A systematic review on the relationship between mental health, radicalization and mass violence.

Radicalization is a process, by which individuals adopt extreme political, social and religious ideation that leads to mass violence acts. It has been hypothesized that mental health characteristics might be associated with a risk of radicalization. However, a qualitative synthesis of studies investigating the relationship between mental health and radicalization has not been performed so far. Therefore, we aimed to perform a systematic review of studies examining the association between mental health characteristics and the risk of radicalization. Two reviewers performed an independent search of online databases from their inception until 8th April 2018 and 12 publications met eligibility criteria. There were several methodological limitations across the majority of eligible publications, including doubtful sample representativeness, use of diagnostic procedures without personal assessment of mental health status or lack of standardized tools for assessment of mental health. Representative cross-sectional studies revealed that depressive symptoms might be associated with radicalization proneness. However, it remains unknown whether depressive symptoms are associated with resilience or vulnerability to radicalization. Another finding from our systematic review is that several personality traits might predispose to develop extreme ideation. Finally, there is some evidence that lone-actors might represent a specific subgroup of subjects with extreme beliefs which can be characterized by high prevalence of psychotic and/or mood disorders. In conclusion, this systematic review indicates that caution should be taken on how the association between 'mental health' and 'radicalization' is being claimed, because of limited evidence so far, and a number of methodological limitations of studies addressing this issue.

Prescribing preferences in rapid tranquillisation: a survey in Belgian psychiatrists and emergency physicians.

BACKGROUND: The pharmacotherapeutic management of agitation is a common clinical challenge. Pharmacotherapy is frequently used, the use of published guidelines is not known. The purpose of this study was twofold; to describe the prescribing patterns of psychiatrists and emergency physicians and to evaluate to which extent guidelines are used. METHODS: A cross-sectional survey in the Dutch-speaking part of Belgium is carried out in 39 psychiatric hospitals, 11 psychiatric wards of a general hospital and 61 emergency departments. All physicians are asked for demographic information, their prescribing preferences, their use of guidelines and the type of monitoring (effectiveness, safety). For the basic demographic data and prescription preferences descriptive statistics are given. For comparing prescribing preferences of the drug between groups Chi square tests (or in case of low numbers Fisher's exact test) were performed. Mc Nemar test for binomial proportions for matched-pair data was performed to see if the prescription preferences of the participants differ between secluded and non-secluded patients. RESULTS: 550 psychiatrist and emergency physicians were invited. The overall response rate was 20% (n = 108). The number 1 preferred medication classes were antipsychotics (59.3%) and benzodiazepines (40.7%). In non-secluded patients, olanzapine (22.2%), lorazepam (21.3%) and clotiapine (19.4%) were most frequently picked as number 1 choice drug. In secluded patients, clotiapine (21.3%), olanzapine (21.3%) and droperidol (14.8%) were the three most frequently chosen number 1 preferred drugs. Between-group comparisons show that emergency physicians prefer benzodiazepines significantly more than psychiatrists do. Zuclopenthixol and olanzapine show a particular profile in both groups of physicians. Polypharmacy is more frequently used in secluded patients. Published guidelines and safety or outcome monitoring are rarely used. CONCLUSIONS: Our results show that prescription practice in Flanders (Belgium) in acute agitation shows a complex relationship with published guidelines. Prescription preferences differ accordingly to medical specialty. These findings should be taken into account in future research.

Neurocognition in clinical high risk young adults who did or did not convert to a first schizophrenic psychosis: a meta-analysis.

BACKGROUND: Individuals at clinical high risk (CHR) for psychosis have become a major focus for research designed to explore early predictors of transition to full psychosis. Characterizing differences in neurocognitive (NC) functioning between psychosis converters (CHR-C) and non-converters (CHR-NC) might contribute to the identification of specific NC predictors of psychosis onset. Therefore, the aim of the present meta-analysis was to compare the baseline NC performance between CHR-C and CHR-NC. METHOD: PubMed (MEDLINE), Web of Science, Embase and reference lists were searched for studies reporting baseline cognitive data of CHR-C and CHR-NC. Included NC tests were classified within the MATRICS - Measurement and Treatment Research to Improve Cognition in Schizophrenia - cognitive domains. RESULTS: Of 95 studies assessed for eligibility, 9 studies comprising 583 CHR subjects (N CHR-C=195, N CHR-NC=388) met all the inclusion criteria. CHR-C performed significantly worse compared to CHR-NC on 2 MATRICS domains namely working memory (ES=-0.29, 95% CI=-0.53 to -0.05) and visual learning (ES=-0.40, 95% CI=-0.68 to -0.13). For the remaining 4 domains (processing speed, attention/vigilance, verbal learning, reasoning/problem solving) no significant differences between CHR-C and CHR-NC were observed. CONCLUSION: Based on the current meta-analytic data we might conclude that it is possible to differentiate between CHR-C and CHR-NC with respect to working memory and visual learning. The addition of visual learning and working memory tasks to psychosis regression models might contribute to the predictive power of these models.

Prevalence and correlates of seclusion and restraint use in children and adolescents: a systematic review.

Seclusion and restraint are frequent procedures to intervene in aggressive and potentially dangerous patients in psychiatric settings. However, little is known about their utilization and effectiveness in pediatric populations. We aimed to examine the prevalence and determinants of seclusion and restraint utilization in children and adolescents in psychiatric settings. Using PubMed, PsychInfo and Cinahl, we performed a systematic literature review of studies published in the last 10 years reporting on the prevalence of seclusion and restraint use in psychiatrically ill youth (<21 years old) treated in psychiatric settings. Only seven publications addressed the topic. Primary outcomes were prevalence rates, reported either as the proportion of patients restrained/secluded or as the number of restraints/seclusions per number of patient days. All studies found relatively high baseline rates of seclusion (26% of patients; 67/1,000 patient days), and restraints (29% of patients; 42.7/1,000 patient days). In four studies, an intervention, implemented to reduce seclusion and restraints, resulted in a dramatic weighted mean reduction in the more restrictive use of restraints by 93.2%, with a 54.2% shorter duration. There was a small, weighted mean reduction in the use of less restrictive seclusions (-0.6%), but results were heterogeneous (-97.2 to +71.0%), with the only increase in seclusions being reported in one study in which the intervention-based padded seclusion room was utilized more frequently instead of more restrictive measures. Otherwise, seclusion episodes reduced by 74.7%, including a 32.4% shorter duration. Few studies reported on risk-factors and predictors, consisting of past or current aggression and/or violence, suicidal behavior, more severe psychopathology, non-White ethnicity, emergency admissions, out-of-home placement, and poorer family functioning, while findings regarding age were inconsistent Except for duration, data about the effectiveness of seclusion and restraints were missing, although there is some indication that seclusion and restraints can lead to severe psychological and physical consequences. Future research should focus on indications, predictors, preventive and alternative strategies, as well as on clinical outcomes of seclusion and restraints in psychiatrically ill youth. In addition, there is a clear need for transparent policies and guidelines.

State anxiety, psychological stress and positive well-being responses to yoga and aerobic exercise in people with schizophrenia: a pilot study.

PURPOSE: Worsening of schizophrenia symptoms is related to stress and anxiety. People with schizophrenia often experience difficulties in coping with stress and possess a limited repertoire of coping strategies. A randomised comparative trial was undertaken in patients with schizophrenia to evaluate changes in state anxiety, psychological stress and subjective well-being after single sessions of yoga and aerobic exercise compared with a control condition. METHOD: Forty participants performed a single 30-min yoga session, 20-min of aerobic exercise on a bicycle ergometre at self-selected intensity and a 20-min no exercise control condition in random order. RESULTS: After single sessions of yoga and aerobic exercise individuals with schizophrenia or schizoaffective disorder showed significantly decreased state anxiety (p < 0.0001), decreased psychological stress (p < 0.0001) and increased subjective well-being (p < 0.0001) compared to a no exercise control condition. Effect sizes ranged from 0.82 for psychological stress after aerobic exercise to 1.01 for state anxiety after yoga. The magnitude of the changes did not differ significantly between yoga and aerobic exercise. CONCLUSION: People with schizophrenia and physiotherapists can choose either yoga or aerobic exercise in reducing acute stress and anxiety taking into account the personal preference of each individual.

Concurrent use of lamotrigine and electroconvulsive therapy.

OBJECTIVE: : To evaluate the effect of lamotrigine (LMT) on electroconvulsive therapy (ECT)-induced seizures. METHODS: : Charts of all patients receiving LMT while undergoing an ECT course from July 2001 through May 2009 were reviewed. Apart from demographic variables, data collection consisted of diagnosis, indication for ECT, index or continuation ECT, electrode placement, stimulus dose, motor and electroencephalographic seizure duration, LMT dose, and number of restimulations. The stimulus dose and the seizure duration of ECT treatments with concurrent LMT (≥200 mg/d) were compared with the stimulus dose and seizure duration of ECT treatments without concurrent LMT. RESULTS: : Lamotrigine was used by 19 patients (16 women, 3 men) during 289 treatment sessions. Eleven patients had ECT treatments with and without LMT, of which 8 were at a dosage of 200 mg/d or higher. Analyses did not reveal a significant difference in seizure duration and stimulus dose. Missed seizures, however, occurred more frequently during ECT treatments with concurrent LMT. CONCLUSIONS: : In all patients, seizures of adequate duration could be elicited. The combination was well tolerated. Therapeutic doses of LMT do not seem to have a clinically significant influence on the length of ECT-induced seizures nor on the stimulus dose.