¿Cómo actualizar la propuesta psicopatológica de Castilla del Pino (y no morir en el intento)? / How to Update Castilla del Pino’s Work on Psychopathology (and Not Die Trying)?

La obra psicopatológica de Carlos Castilla del Pino es poco conocida por las nuevas generaciones de residentes. Existen razones externas e internas a la propia obra que podrían servir de explicación de este hecho. Sin embargo, las cuestiones planteadas por Castilla del Pino en su obra psicopatológica pueden tener plena vigencia, indepen-dientemente de que las respuestas por él ofrecidas puedan ser objeto de análisis crítico. Se proponen algunas estrategias para actualizar los planteamientos del autor en la ense-ñanza de la psicopatología descriptiva de los profesionales en formación. (AU)

Carlos Castilla del Pino’s work on psychopathology is mostly unknown by the new generations of residents. This can be accounted for by reasons that are external and internal to his work. However, questions posed by Castilla in his psychopathology work may have validity, irrespective of the answers he proposed, which can be criticised. Some strategies to update Castilla’s proposals that can be used on teaching descriptive psychopathology to trainees are presented. (AU)

Factors associated with prolonged episodes of mechanical restraint in mental health hospitalization units in Andalusia.

WHAT IS KNOWN ON THE SUBJECT?: Risk factors associated with prolonged episodes of mechanical restraint and other coercive measures are understudied. There have been no studies of this phenomenon in the context of the Andalusian public health system. Knowledge about factors associated with prolonged episodes is essential to increase the understanding of this phenomenon and develop strategies to reduce its occurrence. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: In Andalusia, prolonged restraint is still frequent and varies depending on the unit. It is associated with less time since admission, male gender, diagnosis, reason for restraint and the shift on which it was initiated. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Interventions at the level of the units could be necessary to prevent prolonged episodes of mechanical restraint. The results suggest the need for stricter control during the shifts on which restraint starts, especially in the first days after the patient's admission. Preventive risk assessment considering clinical and sociodemographic risk factors could help to reduce prolonged restraint. ABSTRACT: Introduction Factors associated with prolonged episodes of mechanical restraint and other coercive interventions are not clearly established and have been not studied in Andalusia (Spain). Aim To study factors associated with prolonged episodes of mechanical restraint. Method We analysed retrospectively episodes of mechanical restraint (N = 6267, prolonged episode >9.5 hours) in all public mental health hospitalization units (N = 20, 535 beds) that offer health coverage for the autonomous community of Andalusia. The data came from clinical records. A multivariable mixed logistic regression was used. Results In Andalusia, prolonged restraint is still frequent and varies depending on the unit. It is associated with less time since admission, male gender, diagnosis, reason for restraint and the shift on which it was initiated. Discussion The results provide evidence that prolonged episodes largely depend on the unit where they occur and that stricter control and regulation are necessary to prevent prolonged episodes. Implications for practice Interventions at the level of the unit are necessary. Stricter control in the shifts during which there is more risk of prolonged restraint may be necessary, especially in the first days following admission.

A regional multicomponent intervention for mechanical restraint reduction in acute psychiatric wards.

WHAT IS KNOWN ON THE SUBJECT?: A relevant number of restraint prevention programmes have been developed internationally. In Spain, there is no harmonized policy to prevent the use of restraint. More studies are necessary to establish which programmes and components are necessary to prevent restraint. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: There was a significant decreasing trend in the total number of mechanical restraint hours during the implementation of the intervention. There was no significant decreasing trend in the number of mechanical restraint episodes. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Interventions at a regional level aimed at preventing mechanical restraint are feasible in the Spanish context. All components of the Six Core Strategies could be necessary to prevent episodes of mechanical restraint. ABSTRACT: Introduction Mechanical restraint (MR) is used in many countries, including Spain, where non-harmonized policies between autonomous communities exist. There is a lack of research about interventions at regional levels to reduce their use. Aim To analyse data on key outcomes during the implementation of a multicomponent intervention in Andalusia (Spain) to reduce the use of MR. Method Episodes in a period of 30 months in all wards (N = 20) were analysed. The intervention consisted of five strategies: (a) leadership, (b) analysis of the situation, (c) awareness training for the heads of the wards, (d) unified record of MR and (e) staff training. We analysed the monthly trend of restraint hours and restraint episodes/1,000 bed days using segmented regression. Results There were 206.32 restraint hours and 12.96 restraint episodes/1,000 bed days during the study period. A significant decreasing trend was observed in restraint hours (-1.79%, p < .001), but not in the number of restraint episodes (-0.45%; p = .149). Discussion The results coincide with other international studies; however, studies with better designs are required to evaluate the effectiveness of the intervention. Implications for Practice Interventions at a regional level aimed at preventing MR are feasible in the Spanish context.

Experience coercion, post-traumatic stress, and satisfaction with treatment associated with different coercive measures during psychiatric hospitalization.

Coercive measures are frequently used in psychiatric hospitalization. However, there are few studies that analyse perceived coercion, post-traumatic stress, and subjective satisfaction with the hospitalization treatment associated with different types of coercive measures. The sample consisted of 111 patients admitted to two psychiatric units and divided into three groups based on the measure applied: involuntary medication (N = 41), mechanical restraint (N = 32), and combined measures (mechanical restraint and involuntary medication; N = 38). The outcome variables were perceived coercion evaluated with the Coercion Experience Scale (CES), post-traumatic stress evaluated with the Davidson Trauma Scale (DTS), and satisfaction with the treatment evaluated with the Client's Assessment of Treatment (CAT). The results found higher levels of perceived coercion associated with the use of mechanical restraint (P = 0.002) and combined measures (P < 0.001) in comparison with involuntary medication. Additionally, in relation to post-traumatic stress, mechanical restraint (P = 0.013) and combined measures (P = 0.004) were more stressful compared to involuntary medication. Finally, the use of combined measures was associated with lower satisfaction with inpatient psychiatric treatment compared to the use of involuntary medication (P = 0.006). The following recommendation would be consistent with the results found: if a patient does not specify a preference for some type of measure, involuntary medication could be used and mechanical restraint avoided, especially when used in combination with involuntary medication.