Predictors for early and long-term readmission in involuntarily admitted patients.

BACKGROUND: It is a common aim to reduce psychiatric readmissions. Although risk factors for readmissions were described, specific data in the group of patients with potentially aversively experienced involuntary admissions are lacking. To better understand underlying mechanisms, it is important to identify factors that are linked to readmissions in this specific patient group, which is the purpose of the current paper. METHODS: A four-year cohort of N = 3575 involuntary admissions (IA) was followed-up for subsequent re-hospitalization. Demographic, administrative and clinical factors associated with short- (within 30 days) or long-term (> 30 days) readmissions were examined using logistic regression modelling. RESULTS: Almost half of all IA cases were readmitted within the observation period, whereof every fifth readmission was within the first month after discharge from the involuntary index hospitalization. Adjusted regression modelling revealed problematic substance use at admission and assisted living or homelessness as risk factors for readmission, while high functioning at discharge, anxiety disorders, no subsequent treatment after discharge or IA due to danger to others were negatively associated with readmission. Factors specifically linked to short-term readmission were substance use and personality disorders, abscondence or discharge by initiation of the clinic, as well as being discharged to any place except the patient's home. There were no specific risk-factors for long-term readmission. CONCLUSIONS: To prevent readmissions after IA, especially for patients at risk, the aim of treatment strategies should be to focus on intensive discharge planning, enable continuous treatment in the outpatient setting, and provide social support.

[Forensic-Psychiatric Consultations in General Psychiatry]. / Forensisch-psychiatrisches Konsilangebot für die Allgemeinpsychiatrie.

A subgroup of psychiatric patients are at increased risk of committing interpersonal violence, which may lead to placements in forensic-psychiatric institutions. The majority of patients treated in forensic hospitals have had contact with the general psychiatric care system years before being forensically committed due to an offence. Nevertheless, attempts to establish models related to violence prevention in general psychiatry have remained sparse. In the Canton of Zurich, the forensic psychiatric consultation liaison service provides the general psychiatric clinics with access to forensic psychiatric expertise. In this paper, we describe the consultation service's diagnostic and advisory offers and aim to characterize the patient population seen by the service. We compared the three most common diagnostic groups (schizophrenic, affective and personality disorders) regarding reason for consultation, history of violence and substance abuse. In addition, we analyzed content and kind of the recommendations made. From 2013 to 2021, 188 patients in general psychiatric clinics in Zurich have been examined after informed consent. Most patients had a positive history of violence (72.7%) and substance use (66.1%). Almost half of the patients (48.4%) had been diagnosed with schizophrenia or a related disorder.

[Which Treatment Setting is Suited for Forensic Inpatients Aged≥60 Years?A Systemic Literature Analysis]. / Welches Behandlungssetting ist für stationäre forensische Patienten im Alter ≥ 60 Jahre geeignet?Eine systematische Analyse der Literatur.

In the inpatient correctional system, the question of a suitable treatment setting for older forensic inpatients (i. e. ≥60 years) arises against the background of demographic change. In this regard, the research literature was examined using four medical databases (PsycInfo, Medline, Embase, Web of Science) for relevant keywords (elderly offender/perpetrator, aged, mental disorder, forensic treatment, forensic psychiatry). Out of 744 pre-selected articles, only 5 studies made it into the final selection. The majority of the sample is composed of men with previous criminal justice experience, who may be mentally and/or physically ill. Placement and capacity problems as well as a lack of age-appropriate infrastructure are reported. Based on the study results, an empirical recommendation regarding a suitable treatment setting cannot be given.

Predicting coercion during the course of psychiatric hospitalizations.

BACKGROUND: Coercive measures (such as seclusion, mechanical restraint, and forced medication) during psychiatric inpatient treatment should be avoided whenever possible. Different interventions were already developed to reduce coercion, but for their effective application, it is crucial to know the risk factors of individuals and clinical situations that might be associated with coercion. Since the results of previous studies differ considerably the current study aims to fill this gap by evaluating the course of the exertion of coercion in detail. METHODS: In this study, we analyzed clinical, procedural, and sociodemographic data from patients (n = 16,607 cases) who were treated as inpatients in Switzerland's largest psychiatric institution with 320 beds during the years 2017 to 2020. We used regression models to identify predictors for the exertion of coercion, the number of coercive measures during a treatment episode and time until exertion of the first and last coercive measure. RESULTS: Coercive measures are mostly used during the first days of treatment. We identified clinical parameters such as manic or psychotic episodes to be the most relevant predictors for the exertion of coercion. Cases with those disorders also received coercion more often and earlier in their treatment course than other diagnostic groups. Other promoting factors for frequency and early application of coercion were involuntary admission and factors of chronicity and clinical severity. CONCLUSIONS: Knowing the risk factors may help to target preventive strategies for those at highest risk. In particular, interventions should focus on the critical timeframe at the beginning of treatment.

Social exclusion evokes different psychophysiological responses in individuals high on the psychopathy facets fearless dominance and self-centered impulsivity.

Individuals with psychopathic personality traits are generally thought to have difficulties in processing and experiencing emotions. These difficulties could also translate to emotionally charged social situations such as social exclusion. Being socially excluded is often experienced as stressful and unpleasant, potentially even leading to selfish or aggressive behavior-both of which are linked to certain aspects of psychopathy. The current study investigated self-report and physiological responses to social exclusion in the cyberball paradigm in a carefully selected community sample of individuals either scoring high on primary (N = 24) or secondary psychopathy traits (N = 17). Across the sample, the cyberball paradigm decreased experiences of joy and approach motivation, increased subjective anger reports, and induced changes in heart rate. In contrast, individuals scoring high on secondary psychopathy traits (Self-Centered Impulsivity group) displayed stronger physiological reactivity during a habituation phase of prolonged social exclusion than individuals scoring high on primary psychopathy traits (Fearless Dominance group), indexed by changes in skin conductance level. Moreover, a potential mismatch between self-reported and physiological arousal seemed to be only observable in individuals with high secondary psychopathy traits. Overall, the current results suggest diverging patterns of emotional processing and regulation in a social exclusion situation when comparing well-functioning individuals with varying psychopathy traits. It seemed as if individuals high on primary psychopathy traits were insensitive to contextual social cues, while individuals high on secondary psychopathy traits were more affected by the potentially threatening social situation. Cautiously transferring the current findings to forensic samples, they support the idea of moving from a behavioral understanding of the psychopathy construct to a more clinical picture with distinct cognitive and emotional processing patterns in individuals high on either primary or secondary psychopathy traits.

Utility and validity of the Brief Psychiatric Rating Scale (BPRS) as a transdiagnostic scale.

The Brief Psychiatric Rating Scale (BPRS) was originally conceived to assess psychopathology in several psychiatric disorders, making it an appropriate candidate to be used as a transdiagnostic instrument. We analyzed the utility and validity of the BPRS in a diagnostically heterogeneous sample of 600 psychiatric inpatients. As a comparator, we chose the mini-ICF-APP, a scale used to measure functioning and impairment across the diagnostic spectrum. Both scales had good internal consistency. The BPRS and the mini-ICF-APP showed a moderate correlation, with good levels of agreement. We were able to identify general symptoms present across the diagnostic spectrum, influencing severity and a cluster of symptoms specific for each diagnosis. Our results show the utility and validity of the BPRS as a transdiagnostic assessment tool that could easily be introduced in routine clinical work.

Aims to Reduce Coercive Measures in Forensic Inpatient Treatment: A 9-Year Observational Study.

Protecting the human rights is particularly important within the forensic context because patients in forensic psychiatry are not admitted voluntarily and so the treatment itself is of a coercive nature. Coercive measures (i.e., actions against the will of the patient such as forced medication, seclusion or restraint) form an additional incision of personal rights. Although the use of coercion within forensic psychiatric institutions remains controversial, little empirical research has been conducted on the use of coercive measures within forensic settings. The study presented here can contribute to close this research gap by informing about rates of coercive measures within the present institution. National and international organizations on the prevention of torture or inhuman or degrading treatment have emphasized the need to keep the incidents of coercive measures to a minimum. Criticisms by such organizations on high rates of seclusion, restraint, and compulsory medication have led to organizational changes within the present institution which is Switzerland's largest forensic clinic with an average of 124 patients per year. After a first visit of such a committee, e.g., the detailed documentation of coercive measures became obligatory and part of special reports. Changes in the use of coercive measures are presented here. Data on coercive measures was analyzed for years 2010 to 2018. With respect to the most invasive coercive measurement, restraint, a minimum of four patients in 2017 and a maximum of 14 patients in 2010 have been subject to this form of coercive measurement. A minimum of sixteen patients in 2012 and a maximum of 40 patients in 2010 were secluded. Though total number and duration show a trend towards a reduction in severity of coercive measures on average, a few patients are not responsive to deescalating interventions. Preventive mechanisms, documentation standards, and efforts to ensure humane and adequate treatment are discussed under ethical considerations of coercive measures within court mandated treatment.

[Depression and Violence: A Contradiction?] / Depression und Gewalt: Ein Widerspruch?

Depression and Violence: A Contradiction? Abstract. Depression is one of the leading diseases worldwide. Its symptoms are of great importance for a variety of areas within internal medicine, as patients often pay a visit to their general practitioners first. Although symptoms of depression are observed in both genders, existing peculiarities of the symptoms in men are only insufficiently known or acknowledged. Therefore, we dedicate this article to the concept of male depression, which can be characterized by social withdrawal, irritability or substance abuse. Here, we present practice-related associations between depression and violent behavior, which will be illustrated by two case studies. Of particular relevance is the so-called suicidal-homicidal syndrome, which should make further psychiatric, if not forensic-psychiatric evaluation mandatory.

[Concretism as a Correlate of the Acuteness of Schizophrenic Symptomatology]. / Konkretistische Denkstörungen als Indikator der Akuität bei Schizophrenieerkrankungen.

Formal thought disorders are common in people diagnosed with schizophrenia. Among them, concretism stands for deficiencies in the understanding of idiomatic expressions, metaphors and proverbs. However, little is known as to whether concretism is a correlate of the acuteness or severity of schizophrenia within patients. In this pilot study data of 28 patients was collected in the process of implementing a proverb test for screening purposes as part of an enhancement to the standard assessment of the general cognitive functioning of the patients. Our findings support the argument for such a coherence as a significant correlation between the degree of acuteness and concretism was found. However, the proverb test also correlated significantly with our standard cognitive assessment so the question as to which degree the proverb test will add further information regarding the general cognitive functioning needs to be addressed. Finally, the question as to whether there is an indication to specifically approach concretism in the treatment of patients with schizophrenia is discussed.

Developmental trends in lineup performance: Adolescents are more prone to innocent bystander misidentifications than children and adults.

We tested developmental trends in eyewitness identification in biased and unbiased lineups. Our main interest was adolescent's lineup performance compared with children and adults. 7-10-year-olds, 11-13-year-olds, 14-16-year-olds, and adults (N = 431) watched a wallet-theft-video and subsequently identified the thief, victim, and witness from simultaneous target-present and target-absent six-person photo lineups. The thief-absent lineup included a bystander previously seen in thief proximity. Research on unconscious transference suggested a selection bias toward the bystander in adults and 11-13-year-olds, but not in younger children. Confirming our hypothesis, adolescents were more prone to bystander bias than all other age groups. This may be due to adolescents making more inferential errors than children, as predicted by fuzzy-trace theory and associative-activation theory, combined with lower inhibition control in adolescents compared with adults. We also replicated a clothing bias for all age groups and age-related performance differences in our unbiased lineups. Consistent with previous findings, participants were generally overconfident in their decisions, even though confidence was a better predictor of accuracy in older compared with younger participants. With this study, we show that adolescents have an increased tendency to misidentify an innocent bystander. Continued efforts are needed to disentangle how adolescents in comparison to other age groups perform in forensically relevant situations.

Conflicting Priorities Between Risk Management and Treatment of Schizophrenia in Swiss Forensic Services-A Case Report.

The Swiss Criminal Code provides measures for mentally-ill offenders focusing on their need for treatment. This may lead to the deprivation of the patient's liberty up to several years. Under certain circumstances the mentally-ill offender can be sentenced to an indefinite incarceration. This case presentation we will describe a forensic psychiatric patient diagnosed with schizophrenia who was ordered an indefinite incarceration in Switzerland after he had been sentenced to 8 years of imprisonment for a deliberate killing. Initial presentation of symptomatology included formal thought disorders and negative symptoms such as affective flattening and alogia. Due to a scarcity of adequate treatment sites in the 90s and lack of scope for risk assessment and management, the patient could only be treated within highly regiment prison environments in the past. There, the patient's treatment concept primarily focused on short-term psychiatric care instead of providing an adequate treatment plan that would have been essential for the patient's improvement of chronic symptoms. This case description aims to present some of the fundamental issues observed in the forensic mental health system, where strong efforts are made to balance risk management and the treatment of severe mental health disorders. We will put the patient's own course of treatment and his progress within the penal system into context with ethical challenges in the forensic and correctional services and will provide potential recommendations for future research in the field of forensic psychiatry.

Eliminating age differences in children's and adults' suggestibility and memory conformity effects.

We examined whether typical developmental trends in suggestion-induced false memories (i.e., age-related decrease) could be changed. Using theoretical principles from the spontaneous false memory field, we adapted 2 often-used false memory procedures: misinformation (Experiment 1) and memory conformity (Experiment 2). In Experiment 1, 7- to 9-year-old children (n = 33) and adults (n = 39) received stories containing associatively related details. They then listened to misinformation in the form of short narratives preserving the meaning of the story. Children and adults were equally susceptible to the misinformation effect. In Experiment 2, younger (7- to 8-year-olds, n = 30) and older (11- to 12-year-olds, n = 30) children and adults (n = 30) viewed pictures containing associatively related details. They viewed these pictures in pairs. Although the pictures differed, participants believed they had viewed the same pictures. Participants had to report what they could recollect during collaborative and individual recall tests. Children and adults were equally susceptible to memory conformity effects. When correcting for response bias, adults' false memory scores were even higher than children's. Our results show that age trends in suggestion-induced false memories are not developmentally invariant. (PsycINFO Database Record

The Impact of Testing on the Formation of Children's and Adults' False Memories.

Witnesses are frequently questioned immediately following a crime. The effects of such testing on false recall are inconclusive: Testing may inoculate against subsequent misinformation or enhance false memory formation. We examined whether different types of processing can account for these discrepancies. Drawing from Fuzzy-trace and Associative-activation theories, immediate questions that trigger the processing of the global understanding of the event can heighten false memory rates. However, questions that trigger the processing of specific details can inoculate memories against subsequent misinformation. These effects were hypothesized to be more pronounced in children than in adults. Seven/eight-, 11/12-, 14/15-year-olds, and adults (N = 220) saw a mock-theft film and were tested immediately with meaning or item-specific questions. Test results on the succeeding day replicated classic misinformation and testing effects, although our processing hypothesis was not supported. Only adults who received meaning questions benefited from immediate testing and, across all ages, testing led to retrieval-enhanced suggestibility. © 2016 The Authors. Applied Cognitive Psychology Published by John Wiley & Sons, Ltd.

When Children are the Least Vulnerable to False Memories: A True Report or a Case of Autosuggestion?

In this case report, a legal case revolving around the reliability of statements given by a 6-year-old girl is described. She claimed to have witnessed her mother being murdered by her father. Two psychological experts provided diametrically opposed opinions about the reliability of her statements. One expert, a clinician, opined that the girl's statements were based on autosuggestion whereas the other expert, a memory researcher, stated that autosuggestion was unlikely to have played a role. This case and the analysis of the experts' opinions illustrate what may happen when experts in court are unaware of the recent literature on (false) memory. That is, recent studies show that autosuggestion is less likely to occur in young children than in older children and adults. The current case stresses the importance and implications of relying on memory experts in cases concerning the reliability of eyewitness statements.

The malleability of developmental trends in neutral and negative memory illusions.

Among many legal professionals and memory researchers there exists the assumption that susceptibility to false memory decreases with age. In 4 misinformation experiments, we show that under conditions that focus on the meaning of experiences, children are not always the most susceptible to suggestion-induced false memories. We begin by presenting a short overview of previous developmental false memory studies, the majority of which have found that the susceptibility to misinformation decreases with age. In Experiment 1, 6/7-year-olds, 11/12-year-olds, and adults received a video and were confronted with misinformation about related but nonpresented details. Older children and adults had higher misinformation acceptance rates than younger children. In Experiment 2, we replicated this finding adding a younger child group (4/6-year-olds). In Experiments 3 and 4, we used new material and again found that susceptibility to misinformation increased with age. Together, these experiments show that children's memory accuracy is not necessarily inferior to that of adults.'