[Music therapy for negative symptoms in patients with schizophrenia: five systemic N-of-1 trials in a high-security psychiatric hospital]. / Muziektherapie voor negatieve symptomen bij schizofrenie: vijf n=1-studies in een tbs-kliniek.

BACKGROUND Negative symptoms hamper treatment progress of patients with schizophrenia. AIM This study evaluates the effect of a music therapy module on negative symptoms, composed of activating music therapy as usual, augmented by elements of neurologic music therapy on negative symptoms. METHOD A pre- and posttreatment measurement with the Dutch version of the Brief Negative Symptom Scale has been taken from five forensic psychiatric patients and their personal nurses. During the module, sociotherapist scored the Negative Symptom Scale three times a week. Applying the reliable change index and simulation modeling analysis, the quantitative change in negative symptoms was analyzed for each patient, supported by a qualitative analysis of the medical files. RESULTS Four out of five patients showed reduction in negative symptoms. CONCLUSION Music therapy seems to have a positive effect on the reduction of negative symptoms and regaining of activity and treatment motivation in forensic psychiatric patients, who prior to the study were long-lasting inactive and difficult to motivate. Adjusting the music therapy to individual needs, personalized treatment, is in line with the complexity of the target group.

[Predicting short term intramural violence with the Instrument for Forensic Treatment Evaluation (IBFE), ROM-instrument in tbs for different target groups]. / Voorspellen van intramuraal geweld op korte termijn met het Instrument voor Forensische Behandelevaluatie (IFBE), ROM-instrument in de tbs voor verschillende doelgroepen.

BACKGROUND: The Instrument for Forensic Treatment Evaluation (IFTE) has proven to be useful as an instrument for treatment evaluation and risk management in a heterogeneous group of tbs-patients (tbs = court ordered psychiatric treatment for offenders with a mental disorder). However, it is not known whether this ROM-instrument is a predictor of short term inpatient violence in different tbs-groups.
AIM: To investigate the extent to which the factor Problematic behavior of the IFBE is useful for predicting intramural violence, taking the different target groups in tbs into account. To demonstrate the practical value of the ifte factor Problematic behavior for inpatient violence risk management.
METHOD: Using logistic regression, the predictive validity of the ifte-factor Problematic behavior for inpatient violence was established in a 4 to 8-month follow-up, taking the different target groups into account. Cut-off points based on ROC analysis determined whether this factor could be of practical value for risk management.
RESULTS: The factor Problematic behavior predicted inpatient violence, irrespective of the target group, with an odds ratio of 1.68. A cut-off score of 7, on a scale of 1 to 17, correctly assessed 82% of the patients as a high or low risk for inpatient violent behavior.
CONCLUSION: The factor Problematic behavior of the IFBE can contribute to the prediction of short term inpatient violence for different tbs patient groups.

[Clinical decision making with regard to the granting of escorted leave for forensic patients detained by court order in a Dutch psychiatric clinic. Role of gender, disorder and the type of offence in the procedure]. / Behandelduur tot eerste toekenning tbs-verlof in een Nederlandse forensische psychiatrische kliniek; dossieronderzoek naar invloed van patiëntkenmerken en delict.

BACKGROUND: An increase in the length of time until the first escorted leave is granted to a patient detained by court order (tbs) results in a longer period of treatment. Physicians involved in the treatment and clinic managers are striving to reduce, in a responsible manner, the length of the period of treatment preceding the patient's first escorted leave.
AIM: Forensic Psychiatric Clinic (fpk) 'De Woenselse Poort' aims to find out to what extent gender, pathology and the type of offence committed by the detainee influence the length of time that elapses before the patient's first leave is granted. METHOD: We conducted a retrospective study based on patients' records. RESULTS: Although men use physical aggression more often than women, we found that gender, pathology and the type of offence had no influence on the length of the treatment period that preceded the granting of the patient's first escorted leave. CONCLUSION: Partly on the basis of risk management scales, clinicians judge whether the patient has adopted a more positive or a more negative attitude to risk factors relating to his or her offence. If the risk factors have become more positive, one would expect the application for leave to be made earlier. Surprisingly, this was not the case. In order to speed up the decision-making process regarding the application for leave, a clinical method for evaluating risk related treatment needs to be developed in which offence related risk factors are identified and the patient's positive or negative attitude to these risks are measured and monitored. At each treatment evaluation practitioners should be required to produce arguments that determine whether or not the patient is to be granted permission to go on leave at a particular moment.

[Treatment evaluation and clinical decision making using HKT-30-ROM]. / Behandelevaluatie en klinische besluitvorming met HKT-30-ROM.

BACKGROUND: By means of repeated, well-supported measurements of clinical dynamic indicators from the Historical, Clinical and Future - 30 (HKT-30) it is possible to monitor behavioural changes on the basis of risks and needs. The addition of extra score parameters allows us to distinguish client-specific risks and needs. In treatment evaluation it is important to visualise changes in these indicators of treatment evaluation because they are the key to the clinical decision-making process that determines further treatment and rehabilitation. AIM: To investigate whether HKT-30 indicators can be used to measure and visualise behavioral changes for the purpose of treatment evaluation. METHOD: A case study is used to illustrate how clinicians at the Forensic Psychiatric Clinic (FPK), De Woenselse Poort, ascertain risks, needs and changes and clarify these factors for the purpose of treatment evaluation and clinical decision-making. RESULTS: Routine treatment evaluation aided by visualised clinical HKT-30 indicators give the treatment team and the client a clearer picture of the behavioral changes for which the forensic treatment was prescribed. This evaluation provides significant starting-points for clinical decision making. CONCLUSION: Routine treatment evaluation along with a suitably adjusted HKT-30 make behavioural changes visible, render clinical decisions more transparent and provide valuable starting-points for a dialogue with the client about his treatment.

Halitosis and oral health-related quality of life: a case report.

OBJECTIVES: This is a clinical case of a 36-year-old Dutch male, patient in the Dr. S. van Mesdag Forensic Psychiatric Centre in Groningen. It demonstrates a short-time effect of a tailored oral hygiene self-care intervention in three sessions over a period of 3 months on halitosis and a patient's oral health-related quality of life (OH-QoL). METHODS: In addition to a dental screening and professional oral hygiene care, a semi-structured interview was conducted by the dental hygienist, and questionnaires were administered. The questionnaires included were; the Dutch version of the Oral Health Impact Profile-14 (OHIP-14-NL; used as a measurement of OH-QoL), scales for expected social outcomes for having healthy teeth, attitudes towards oral hygiene behaviour (OHB) and dental anxiety. RESULTS: Clinical observations showed an improvement in patient's OHB, while the extreme foetor-ex-ore was reduced to an acceptable level. A retrospective assessment showed that patient's attitude towards the recommended OHB together with his self-perceived OH-QoL had positively increased. CONCLUSIONS: This case highlights the value of professional individual oral hygiene instructions performed by a dental hygienist. It also illustrates that a patient's effective OHB may play an important role in the reduction in halitosis and self-perceived OH-QoL. Finally, the retrospective version of the OHIP-14-NL may be an adequate method to assess self-perceived OH-QoL within a relative short period of time.

[Can the clinical items of the risk assessment instrument HKT-30 predict to what extent forensic patients will break agreements during the resocialisation phase of treatment?]. / De HKT-30 als instrument voor beslismomenten binnen een tbs-behandeling.

BACKGROUND: Up till now, little research has been done into the factors that psychologists use during a patient's Involuntary Commitment process in order to decide whether the patient should be transferred from the transitional phase of treatment to the pre-release resocialisation phase. In forensic treatment a premature decision can result in a problematical resocialisation phase and prolong the period of treatment. AIM: To find out whether the K-items of the HKT-30, measured in the 12 months prior to the decision-making moment, can predict whether a patient, upon transfer to the resocialisation phase, will likely break agreements made in the transitional phase. METHOD: With logistic regression and roc-analyses, the K-items of the HKT-30 for 94 patients, measured between 2003 and 2009, were used to predict the course and length of these patients' treatment in the resocialisation phase. RESULTS: Some clinical items of the HKT-30 appear to provide a predictive value for the course of the pre-release resocialisation phase. Impulsiveness is one of the risk factors affecting the resocialisation phase. CONCLUSION: Some K-items of the HKT-30 do appear to support the decisions to allow patients receiving forensic inpatient treatment to be transferred to the resocialisation phase.

Poor sleep quality at baseline is associated with increased aggression over one year in forensic psychiatric patients.

OBJECTIVE: In forensic psychiatric patients, sleep problems as well as impulsivity and aggression are highly prevalent, yet studies on their association over time are lacking. This study investigates the association between sleep quality and changes in impulsivity and aggression in forensic psychiatric patients over one year. METHODS: Data were drawn from an ongoing prospective observational study in adult forensic psychiatric patients admitted to a forensic treatment facility between October 2006 and January 2018. Validated self-reports and observational instruments were used to assess sleep quality, impulsivity and aggression upon admission to the hospital and after one year. Linear regression analyses were performed to examine the association between sleep quality, impulsivity and aggression. All models were adjusted for baseline values of outcome measures, demographic features and general psychopathology. RESULTS: Data from 83 men (age 37.7 ± 11.7 years) with completed consecutive measurements were analyzed. Poor sleep quality was associated with increased self-reported aggression (ß = 1.08; 95% CI, 0.38-1.78). This association was positively confounded by general psychopathology, indicating that sleep quality is specifically related to self-reported aggression instead of being part of general psychopathology (adjusted ß = 1.18; 95% CI, 0.39-1.97). Poor sleep quality was not associated with changes in self-reported impulsivity, clinician-rated impulsivity or clinician-rated hostility in this population. CONCLUSION: Poor sleep quality was associated with an increase in self-reported aggression over one year in male forensic psychiatric patients. Early evaluation and treatment of sleep problems in (forensic) psychiatric patients may play an important role in reducing the risk of aggressive behavior.

Theta/SMR Neurofeedback Training Works Well for Some Forensic Psychiatric Patients, But Not for Others: A Sham-Controlled Clinical Case Series.

Electroencephalographic (EEG) neurofeedback could be a promising treatment for forensic psychiatric patients. Increasing evidence shows some patients are unable to regulate cortical activity. Before neurofeedback can be applied successfully, research is needed to investigate the interpersonal mechanisms responsible for patients' ability to respond to neurofeedback. A single-case experimental design allows for close monitoring of individual patients, providing valuable information about patients' response to the intervention and the time frame in which changes in clinical symptoms can be observed. Four patients with Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR) substance use disorder and various comorbidities participated in a sham-controlled clinical case study. Self-report level of impulsivity and craving were assessed. Results indicate that one patient showed more improvements on behavioral measures after the neurofeedback training than did the others. This patient reported less impulsivity and reduced levels of self-reported craving. However, these findings could not be attributed to the neurofeedback intervention. The findings suggest that there is insufficient evidence for the beneficial effects of a theta/sensorimotor rhythm (SMR) neurofeedback intervention on measures of impulsivity and craving, and that there may be great interindividual differences in patients' ability to regulate cortical activity.