Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 34.243
Filtrar
1.
Z Psychosom Med Psychother ; 67(1): 21-35, 2021.
Artículo en Alemán | MEDLINE | ID: mdl-33565376

RESUMEN

Question: For decades hysteria has been psychodynamically interpreted sexualized as part of a frustrated desire with a depressive core. However, this "victim" side should be faced with the other often hidden aspects of hysteria with aggression and striving for power. Method: The basic hypothesis pursued here is that the hysterical/histrionic person was not primarily "disadvantaged" in his or her development, but that his or her striving for power and thus his or her potential for aggression is to be understood above all as a learned mode of global relationship that the adolescents have learned to respond and assert themselves to an intra-familiar situation of tension and pressure. Results: Any therapy that does not take this sufficiently into account falls short and reinforces the underlying mechanism of the therapeutic relationship dynamics. During treatment the patient must increasingly feel how much destruction and loneliness this global relationship implies. Conclusions: Only if the patient experiences that reduction of dominance and self-reference as well as increase of "true" felt empathy lead to more satisfying relations, the "imprisonment" in hysterical mode can be gradually lifted.


Asunto(s)
Agresión , Histeria/psicología , Histeria/terapia , Poder Psicológico , Psicoterapia , Adolescente , Femenino , Humanos , Masculino
2.
Medicine (Baltimore) ; 100(4): e23894, 2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-33530185

RESUMEN

BACKGROUND: We aimed to evaluate the effect of music-based intervention on the aggressive behavior in children and adolescents, and made a comparison of music medicine and music therapy. METHODS: We searched PubMed (MEDLINE), Ovid-Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) to identify relevant studies. Standardized mean differences (SMDs) were estimated with random-effect model. RESULTS: We included 10 studies and found a significant decrease of aggressive behavior (SMD = -0.99; 95% CI = -1.42 to -0.56) and a significant increase of self-control (SMD = 0.56; 95% CI: 0.19 to 0.93) in the music-based intervention group compared with the control group. The aggressive behavior was significantly decreased in the music therapy group compared with the control group (SMD = -1.79; 95% CI = -3.23 to -0.35); while, no difference was observed between music medicine group and control group. Sub-group analyses exhibited a more efficacious in reducing aggressive behavior in the children received ≥2 sessions per week, the children with a mean age > 10 years, the children whose behavior were reported by teachers, and the children with aggressive behavior before intervention. Sensitivity analyses yielded similar results. CONCLUSION: Music-based intervention seemed to be more efficacious for reducing aggression and increasing self-control in children and adolescents, especially music therapy.


Asunto(s)
Conducta del Adolescente , Agresión , Trastornos de la Conducta Infantil/terapia , Musicoterapia , Adolescente , Conducta del Adolescente/psicología , Niño , Trastornos de la Conducta Infantil/psicología , Humanos , Autocontrol
3.
Behav Processes ; 183: 104318, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33434628

RESUMEN

Intraspecific interactions among predators can change the game between a predator and its prey. Individuals of different size or sex can differ in their responses to conspecific competitors. We studied intraspecific interactions among pairs of little egrets (Egretta garzetta) while foraging on responsive prey (comet goldfish, Carassius auratus). Testing little egrets in an artificial patchy environment both singly and while engaged in social forging in pairs (male & female) at two prey densities, allowed us to explore individual differences in foraging success. We found sexual dimorphism with males being bigger and more aggressive than females. However, female foraging success was positively affected by the time they spent foraging with a conspecific male, suggesting they might be able to mitigate male aggressiveness with an indirect positive interaction. Despite the presence of direct interactions between individuals in the pair, egret foraging success was not affected by such interactions, nor by prey density. Our results demonstrate the importance of sex and an individual's ability to adjust its social behaviour based on the behaviour of others in this predator-prey foraging game.


Asunto(s)
Aves , Conducta Predatoria , Agresión , Animales , Femenino , Carpa Dorada , Humanos , Masculino
4.
Psychiatry Res ; 296: 113692, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33421841

RESUMEN

The current study examined the impact of the lockdown due to the Covid-19 disease on mood state and behaviours of children and adolescents with ADHD. Nine hundred ninety-two parents of children and adolescents with ADHD filled out an anonymous online survey through the ADHD family association website. The survey investigated the degree of severity of six emotional and mood states (sadness, boredom, little enjoyment/interest, irritability, temper tantrums, anxiety) and five disrupted behaviours (verbal and physical aggression, argument, opposition, restlessness) based on their frequency/week (absent; low: 1-2 days/week; moderate: 3-4 days/week; severe: 5-7 days/week) before and during the lockdown. Important fluctuations were found in all dimensions during the lockdown independently by the severity degree. Subjects with previous low severity degree of these behaviors significantly worsened in almost all dimensions during the lockdown. On the contrary, ADHD patients with moderate and severe degree showed important improvement during the lockdown. Little enjoyment/interests and boredom resulted the dimensions more strongly affected by the condition of restriction, overall in children. Children vs. adolescents showed substantially similar trend but the former resulted significantly more vulnerable to emotive changes. The results provided both the individuation of domains affected, and the indirect benefits produced by restriction condition.


Asunto(s)
Síntomas Afectivos/psicología , Trastorno por Déficit de Atención con Hiperactividad/psicología , Trastornos de la Conducta Infantil/psicología , Aislamiento Social , Adolescente , Agresión/psicología , Ansiedad/diagnóstico , Ansiedad/psicología , Trastornos de Ansiedad/psicología , Tedio , Niño , Femenino , Humanos , Genio Irritable , Masculino , Factores de Riesgo , Encuestas y Cuestionarios
5.
Medicina (Kaunas) ; 57(1)2021 Jan 09.
Artículo en Inglés | MEDLINE | ID: mdl-33435391

RESUMEN

Background and objectives: Bipolar disorder (BD) is one of the most burdensome psychiatric illnesses, being associated with a negative long-term outcome and the highest suicide rate. Although affective temperaments can impact on BD long-term outcome, their role remains poorly investigated. The aims of the present study are to describe the clinical characteristics of patients with BD more frequently associated with the different affective temperaments and to assess the relation between affective temperaments and severity of clinical picture in a sample of patients with BD. Materials and Methods: A total of 199 patients have been recruited in the outpatients units of two university sites. Patients' psychiatric symptoms, affective temperaments, and quality of life were investigated through validated assessment instruments. Results: Predominant cyclothymic and irritable temperaments are associated to higher number of relapses, poorer quality of life, higher rates of aggressive behaviors, and suicide attempts. Conversely, the predominant hyperthymic disposition was a protective factor for several outcome measures, including relapse rate, severity of anxiety, depressive and manic symptoms, suicidality, and earlier age at onset. One limitation of the present study is that the recruitment took place in two university sites; therefore, our findings cannot be fully generalized to the whole community of BD patients. Other limitations are the lack of a control group and the cross-sectional design of the study. Conclusions: The early identification of affective temperaments can help clinicians to identify those BD patients who are more likely to show a poor long-term outcome. An early screening of affective temperaments can be useful to develop targeted integrated pharmacological and psychosocial interventions.


Asunto(s)
Trastorno Bipolar/psicología , Trastorno Ciclotímico/psicología , Genio Irritable , Calidad de Vida/psicología , Temperamento , Adulto , Afecto , Edad de Inicio , Agresión/psicología , Ansiedad/psicología , Trastorno Bipolar/fisiopatología , Depresión/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Índice de Severidad de la Enfermedad , Ideación Suicida , Intento de Suicidio/psicología
6.
Z Evid Fortbild Qual Gesundhwes ; 160: 68-77, 2021 Feb.
Artículo en Alemán | MEDLINE | ID: mdl-33483286

RESUMEN

BACKGROUND: Reduction or prevention of violence is one of the fields of preventive interventions in nursing homes. To prove the effectiveness of appropriate interventions, valid instruments are crucial to measure violence. METHODS: Between November 2019 and May 2020, a systematic search for studies and instruments was conducted in relevant databases and reference directories assessing violent behaviour by employees towards residents, by residents towards employees and resident-to-resident abuse. RESULTS: 24 instruments were identified. 8 instruments capture staff-to-resident violence, 14 capture resident-to-staff violence, 3 resident-to-resident aggression, and 5 instruments are not exactly attributable to the constellation of violence. No instrument covers all three situations of violence. Four of the instruments used to capture violence by staff cover all forms of personal violence. Validity and reliability data are inadequate. DISCUSSION: At present, there is no tool that fully depicts violence in resident homes and is suitable for measuring the effectiveness of interventions. There are sufficient tools for the individual constellations of violence that represent all forms of violence. Not all instruments could be procured in their original form, and even available instruments did not always provide information on the development of the instruments and a possible review of their quality. CONCLUSION: There is a lack of an internationally comparable instrument representing elder abuse in the inpatient setting with sufficient validity and reliability.


Asunto(s)
Agresión , Casas de Salud , Anciano , Alemania , Humanos , Prevalencia , Reproducibilidad de los Resultados
7.
Behav Processes ; 183: 104298, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33347960

RESUMEN

Despite the prevalence and research interest of animal personality, its underlying mechanisms are not yet fully understood. Due to the essential role of monoamines in modulating behaviour, we manipulated the monoaminergic systems of Mediterranean field crickets (Gryllus bimaculatus) to explore whether this altered behavioural responses commonly used to describe animal personality. Previous work has shown that both serotonin and dopamine manipulations can alter cricket behaviour, although results differ depending on the drug in focus. Here, we investigate the effect of Fluphenazine, a dopamine antagonist which also interacts with serotonin receptors, on activity, exploration, boldness, and aggression. These results are compared with those of our earlier work that investigated the effect of drugs that more specifically target serotonin or dopamine systems (Fluoxetine and Ropinirole, respectively). Due to limited research on dose-effects of Fluphenazine, we created dose-response curves with concentrations ranging from those measured in surface waters up to human therapeutic doses. We show that compared to control animals, Fluphenazine manipulation resulted in lower levels of both exploration and boldness, but did not affect activity nor aggression. The effect on explorative behaviour contradicts our previous results of serotonin and dopamine manipulations. These results together confirm the causal role of monoamines in explaining variation in behaviour often used to describe animal personality, effects that can be both dose- and behaviour-dependent. Further, our results suggest that previous results assigned specifically to the dopaminergic system, may at least partly be explained by effects of the serotonergic system. Thus, future studies should continue to investigate the explicit underlying roles of specific monoamines in explaining behavioural variation.


Asunto(s)
Gryllidae , Agresión , Animales , Conducta Animal , Humanos , Personalidad , Serotonina
8.
Clin Dermatol ; 38(6): 788-792, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33341218

RESUMEN

Epidemiologic studies suggest that individuals with tattoos are more extroverted, aggressive, and more likely to take risks than individuals with no tattoos. Whether these personality traits affect athletic performance is uncertain. We compared behavioral patterns and rates of success of football players at the International Federation of Association Football (FIFA) World Cup 2018 by tattoo status. In this cross-sectional study, 32.7% of football players had visible tattoos (241 of 736), mostly on their arms (97.1%). Footballers with tattoos played longer on average (208 versus 160 minutes; P < .001), received more cards (.38 versus .27; P < .001), and committed more fouls per player (2.64 versus 2.2; P < .001). Players with tattoos attempted more shots at goal (P = .016), but without higher goal success (P = .204). The higher number of disciplinary events (being whistled for fouls and given yellow or red cards) and longer playing time of football players with tattoos may reflect personality traits reported in nonathletic individuals with tattoos, such as dominance, extroversion, aggressiveness, and willingness to take risks.


Asunto(s)
Atletas/psicología , Rendimiento Atlético , Fútbol Americano , Tatuaje/psicología , Tatuaje/estadística & datos numéricos , Adulto , Agresión , Estudios Transversales , Humanos , Masculino , Personalidad , Asunción de Riesgos , Adulto Joven
9.
Artículo en Inglés | MEDLINE | ID: mdl-33322053

RESUMEN

Transgressive conduct and opposition towards the rules often characterize adolescence. During the development, antisocial and aggressive behavior could be a way to grow personally and to be independent. According to previous studies results, the family has a high impact on teens' aggressive behaviors and moral disengagement. Our research involved 2328 Italian adolescents (13-19 years old) who have filled in the following questionnaires: deviant behavior questionnaire; aggression questionnaire; family communication scale; moral disengagement scale; the multidimensional scale of perceived social support. Our study investigated the role of family structure on deviance propensity through family climate and anger dysregulation joint influence. We conducted a mediation analysis to reach this goal using structural equation modeling (SEM). We have also conducted a multigroup analysis in order to evaluate gender differences in the SEM. Results showed that both family climate and anger dysregulation mediated the relationship between family structure and deviance propensity. The multigroup analysis revealed that the indirect relationship between variables through family climate is significant for both boys and girls (higher in females); variables indirect relationship through anger dysregulation was significant only for girls. These data could be useful for prevention and intervention programs on children-parent relationships and to reduce antisociality and teenager's aggressive behavior.


Asunto(s)
Conducta del Adolescente , Agresión , Ira , Relaciones Familiares , Adolescente , Conducta del Adolescente/psicología , Adulto , Trastorno de Personalidad Antisocial/prevención & control , Relaciones Familiares/psicología , Femenino , Humanos , Italia , Masculino , Motivación , Adulto Joven
10.
Artículo en Inglés | MEDLINE | ID: mdl-33375226

RESUMEN

The aim of this study was to analyze the relationships between sociometric types in the classroom-rejected, preferred, neglected, controversial and average-and psychological discomfort, life satisfaction and cyber-aggression, based on the adolescent's gender. 2398 adolescents of both sexes participated in the study (49.8% girls), aged between 12 and 18 years (M = 16.03, SD = 1.91). Multivariate analyses of variance were performed. The results showed significant relationships between sociometric types, life satisfaction and cyber-aggression. Rejected adolescents also showed less satisfaction with life and greater cyber-aggression. Furthermore, the boys, regardless of their sociometric type in the classroom, displayed less psychological distress and less involvement in cyber-aggression. Controversial adolescents also showed greater involvement in cyber-aggression. Finally, programs should be promoted for the prevention of social difficulties in the school, based on the promotion of social integration, not only in the classroom, but also on the Internet.


Asunto(s)
Agresión , Ciberacoso , Instituciones Académicas , Adolescente , Niño , Femenino , Humanos , Masculino , Satisfacción Personal , Integración Social
11.
BMJ Case Rep ; 13(12)2020 Dec 12.
Artículo en Inglés | MEDLINE | ID: mdl-33310825

RESUMEN

Histamine is involved in various physiological functions like sleep-wake cycle and stress regulation. The histamine N-methyltransferase (HNMT) enzyme is the only pathway for termination of histamine neurotransmission in the central nervous system. Experiments with HNMT knockout mice generated aggressive behaviours and dysregulation of sleep-wake cycles. Recently, seven members of two unrelated consanguineous families have been reported in whom two different missense HNMT mutations were identified. All showed severe intellectual disability, delayed speech development and mild regression from the age of 5 years without, however, any dysmorphisms or congenital abnormality. A diagnosis of mental retardation, autosomal recessive 51 was made. Here, we describe a severely mentally retarded adolescent male born from second cousins with a homozygous mutation in HNMT. His phenotypic profile comprised aggression, delayed speech, autism, sleep disturbances and gastro-intestinal problems. At early age, regression occurred. Treatment with hydroxyzine combined with a histamine-restricted diet resulted in significant general improvement.


Asunto(s)
Histamina N-Metiltransferasa/genética , Homocigoto , Discapacidad Intelectual/genética , Mutación , Agresión/fisiología , Encéfalo/metabolismo , Histamina/metabolismo , Histamina N-Metiltransferasa/metabolismo , Humanos , Hidroxizina/uso terapéutico , Discapacidad Intelectual/dietoterapia , Discapacidad Intelectual/tratamiento farmacológico , Discapacidad Intelectual/metabolismo , Masculino , Sueño/fisiología , Resultado del Tratamiento , Adulto Joven
13.
BMC Psychol ; 8(1): 111, 2020 Oct 23.
Artículo en Inglés | MEDLINE | ID: mdl-33097084

RESUMEN

BACKGROUND: Pierce's (The Black seventies: an extending horizon book, 1970) conception of "subtle and stunning" daily racial offenses, or microaggressions, remains salient even 50 years after it was introduced. Microaggressions were defined further by Sue and colleagues (Am Psychol 62:271, 2007), and this construct has found growing utility as the deleterious effects of microaggressions on the health of people of color continues to mount. Microaggressions are common on campuses and contribute to negative social, academic, and mental health outcomes. METHOD: This paper explores how Black college students' experiences correspond to or differ from the microaggression types originally proposed by Sue et al. (Am Psychol 62:271, 2007). Themes were identified from focus group data of students of color (N = 36) from predominately White institutions (PWIs) of higher learning (N = 3) using interpretative phenomenological analysis. RESULTS: We identified 15 categories of racial microaggressions, largely consistent with the original taxonomy of Sue et al. but expanded in several notable ways. New categories in our data and observed by other researchers, included categories termed Connecting via Stereotypes, Exoticization and Eroticization, and Avoidance and Distancing. Lesser studied categories identified included Sue et al.'s Denial of Individual Racism, and new categories termed Reverse Racism Hostility, Connecting via Stereotypes, and Environmental Attacks. DISCUSSION: While previous literature has either embraced the taxonomy developed by Sue and colleagues or proposed a novel taxonomy, this study synthesized the Sue framework in concert with our own focus group findings and the contributions of other researchers. Improving our understanding of microaggressions as they impact people of color may better allow for improved understanding and measurement of this important construct.


Asunto(s)
Afroamericanos/psicología , Agresión , Grupo de Ascendencia Continental Europea/psicología , Investigación Cualitativa , Racismo/estadística & datos numéricos , Universidades , Femenino , Humanos , Masculino , Adulto Joven
14.
Acad Med ; 95(10): 1529-1538, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33006870

RESUMEN

Though overt sexism is decreasing, women now experience subtle, often unconscious, gender bias as microaggressions. The authors sought to explore the prevalence and impact of the sexist microaggressions female surgeons experience, using a sequential exploratory mixed methods approach (January 2018-April 2018), to identify opportunities for education and prevention. First, all resident, fellow, and attending female surgeons at the University of New Mexico Health Sciences Center (UNM HSC) were invited to participate in focus groups conducted by experienced moderators using a semistructured interview guide based on the 7 Sexist Microaggressions Experiences and Stress Scale (Sexist MESS) domains. Qualitative analysis was performed using line-by-line manual coding to identify themes aligned with the Sexist MESS domains as well as other gender bias experiences of female surgeons. Next, a survey was sent to all resident, fellow, and attending female surgeons at the UNM HSC, which included the Sexist MESS questionnaire and questions related to surgeon-specific experiences of gender bias that the authors developed based on major thematic categories from the focus groups.Four focus groups of 23 female surgeons were conducted, revealing 4 themes: exclusion, increased effort, adaptation, and resilience to workplace slights. The survey response rate was 64% (65/101 surgeons). Across Sexist MESS domains, the frequency and severity of microaggressions was higher for trainees than attendings. The variables of non-White race/ethnicity, having children under 18, and fellowship training generally did not demonstrate statistical significance. This exploratory study adds to the growing body of evidence that gender bias in surgery continues and frequently manifests as microaggressions. Trainees reported the highest rates and severity of microaggressions and bias experiences. Further research should investigate how to address microaggressions, the experiences of male surgeons, the perspectives of medical students and groups who were reported as often perpetuating gender bias, and the efficacy of possible interventions.


Asunto(s)
Médicos Mujeres/psicología , Sexismo/psicología , Cirujanos/psicología , Lugar de Trabajo/psicología , Adulto , Agresión/psicología , Acoso Escolar/psicología , Femenino , Grupos Focales , Humanos , New Mexico , Investigación Cualitativa , Encuestas y Cuestionarios
15.
PLoS One ; 15(10): e0240163, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33007027

RESUMEN

Evidence of risk assessment procedures is scarce and inconclusive. The aim of this study is to evaluate the effects of risk assessment on aggression and the use of coercive interventions in an acute psychiatric admission setting. In addition, we evaluated nurse behaviour before and after the use of risk assessment. To take the fluctuations with regard to aggression and coercive interventions into account, we allowed 26 weeks for baseline measurements, followed by a 26 weeks steady-state period after the implementation of the risk assessment instrument. Contrary to expectations, no positive effects of risk assessment were found on aggression or on coercive interventions. Time spent in seclusion increased significantly with more than 10 hours on average after implementation. Furthermore, there were only negative effects on nurse behaviour and experiences. Among other things, they felt more stressed, spent more time on administration tasks and spent less time with patients after the implementation. In conclusion, there is insufficient evidence to use structured short-term risk assessment to reduce aggression or coercive interventions.


Asunto(s)
Agresión , Actitud del Personal de Salud , Enfermeras y Enfermeros , Servicio de Psiquiatría en Hospital , Medición de Riesgo , Adulto , Femenino , Humanos , Masculino , Análisis Multinivel , Evaluación de Resultado en la Atención de Salud , Análisis de Regresión
16.
Psychiatr Danub ; 32(Suppl 3): 371-377, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33030456

RESUMEN

INTRODUCTION: The problem of peer violence is increasingly discussed. It is noticeable that it is not sufficiently researched and there is no sufficient information about its prevalence, forms, prevention methods, repression and coping with the problem and its consequences. It seems that it gets discussed more intensively only in case of a traumatic incident whose consequences cannot be denied and if they make a large impact on the entire society. To show the prevalence and manifestation of peer violence as well as problems in the prevention and addressing consequences of peer violence. METHODS: Data are collected from several studies on peer violence conducted in Bosnia and Herzegovina and worldwide. RESULTS: Collected data indicate that the peer violence ranges from 15% to 50% depending on the development of the country where research is conducted. CONCLUSIONS: It is necessary to identify peer violence on time and respond in a timely manner. Any claim of a child needs to be taken seriously, because timely response prevents the child who experienced some form of violence to revenge or become violent. It is important to start raising awareness among children from their early age and train them on techniques of non-violent communication, forms of violence, the ways of expressing violence and its effects on victims and observers of violence and why it is important to talk about it. They need to know where to report violence and what the duties of relevant institutions are. In addition to children, it is important to raise awareness among parents, teachers, politicians as well as mental health professionals. The entire society needs to be involved in the prevention of peer violence.


Asunto(s)
Agresión , Grupo Paritario , Violencia/estadística & datos numéricos , Adolescente , Bosnia y Herzegovina/epidemiología , Niño , Femenino , Humanos , Internacionalidad , Masculino , Prevalencia
18.
Medicine (Baltimore) ; 99(33): e21639, 2020 Aug 14.
Artículo en Inglés | MEDLINE | ID: mdl-32872027

RESUMEN

INTRODUCTION: Anabolic steroids are commonly used by athletes, body builders, and young adults to improve muscle strength. Deleterious effects of anabolic steroids on physical health are well-established. Psychiatric aspects are of particular importance and include psychosis, delirium, mania, depression, and aggression. We describe the case of a young gentleman who was managed as a case of androgenic steroid induced delirium. PATIENT CONCERN: A 33-year-old gentleman presented with increased aggression, hostility, and destructive impulses. He was a regular user of testosterone propionate, testosterone cyprionate and trenbolone acetate up to 200 mg daily in injectable form. His mental status examination showed labile effect, flight of ideas and persecutory delusions. Physical examination was positive for atrophic testes. Laboratory results showed a decreased plasma testosterone level of 9.59 nmol/l (10.4-37.4 nmol/l). Sex Hormone Binding Globulin was 23.8 nmol/l (18.3-54.1 nmol/l) and bioavailable testosterone was 5.110 nmol/l (4.36-14.30 nmol/l). DIAGNOSIS: He was diagnosed as a case of anabolic steroids induced delirium. INTERVENTIONS AND OUTCOME: Patient was treated with regular haloperidol and quetiapine after which his sensorium, speech and behavior improved. He was discharged on haloperidol 7.5 mg and quetiapine 700 mg daily. CONCLUSION: The purpose of this case report is to emphasize on the neuropsychiatric effects and management of anabolic steroids manifested by delirium, increased aggression, hostility, and destructive impulses.


Asunto(s)
Delirio/inducido químicamente , Congéneres de la Testosterona/efectos adversos , Adulto , Agresión/efectos de los fármacos , Antipsicóticos/administración & dosificación , Delirio/tratamiento farmacológico , Haloperidol/administración & dosificación , Humanos , Masculino , Fumarato de Quetiapina/administración & dosificación , Testosterona/sangre , Congéneres de la Testosterona/administración & dosificación
19.
Cochrane Database Syst Rev ; 9: CD011860, 2020 09 08.
Artículo en Inglés | MEDLINE | ID: mdl-32898304

RESUMEN

BACKGROUND: Workplace aggression constitutes a serious issue for healthcare workers and organizations. Aggression is tied to physical and mental health issues at an individual level, as well as to absenteeism, decreased productivity or quality of work, and high employee turnover rates at an organizational level. To counteract these negative impacts, organizations have used a variety of interventions, including education and training, to provide workers with the knowledge and skills needed to prevent aggression.  OBJECTIVES: To assess the effectiveness of education and training interventions that aim to prevent and minimize workplace aggression directed toward healthcare workers by patients and patient advocates. SEARCH METHODS: CENTRAL, MEDLINE, Embase, six other databases and five trial registers were searched from their inception to June 2020 together with reference checking, citation searching and contact with study authors to identify additional studies. SELECTION CRITERIA: Randomized controlled trials (RCTs), cluster-randomized controlled trials (CRCTs), and controlled before and after studies (CBAs) that investigated the effectiveness of education and training interventions targeting aggression prevention for healthcare workers. DATA COLLECTION AND ANALYSIS: Four review authors evaluated and selected the studies resulting from the search. We used standard methodological procedures expected by Cochrane. We assessed the certainty of evidence using the GRADE approach. MAIN RESULTS: We included nine studies-four CRCTs, three RCTs, and two CBAs-with a total of 1688 participants. Five studies reported episodes of aggression, and six studies reported secondary outcomes. Seven studies were conducted among nurses or nurse aides, and two studies among healthcare workers in general. Three studies took place in long-term care, two in the psychiatric ward, and four in hospitals or health centers. Studies were reported from the United States, Switzerland, the United Kingdom, Taiwan, and Sweden. All included studies reported on education combined with training interventions. Four studies evaluated online programs, and five evaluated face-to-face programs. Five studies were of long duration (up to 52 weeks), and four studies were of short duration. Eight studies had short-term follow-up (< 3 months), and one study long-term follow-up (> 1 year). Seven studies were rated as being at "high" risk of bias in multiple domains, and all had "unclear" risk of bias in a single domain or in multiple domains. Effects on aggression Short-term follow-up The evidence is very uncertain about effects of education and training on aggression at short-term follow-up compared to no intervention (standardized mean difference [SMD] -0.33, 95% confidence interval [CI] -1.27 to 0.61, 2 CRCTs; risk ratio [RR] 2.30, 95% CI 0.97 to 5.42, 1 CBA; SMD -1.24, 95% CI -2.16 to -0.33, 1 CBA; very low-certainty evidence). Long-term follow-up Education may not reduce aggression compared to no intervention in the long term (RR 1.14, 95% CI 0.95 to 1.37, 1 CRCT; low-certainty evidence). Effects on knowledge, attitudes, skills, and adverse outcomes Education may increase personal knowledge about workplace aggression at short-term follow-up (SMD 0.86, 95% CI 0.34 to 1.38, 1 RCT; low-certainty evidence). The evidence is very uncertain about effects of education on personal knowledge in the long term (RR 1.26, 95% CI 0.90 to 1.75, 1 RCT; very low-certainty evidence). Education may improve attitudes among healthcare workers at short-term follow-up, but the evidence is very uncertain (SMD 0.59, 95% CI 0.24 to 0.94, 2 CRCTs and 3 RCTs; very low-certainty evidence). The type and duration of interventions resulted in different sizes of effects. Education may not have an effect on skills related to workplace aggression (SMD 0.21, 95% CI -0.07 to 0.49, 1 RCT and 1 CRCT; very low-certainty evidence) nor on adverse personal outcomes, but the evidence is very uncertain (SMD -0.31, 95% CI -1.02 to 0.40, 1 RCT; very low-certainty evidence). Measurements of these concepts showed high heterogeneity. AUTHORS' CONCLUSIONS: Education combined with training may not have an effect on workplace aggression directed toward healthcare workers, even though education and training may increase personal knowledge and positive attitudes. Better quality studies that focus on specific settings of healthcare work where exposure to patient aggression is high are needed. Moreover, as most studies have assessed episodes of aggression toward nurses, future studies should include other types of healthcare workers who are also victims of aggression in the same settings, such as orderlies (healthcare assistants). Studies should especially use reports of aggression at an institutional level and should rely on multi-source data while relying on validated measures. Studies should also include days lost to sick leave and employee turnover and should measure outcomes at one-year follow-up. Studies should specify the duration and type of delivery of education and should use an active comparison to prevent raising awareness and reporting in the intervention group only.


Asunto(s)
Agresión , Personal de Salud/educación , Violencia Laboral/prevención & control , Sesgo , Estudios Controlados Antes y Después , Exposición a la Violencia/prevención & control , Humanos , Asistentes de Enfermería/educación , Personal de Enfermería/educación , Ensayos Clínicos Controlados Aleatorios como Asunto
20.
Cochrane Database Syst Rev ; 9: CD007668, 2020 09 03.
Artículo en Inglés | MEDLINE | ID: mdl-32880104

RESUMEN

BACKGROUND: Antisocial personality disorder (AsPD) is associated with poor mental health, criminality, substance use and relationship difficulties. This review updates Gibbon 2010 (previous version of the review). OBJECTIVES: To evaluate the potential benefits and adverse effects of psychological interventions for adults with AsPD. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, 13 other databases and two trials registers up to 5 September 2019. We also searched reference lists and contacted study authors to identify studies. SELECTION CRITERIA: Randomised controlled trials of adults, where participants with an AsPD or dissocial personality disorder diagnosis comprised at least 75% of the sample randomly allocated to receive a psychological intervention, treatment-as-usual (TAU), waiting list or no treatment. The primary outcomes were aggression, reconviction, global state/functioning, social functioning and adverse events. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. MAIN RESULTS: This review includes 19 studies (eight new to this update), comparing a psychological intervention against TAU (also called 'standard Maintenance'(SM) in some studies). Eight of the 18 psychological interventions reported data on our primary outcomes. Four studies focussed exclusively on participants with AsPD, and 15 on subgroups of participants with AsPD. Data were available from only 10 studies involving 605 participants. Eight studies were conducted in the UK and North America, and one each in Iran, Denmark and the Netherlands. Study duration ranged from 4 to 156 weeks (median = 26 weeks). Most participants (75%) were male; the mean age was 35.5 years. Eleven studies (58%) were funded by research councils. Risk of bias was high for 13% of criteria, unclear for 54% and low for 33%. Cognitive behaviour therapy (CBT) + TAU versus TAU One study (52 participants) found no evidence of a difference between CBT + TAU and TAU for physical aggression (odds ratio (OR) 0.92, 95% CI 0.28 to 3.07; low-certainty evidence) for outpatients at 12 months post-intervention. One study (39 participants) found no evidence of a difference between CBT + TAU and TAU for social functioning (mean difference (MD) -1.60 points, 95% CI -5.21 to 2.01; very low-certainty evidence), measured by the Social Functioning Questionnaire (SFQ; range = 0-24), for outpatients at 12 months post-intervention. Impulsive lifestyle counselling (ILC) + TAU versus TAU One study (118 participants) found no evidence of a difference between ILC + TAU and TAU for trait aggression (assessed with Buss-Perry Aggression Questionnaire-Short Form) for outpatients at nine months (MD 0.07, CI -0.35 to 0.49; very low-certainty evidence). One study (142 participants) found no evidence of a difference between ILC + TAU and TAU alone for the adverse event of death (OR 0.40, 95% CI 0.04 to 4.54; very low-certainty evidence) or incarceration (OR 0.70, 95% CI 0.27 to 1.86; very low-certainty evidence) for outpatients between three and nine months follow-up. Contingency management (CM) + SM versus SM One study (83 participants) found evidence that, compared to SM alone, CM + SM may improve social functioning measured by family/social scores on the Addiction Severity Index (ASI; range = 0 (no problems) to 1 (severe problems); MD -0.08, 95% CI -0.14 to -0.02; low-certainty evidence) for outpatients at six months. 'Driving whilst intoxicated' programme (DWI) + incarceration versus incarceration One study (52 participants) found no evidence of a difference between DWI + incarceration and incarceration alone on reconviction rates (hazard ratio 0.56, CI -0.19 to 1.31; very low-certainty evidence) for prisoner participants at 24 months. Schema therapy (ST) versus TAU One study (30 participants in a secure psychiatric hospital, 87% had AsPD diagnosis) found no evidence of a difference between ST and TAU for the number of participants who were reconvicted (OR 2.81, 95% CI 0.11 to 74.56, P = 0.54) at three years. The same study found that ST may be more likely to improve social functioning (assessed by the mean number of days until patients gain unsupervised leave (MD -137.33, 95% CI -271.31 to -3.35) compared to TAU, and no evidence of a difference between the groups for overall adverse events, classified as the number of people experiencing a global negative outcome over a three-year period (OR 0.42, 95% CI 0.08 to 2.19). The certainty of the evidence for all outcomes was very low. Social problem-solving (SPS) + psychoeducation (PE) versus TAU One study (17 participants) found no evidence of a difference between SPS + PE and TAU for participants' level of social functioning (MD -1.60 points, 95% CI -5.43 to 2.23; very low-certainty evidence) assessed with the SFQ at six months post-intervention. Dialectical behaviour therapy versus TAU One study (skewed data, 14 participants) provided very low-certainty, narrative evidence that DBT may reduce the number of self-harm days for outpatients at two months post-intervention compared to TAU. Psychosocial risk management (PSRM; 'Resettle') versus TAU One study (skewed data, 35 participants) found no evidence of a difference between PSRM and TAU for a number of officially recorded offences at one year after release from prison. It also found no evidence of difference between the PSRM and TAU for the adverse event of death during the study period (OR 0.89, 95% CI 0.05 to 14.83, P = 0.94, 72 participants (90% had AsPD), 1 study, very low-certainty evidence). AUTHORS' CONCLUSIONS: There is very limited evidence available on psychological interventions for adults with AsPD. Few interventions addressed the primary outcomes of this review and, of the eight that did, only three (CM + SM, ST and DBT) showed evidence that the intervention may be more effective than the control condition. No intervention reported compelling evidence of change in antisocial behaviour. Overall, the certainty of the evidence was low or very low, meaning that we have little confidence in the effect estimates reported. The conclusions of this update have not changed from those of the original review, despite the addition of eight new studies. This highlights the ongoing need for further methodologically rigorous studies to yield further data to guide the development and application of psychological interventions for AsPD and may suggest that a new approach is required.


Asunto(s)
Trastorno de Personalidad Antisocial/terapia , Psicoterapia/métodos , Adulto , Agresión/psicología , Trastorno de Personalidad Antisocial/mortalidad , Trastornos Relacionados con Cocaína/terapia , Terapia Cognitivo-Conductual/métodos , Conducir bajo la Influencia , Femenino , Humanos , Masculino , Prisioneros/estadística & datos numéricos , Ensayos Clínicos Controlados Aleatorios como Asunto , Reincidencia/estadística & datos numéricos , Recompensa , Resultado del Tratamiento
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA