The use of mechanical restraint in Pacific Rim countries: an international epidemiological study.

AIMS: The use of mechanical restraint is a challenging area for psychiatry. Although mechanical restraint remains accepted as standard practice in some regions, there are ethical, legal and medical reasons to minimise or abolish its use. These concerns have intensified following the Convention on the Rights of Persons with Disabilities. Despite national policies to reduce use, the reporting of mechanical restraint has been poor, hampering a reasonable understanding of the epidemiology of restraint. This paper aims to develop a consistent measure of mechanical restraint and compare the measure within and across countries in the Pacific Rim. METHODS: We used the publicly available data from four Pacific Rim countries (Australia, New Zealand, Japan and the United States) to compare and contrast the reported rates of mechanical restraint. Summary measures were computed so as to enable international comparisons. Variation within each jurisdiction was also analysed. RESULTS: International rates of mechanical restraint in 2017 varied from 0.03 (New Zealand) to 98.9 (Japan) restraint events per million population per day, a variation greater than 3000-fold. Restraint in Australia (0.17 events per million) and the United States (0.37 events per million) fell between these two extremes. Variation as measured by restraint events per 1000 bed-days was less extreme but still substantial. Within all four countries there was also significant variation in restraint across districts. Variation across time did not show a steady reduction in restraint in any country during the period for which data were available (starting from 2003 at the earliest). CONCLUSIONS: Policies to reduce or abolish mechanical restraint do not appear to be effecting change. It is improbable that the variation in restraint within the four examined Pacific Rim countries is accountable for by psychopathology. Greater efforts at reporting, monitoring and carrying out interventions to achieve the stated aim of reducing restraint are urgently needed.

Relation between age of first drinking and mental health and alcohol and drug disorders in adulthood: evidence from a 35-year cohort study.

AIMS: To estimate associations between age of first drinking (AFD) and alcohol use disorder, nicotine dependence, cannabis dependence, illicit drug dependence, major depression and anxiety disorder in adulthood, net of a series of covariate factors. DESIGN: Data were obtained from a longitudinal birth cohort. SETTING: Christchurch, New Zealand. PARTICIPANTS: The Christchurch Health Development Study (CHDS), a longitudinal study of a cohort born in 1977 and studied to age 35 years. Analysis samples ranged in size from 1056 (ages 11-13 years) to 962 (age 35 years); 50.2% of the total sample was male. MEASUREMENTS: A measure of AFD (ages 5-13+ years) was generated using latent class analysis. Outcome measures included: major depression, anxiety disorders, alcohol use disorder, nicotine dependence, cannabis dependence and other illicit drug dependence during the period 15-35 years. Covariate factors measured during childhood included family socio-economic status, family functioning, parental alcohol-related attitudes/behaviours and individual factors. FINDINGS: Earlier AFD was associated significantly (P < 0.05) with increased risk of later alcohol use disorders, nicotine dependence and illicit drug dependence, and was associated marginally (P < 0.10) with cannabis dependence, but not depression or anxiety disorder. After controlling for covariate factors, the associations between AFD and outcomes were no longer statistically significant [alcohol use disorder: B = -0.07, 95% confidence interval (CI) = -0.22, 0.08; nicotine dependence: B = -0.15, 95% CI = -0.34, 0.04; illicit drug dependence: B = -0.29, 95% CI = -0.73, 0.15; cannabis dependence: B = -0.05, 95% CI = -0.31, 0.22]. CONCLUSIONS: The associations between age of first drinking and later alcohol/drug disorders appear to be accounted for at least to some degree by factors related to characteristics of the individual and family during childhood.

Community mental health teams for people with severe mental illnesses and disordered personality.

BACKGROUND: Closure of asylums and institutions for the mentally ill, coupled with government policies focusing on reducing the number of hospital beds for people with severe mental illness in favor of providing care in a variety of nonhospital settings, underpins the rationale behind care in the community. A major thrust toward community care has been the development of community mental health teams.

The prevalence of personality disorder in schizophrenia and psychotic disorders: systematic review of rates and explanatory modelling.

BACKGROUND: Personality disorder (PD) in psychosis is poorly studied. As PD can affect outcome in mental disorders, it is important to understand its prevalence in order to plan services, understand prognosis more fully and maximize management options. MethodLiterature searching revealed 3972 potential papers. Twenty papers including 6345 patients were included in the final analysis. There was great variation in prevalence and multilevel modelling was used to identify possible reasons for this heterogeneity. RESULTS: The prevalence of PD varied from 4.5% to 100%. Multilevel analysis suggested country of study, study type, the instruments used to diagnose PD and patient care correlated with the prevalence data explaining the study level heterogeneity, with 34.2, 33.4, 17.0 and 4.5% by each variable respectively. Personality studies in Canada and Sweden reported lower PD prevalence, whereas in Spain it was higher than the multinational study. Compared with randomized controlled trials, case-control studies reported lower prevalence [odds ratio (OR)=0.35, 95% confidence interval (CI) 0.15-0.79] and observational studies higher prevalence (OR 70.5, 95% CI 8.5-583). Primary-care patients were less likely to be diagnosed (OR 0.02, 95% CI 0-0.19) than hospital patients, and out-patients had higher prevalence (OR 12.5, 95% CI 1.77-88.6). CONCLUSIONS: The reported prevalence of PD in schizophrenia varies significantly. Statistical modelling suggests care, country, study type and diagnostic tools for PD all bias prevalence rates. The number of papers reaching the inclusion criteria, the relative paucity of information and the difficulties in developing an accurate statistical model limited interpretation from the study.