Identifying predictors of adverse outcomes after termination of seclusion in psychiatric intensive care units.

BACKGROUND: Seclusion is a restrictive practice that many healthcare services are trying to reduce. Previous studies have sought to identify predictors of seclusion initiation, but few have investigated factors associated with adverse outcomes after seclusion termination. AIMS: To assess the factors that predict an adverse outcome within 24 h of seclusion termination. METHOD: In a cohort study of individuals secluded in psychiatric intensive care units, we investigated factors associated with any of the following outcomes: actual violence, attempted violence, or reinitiation of seclusion within 24 h of seclusion termination. Among the seclusion episodes that were initiated between 29 March 2018 and 4 March 2019, we investigated the exposures of medication cooperation, seclusion duration, termination out of working hours, involvement of medical staff in the final seclusion review, lack of insight, and agitation or irritability. In a mixed-effects logistic regression model, associations between each exposure and the outcome were calculated. Odds ratios were calculated unadjusted and adjusted for demographic and clinical variables. RESULTS: We identified 254 seclusion episodes from 122 individuals (40 female, 82 male), of which 106 (41.7%) had an adverse outcome within 24 h of seclusion termination. Agitation or irritability was associated with an adverse outcome, odds ratio 1.92 (95% CI 1.03 to 3.56, P = 0.04), but there was no statistically significant association with any of the other exposures, although confidence intervals were broad. CONCLUSIONS: Agitation or irritability in the hours preceding termination of seclusion may predict an adverse outcome. The study was not powered to detect other potentially clinically significant factors.

Electroconvulsive Therapy as a Treatment for Somatization Disorder.

OBJECTIVE: To review the published literature over the last 10 years for the efficacy of electroconvulsive therapy (ECT) in refractory somatization disorder. DATA SOURCES: A comprehensive evidence search of the published literature in the last 10 years (2010-2020) was conducted using the search terms ECT, electroconvulsive therapy, efficacy, effectiveness, use of ECT, chronic pain, somatoform disorders, somatoform pain, somatic symptom disorder, and somatization disorder. The review was limited to articles written in the English language. Databases searched included PsycInfo, MEDLINE, PubMed, Embase, and Google Scholar. A supplementary citation search was also conducted by analyzing the reference lists of identified sources. STUDY SELECTION: The initial search revealed 31 articles of potential relevance. DATA EXTRACTION: The studies were analyzed by both authors to obtain clinical information relevant to meeting the objectives of the review. DATA SYNTHESIS: Five single case studies, 1 case series, and 1 open trial focusing on the use of ECT in somatization disorder were identified for inclusion in the review. There were no controlled trials or systematic reviews, and the evidence collated was of low quality. CONCLUSIONS: This review indicates that ECT may be an effective treatment option for severe and refractory manifestations of somatization disorder. However, further research is required in the assessment of the efficacy, safety, and tolerability of ECT in somatization disorder.

Electroconvulsive Therapy in Multiple Sclerosis: A Review of Current Evidence.

OBJECTIVE: To review the published literature over the last 5 years on the use of electroconvulsive therapy (ECT) in multiple sclerosis (MS), focusing on efficacy, safety, and tolerability. MS commonly has neuropsychiatric comorbidity. ECT is used in MS for severe and life-threatening forms of mental illness when other treatment options have failed or when a rapid response is required. DATA SOURCES: English-language literature published in the last 5 years (January 2015-June 2, 2020) was searched using the terms: ECT, electroconvulsive therapy, shock therapy, electroshock therapy, electroconvulsive therapies, multiple sclerosis, chronic progressive multiple sclerosis, acute relapsing multiple sclerosis, and multiple sclerosis, relapsing and remitting. KnowledgeShare, a National Health Service library application providing updates on evidence-based practice, was used along with EMBASE, PsycInfo, MEDLINE, PubMed, the TRIP database (which offers a complete and updated list of evidence-based online resources), HDAS (Healthcare Databases Advanced Search), CRDWeb (Centre for Reviews and Dissemination), and the Cochrane Library. Reference lists of articles identified in the search were also reviewed. STUDY SELECTION: Our initial search revealed 30 articles of potential relevance. However, after individually evaluating these articles, only 6 case studies and 1 review article detailing the use of ECT in MS were included. DATA EXTRACTION: The studies were analyzed by both authors to obtain clinical information relevant to meeting the objectives of the review. DATA SYNTHESIS: The efficacy and safety in using ECT for MS is derived only from case series and case reports. There were no controlled trials or systematic reviews, and the evidence collated was of low quality. CONCLUSIONS: The consensus is that ECT is an effective treatment for specific mental disorders in MS including catatonia. We have used ECT successfully in our clinic for patients with MS. However, there are concerns about the potential effects of ECT on neurologic and cognitive function. There are also possible risks with using anesthetic agents and particularly neuromuscular blockers.

Electroconvulsive Therapy as a Treatment for Tardive Dyskinesia.

OBJECTIVE: To review the published literature over the last 10 years for the use of electroconvulsive therapy (ECT) in tardive dyskinesia (TD), focusing on the efficacy of this treatment. DATA SOURCES: A comprehensive evidence search of the published literature in the last 10 years (2010-2020) was conducted using the search terms electroconvulsive therapy, electroshock therapy, ECT, tardive dyskinesia, and tardive dystonia. The review was limited to articles published in the English language. MEDLINE, Embase, PubMed, PsycInfo, Cochrane Library, Google Scholar, and the NICE (National Institute for Health and Care Excellence) guidelines were also searched. STUDY SELECTION: Twenty-three case studies published within the last 10 years were retrieved. The search revealed 5 articles of potential relevance. DATA EXTRACTION: The articles were analyzed by both authors to obtain clinical information relevant to meeting the objectives of the review. DATA SYNTHESIS: The efficacy in using ECT for TD is derived only from case series and case reports. There were no controlled trials, and the evidence collated was limited and of low quality. CONCLUSIONS: The review indicates that ECT could be considered as a treatment for TD. However, this treatment may only be considered when patients present with a coexistent refractory mood or affective disorder. Further clinical trials are needed to improve understanding regarding the efficacy, tolerability, and safety of using ECT in this patient group.

Early Diagnosis and Management of Bulimia Nervosa in Type 1 Diabetes.

Treatment outcomes for bulimia nervosa in type 1 diabetes are worse than those for conventional bulimia nervosa. These outcomes may be a consequence of late detection and subsequent management. The combination of these disorders has been referred to as diabulimia; however, this is not an official diagnosis and is a colloquial term used by patients and the media to describe the associated maladaptive pattern of compensatory behaviors. Early intervention is required to prevent short- and longer-term complications, with intensive treatment approaches having the best current evidence. Collaboration is required between specialist services for patients to receive optimal care. This narrative review summarizes the latest published evidence in the formulation, detection, and subsequent management of bulimia nervosa in type 1 diabetes, while highlighting the need for higher-quality research in the assessment and treatment of these comorbidities.

Psychiatric Disorder in Postural Orthostatic Tachycardia Syndrome and Ehlers-Danlos Syndrome-Hypermobility Type.

Postural orthostatic tachycardia syndrome (POTS) and Ehlers-Danlos syndrome-hypermobility type (EDS-HT) are disorders that have a strong association and share a relationship with some mental illnesses. Both are commonly misdiagnosed as mental disorders possibly because they share a similar phenomenology to some. There is limited awareness and recognition of POTS and EDS-HT, which subsequently delays diagnosis. The presence of an underlying mental disorder can complicate the diagnosis and management of an already challenging case, which can cause further strain to patients and their loved ones whose lives have already been destabilized significantly. National support groups have been established to support during the stressful periods of diagnosis and adjustment. In this article, the evidence for the various mental disorders that have been linked to POTS and EDS-HT is reviewed, while highlighting the need to satisfactorily screen for mental disorders in this patient group.​.