PROD-ALERT 2: replicating and extending psychiatric restraint open data analysis using logarithmic estimates of reporting trends.

Care, management, and statute each mandate restraint-reporting in psychiatric settings in England. PROD-ALERT in this journal ("PA1") correlated log incidence of restraint, log institutional size, and log detention. The period was September 2020 to August 2021. It showed a clear trend among reporters. Restraint correlated with institutional size and use of legal detention. Some large detaining providers reported no restraints per month despite that trend. Inference from size suggested that non-complete reporters restrained 1,774 people per month. This paper "PA2" develops analysis repeating it for September 2021 to August 2022. PA2 shows how to count L-information, i.e., questionable information, added by null reports, by applying an L-test to data sets. PA2 uses illustrative vignettes about human height to ground L-information scores from English restraint reporting. In PA2, reported restraint again correlates with size and detention as in PA1. PA2 shows evolving data. Providers still follow a trend in restraint by size and detention. Providers which newly report restraint are on trend. Inference suggests that non-complete reporters restrained 1,305 people per month (536-3233), 95% CI, a large but reduced number since PA1. English restraint data have an L-test L-information score of increase in information by a factor of L = 145. This is as surprising as claiming that an average English man of 1.72 m is 2.64 m tall. Persons restrained per month is a robust measure continuing to log-correlate with size and legal compulsion. Providers over a certain size who report null restraint probably have some. Restraint remains underreported in England. Imputation of incomplete reporters shows a large shrinking cohort of patients detained by incomplete reporters. Knowledge of this may promote reporting. Improved reporting, and the infrastructure and integrity it demands, may help providers measure and reduce restraint. PA1 remains unrefuted. L-test can measure L-information in intuitively representable ways. The informational effect of nulls on the reliable data set is similar to a claim that an average-heighted man is as tall as people with clinical gigantism.

Comparison of coercive practices in worldwide mental healthcare: overcoming difficulties resulting from variations in monitoring strategies.

BACKGROUND: Coercive or restrictive practices such as compulsory admission, involuntary medication, seclusion and restraint impinge on individual autonomy. International consensus mandates reduction or elimination of restrictive practices in mental healthcare. To achieve this requires knowledge of the extent of these practices. AIMS: We determined rates of coercive practices and compared them across countries. METHOD: We identified nine country- or region-wide data-sets of rates and durations of restrictive practices in Australia, England, Germany, Ireland, Japan, New Zealand, The Netherlands, the USA and Wales. We compared the data-sets with each other and with mental healthcare indicators in World Health Organization and Organisation for Economic Cooperation and Development reports. RESULTS: The types and definitions of reported coercive practices varied considerably. Reported rates were highly variable, poorly reported and tracked using a diverse array of measures. However, we were able to combine duration measures to examine numbers of restrictive practices per year per 100 000 population for each country. The rates and durations of seclusion and restraint differed by factors of more than 100 between countries, with Japan showing a particularly high number of restraints. CONCLUSIONS: We recommend a common set of international measures, so that finer comparisons within and between countries can be made, and monitoring of trends to see whether alternatives to restraint are successful. These measurements should include information about the total numbers, durations and rates of coercive measures. We urge the World Health Organization to include these measures in their Mental Health Atlas.

Neuropsychological functioning in health and mood disorder: Modulation by glucocorticoids and their receptors.

Numerous studies have shown that disturbances in hypothalamic-pituitary-adrenal (HPA) axis function and consequent hypercortisolaemia occur in a significant proportion of patients with mood disorders. This dysfunction has been proposed to be an exacerbating factor of depressive symptoms and may predict symptomatic relapse. Glucocorticoids are also known to have a specific role in learning and memory processes. In this review we present a brief overview of the relationship between HPA axis dysfunction and neuropsychological impairment in mood disorders and the specific links between glucocorticoids and cognition in health and illness states. Finally we examine the neuropsychological effects of drugs that specifically target glucocorticoid receptor function.