Suicide behaviours in incarcerated males: Links to psychopathic traits,forms of aggression to others,personal characteristics,and current penitentiary variables

Self-injurious behaviours and suicide attempts among incarcerated people are higher when compared with the general population. The current research is designed to examine the prevalence of self-injurious behaviours and suicide attempts among incarcerated males in Spain, and the factors associated with these behaviours. 201 men imprisoned in Spain completed anonymous self-report measures of demographic variables (e.g., age, marital status), the Triarchic Psychopathy Model (boldness, meanness, and disinhibition) and impulsive/premeditated aggression and aggressive behaviour (including physical, verbal, hostility, and anger). Official records were also consulted for information related to criminality (i.e., prior imprisonment and type of offence). Overall, 37.5% of residents reported having injured themselves at a time of anger or despair and 24.9% reported attempting suicide at any point in their lives. Lower scores in meanness, higher scores on impulsive aggression, serious illnesses and previous imprisonment were associated with an increased risk of self-injurious and/or suicide attempting behaviours. Being married acted as a protective factor of attempting suicide. Trait variables related to psychopathy (lower meanness) and aggression (higher impulsive aggression) were associated with increased frequency of suicide attempts in prisoners even after controlling for personal and criminal variables. The prevention of high rates of suicide in prisons needs the treatment of those cognitive variables in addition to more contextual personal and criminal variables.     

La consultation psychiatrique d’Yves Pélicier ou l’art de la biographie

The teaching and clinical practice of professor Yves Pélicier contributed to the international development of a psychiatry centered on the whole of the person in a humanist approach. The theoretical developments were marked by the authenticity of the practice of the therapist and its deep sense of the human being thus truly founding a School.     

Sécurisation de la prise en charge médicamenteuse des patients sous antipsychotiques : impact de la collaboration médico-pharmaceutique à la Maison d’Arrêt de Lyon-Corbas

ObjectiveAntipsychotics are the standard treatment for psychosis. However, when combined with other lifestyle factors they are partially responsible for an excessive mortality rate. A clinical and paraclinical monitoring of patients is therefore necessary. In 2011, this element led doctors and pharmacists to improve monitoring and formalize a follow-up adapted to inmate patients. The aim of this study was to assess the impact of medical-pharmaceutical collaboration on monitoring quality of patients treated by antipsychotics.MethodsThis is a retrospective study including all patients treated by antipsychotics for at least 6 months in 2011 and again in 2015. Data were collected from medical files. The indicator assessing the monitoring quality was the compliance percentage, of registred parameters for each patient on the basis of specific guidelines.ResultsIn 2015 compared to 2011, the monitoring quality increased for 9 out of 10 parameters. This improvement was statisticaly significant for 7 of them : Body Mass Index, lipid test, complete blood count, transaminase, ionogram, glycemia, glomerular filtration rate.ConclusionThe actions of improvement collectivelly implemented in 2011 had a concrete impact on patients in the follow-up in 2015.     

江苏地区1260名精神科女护士主观幸福感的调查研究

目的 了解江苏地区精神专科医院临床女护士主观幸福感的现状及影响因素,为提高精神专科医院的管理水平提供参考依据。方法 采用中文版的“总体幸福感量表”和自制的“一般情况调查表”对江苏省不同地区的6所精神专科医院1260名女护士进行调查。 结果 被调查对象主观幸福感前18项总分为(67.89±14.09)分,处于中等幸福感49～72分之间,但显著低于全国女性常模(71.00±18.00)分,两者比较,t =-2.768,差异有统计学意义(P<0.01)；经回归分析,其主要影响因素有对职业伤害的担心程度、家庭的支持程度、收入状况、医院支持系统的满意度,差异均有统计学意义(P<0.01或P<0.05)。结论 江苏地区的精神科女护士主观幸福感总体处于中等水平但显著低于全国女性常模,提高其主观幸福感可以从减少精神科护士的职业伤害、关注家庭方面影响、建立合理的薪酬体系和高效的医院支持系统4个方面努力。     

Safety and Efficacy of Accelerated Repetitive Transcranial Magnetic Stimulation Protocol in Elderly Depressed Unipolar and Bipolar Patients

Objective

Major depressive disorder (MDD) is a prevalent condition in older adults. Although antidepressant drugs are commonly prescribed, efficacy is variable, and older patients are more prone to side effects. Repetitive transcranial magnetic stimulation (rTMS) is an alternative therapy used increasingly in the treatment of MDD. Even though recent studies have shown efficacy of rTMS in elderly depressed patients, the safety and efficacy of accelerated rTMS has not been studied in this population.

Vaccinations in prison settings: A systematic review to assess the situation in EU/EEA countries and in other high income countries

IntroductionIn 2016, more than 600,000 persons were being held in EU/EEA correctional facilities on a given day. People in prison may be at risk of vaccine-preventable diseases. While vaccination recommendations for people in prison exist, little is known on coverage and implementation options.MethodsWe performed a systematic review on existing evidence on vaccination in prison settings in the EU/EEA. We searched peer-reviewed and grey literature following international methodology and reporting standards, to gather records published between 1980 and 2016 in all languages. We analysed quantitative (acceptance, uptake, cost-effectiveness) and qualitative (barriers) outcomes.ResultsOut of 7041 identified records, 19 full-text articles were included from peer-reviewed literature and two from grey literature. Of these, 18 reported on hepatitis A and/or B virus (HAV/HBV), two on influenza and one on MMR vaccination. Two studies on HAV vaccine reported varying acceptance (5–91%) and uptake rates (62.9–70.5%). Seven studies reported on HBV vaccination. A comparative study showed a significantly higher uptake of the third HBV vaccine dose with the very rapid (63%) compared to the standard schedule (20%). HBV vaccination was generally well accepted (54–100%), whereas uptake was variable (dose 1:23–100%, dose 2:48–92%, dose 3:19–80%). One study on the combined HAV/HBV vaccine reported an acceptance rate of 34%, and declining uptake following dose 1. One study on influenza vaccine showed an uptake of 42–46%, while another reported a MMR vaccine acceptance of 80% and an uptake of 74%. Overall, main reasons for non-vaccination included release from/or transfer between prisons, and refusal.ConclusionsThis systematic review highlighted important knowledge gaps and operational challenges for vaccination in prison settings. Vaccination is an effective measure that warrants comprehensive and tailored implementation to reduce the preventable disease burden, avoid risks of large outbreaks of vaccine-preventable diseases, and contribute to health equity for people in prison.     

The Extension of the Crimes (Mental Impairment and Unfitness to be Tried) Act 1997 to the Children’s Court: Opportunities and Shortfalls

In 2014, the Crimes (Mental Impairment and Unfitness to be Tried) Act 1997 in Victoria was extended to the Children’s Court of Victoria. This article describes the processes that preceded this change and the changes that occurred. The potential opportunities consequent to the changes are described, with their corresponding ethical implications. The decision not to resource some of the changes as recommended by the Victorian Law Reform Commission is described, with reference to the lack of establishment of an adolescent forensic mental health facility. The shortfalls currently occurring and their ethical implications are also discussed. We note the need for data regarding the number of children whose matters are being heard under the Crimes (Mental Impairment and Unfitness to be Tried) Act 1997, and the resourcing implications that flow from this.     

WFSBP guidelines on how to grade treatment evidence for clinical guideline development

Objective and methods: This paper reviews sources of data typically used in guideline development, available grading systems, their pros and cons, and the methods for evaluating risks of bias in publications, and proposes a revised method for grading evidence and recommendations for use in development of clinical treatment guidelines.

Results: The new World Federation of Societies of Biological Psychiatry (WFSBP) grading system allows guideline developers to follow a multi-step approach of defining levels of evidence, applying criteria for grading (define the acceptability) and the grading of recommendations.

Conclusions: Further, these updated WFSBP recommendations for rating evidence and treatment recommendations provide a grading system that takes into account potential biases in sources of evidence in arriving at final ratings that are likely more clinically meaningful and pragmatic and thus should be used for the development of future treatment guidelines.     

Contrainte carcérale,soin et prise en charge en art-thérapie

AimsThis article is a reflection on the issues of health and care in prison in the setting of art therapy workshops. The questions raised by the practice of art for therapeutic purposes lead on to consideration of many forms of relationships between the individual and society.MethodAn ecological approach makes it possible to take the individual into account via a set of phenomena, using the contemporary art therapy methods specific to the Association Française de Recherches et Applications des Techniques Artistiques en Pédagogie et Médecine (AFRATAPEM). This approach takes the form of a phenomenology of artistic action for therapeutic purposes. The artistic phenomenon is articulated around four phases: impression, intention, action and production.ResultsThe results show that art affords scope for change by way of the use of concepts and phenomena that belong to the artistic phenomenon as a whole. The plasticity that is an integral part of the phenomenological organisation of humans can be used in art therapy. Prison changes people as a result of its violence, while art therapy can help to reduce its harmful impact.DiscussionIn prison, relationships are controlled, and maintained at a certain level of violence, which is coherent with the setting. Thus, in the care plan offered to a detainee, the question of health and well-being is central to the social issues involved, and to how they are dealt with. It is for caregivers to assess the limits of tolerability, and when the intolerable threatens the very humanity of the individual, the legitimacy of the response needs to be discussed. The prison environment lays claim to legitimacy that could be understood as way of changing society. The person discharged after a prison sentence carries with him violence that compounds the violence pre-existing his incarceration. Because imprisonment is not envisaged in terms of its function and in the long term, just as the economy has not taken account of ecology, prisons no longer protect society from violence, but, quite the reverse, manufacture and disseminate it.     

Multiple Administrations of Intravenous Thrombolytic Therapy to a Stroke Mimic

BackgroundPatients who present emergently with focal neurological deficits concerning for acute ischemic stroke can be extremely challenging to diagnose and treat. Unnecessary administration of thrombolytics to potential stroke patients whose symptoms are not caused by an acute ischemic stroke—stroke mimics—may result in patient harm, although the overall risk of hemorrhagic complications among stroke mimics is low.Case ReportWe present a case of a stroke mimic patient with underlying psychiatric disease who was treated with intravenous alteplase on four separate occasions in four different emergency departments in the same city. Although he did not suffer hemorrhagic complications, this case highlights the importance of rapid exchange of health information across institutions to improve diagnostic quality and safety.Why Should an Emergency Physician Be Aware of This?Increased awareness of stroke mimics by emergency physicians may improve diagnostic safety for a subset of high-risk patients. Establishing rapid cross-institutional communication pathways that are integrated into provider's workflows to convey essential patient health information has potential to improve stroke diagnostic decision-making and thus represents an important topic for health systems research in emergency medicine.