatility. Methods: The forensic psychiatric examination statements for male firesetters who underwent a pretrial forensic psychiatric evaluation during a 10-year period (1989 - 1998) were reviewed. The sample comprised 129 firesetters with normal IQ, 41 of whom were fire-setting recidivists. Fifty men were exclusive firesetters. Assessment of psychopathy-like personality character was performed using the 20-item Hare Psychopathy Checklist-Revised. Results: Two individuals (1.6%, 95% CI: 0.0-3.7) scored >= 30 points and 19 (14.7%, 95% CI: 8.6-20.8) >= 25 points on the PCL-R. The mean PCL-R total score was 16.1 (SD 6.88), the mean Factor 1 score 5.0 (SD 3.41), and the mean Factor 2 score 9.9 (SD 3.86). No significant differences emerged between the recidivists and the one-time firesetters. The versatile firesetters exhibited significantly higher mean total and factor scores than the exclusive ones. Conclusion: Among firesetters, there is a subgroup of persons with significant psychopathic traits, which should be recognized in legal and health care organizations. Although psychopathy was associated with greater criminal versatility, it bore no relationship to fire-setting recidivism.