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Abstract: This retrospective study from three catchment-area-based acute psychiatric wards showed that of all the pharmacologically and mechanically restrained patients (n=373) 34 (9.1%) had been frequently restrained (6 or more times). These patients accounted for 39.2% of all restraint episodes during the two-year study period. Adjusted binary logistic regression analyses showed that the odds for being frequently restrained were 91% lower among patients above 50 years compared to those aged 18–29 years; a threefold increase (OR=3.1) for those admitted 3 times or more compared to patients with only one stay; and, finally, a threefold increase (OR=3.1) if the length of stay was 16 days or more compared to those admitted for 0–4 days. Among frequently restrained patients, males (n=15) had significantly longer stays than women (n=19), and 8 of the females had a diagnosis of personality disorder, compared to none among males. Our study showed that being frequently restrained was associated with long inpatient stay, many admissions and young age. Teasing out patient characteristics associated with the risk of being frequently restraint may contribute to reduce use of restraint by developing alternative interventions for these patients. [Copyright &y& Elsevier]

Intimate partner homicide (IPH) is the only lethal violence in which women are the principal victims. This research reports on an investigation of possible differences between dynamics of lethal and nonlethal intimate partner violence (IPV). A representative sample of 157 help-seeking female victims of IPV in Norway was interviewed. Results from multivariate logistic regression analysis indicated that women who perceived they had been subjected to lethal IPV were different from those who had not perceived the IPV as lethal concerning interactional dimensions of IPV and in their help-seeking responses. There was no difference related to sociodemographic factors. Because some IPV help-seeking women may be at a heightened risk for lethal violence, it is imperative that their efforts to seek assistance are responded to with care and structured risk assessment. [ABSTRACT FROM AUTHOR]

Aims and objectives The Forensic Early Warning Signs of Aggression Inventory ( FESAI) was developed to assist nurses and patients in identifying early warning signs and constructing individual early detection plans ( EDP) for the prevention of aggressive incidents. The aims of this research were as follows: First, to study the prevalence of early warning signs of aggression, measured with the FESAI, in a sample of forensic patients, and second, to explore whether there are any types of warning signs typical of diagnostic subgroups or offender subgroups. Background Reconstructing patients' changes in behaviour prior to aggressive incidents may contribute to identify early warning signs specific to the individual patient. The EDP comprises an early intervention strategy suggested by the patient and approved by the nurses. Implementation of EDP may enhance efficient risk assessment and management. Design An explorative design was used to review existing records and to monitor frequencies of early warning signs. Methods Early detection plans of 171 patients from two forensic hospital wards were examined. Frequency distributions were estimated by recording the early warning signs on the FESAI. Rank order correlation analyses were conducted to compare diagnostic subgroups and offender subgroups concerning types and frequencies of warning signs. Results The FESAI categories with the highest frequency rank were the following: (1) anger, (2) social withdrawal, (3) superficial contact and (4) non-aggressive antisocial behaviour. There were no significant differences between subgroups of patients concerning the ranks of the four categories of early warning signs. Conclusion The results suggest that the FESAI covers very well the wide variety of occurred warning signs reported in the EDPs. No group profiles of warning signs were found to be specific to diagnosis or offence type. Relevance to clinical practice Applying the FESAI to develop individual EDPs appears to be a promising approach to enhance risk assessment and management. [ABSTRACT FROM AUTHOR]

This article reports a study of how mothers perceive the effects of intimate partner violence (IPV) during pregnancy and children's exposure to IPV: (a) Do interactional aspects of IPV have a negative impact on the fetus during pregnancy or on the newborn baby? and (b) Is there a relationship between interactional aspects of IPV and (a) children's risk of being exposed to IPV and (b) the age of the child when at risk for exposure to IPV? A representative sample of 137 IPV help-seeking mothers in Norway was interviewed. Severity of physical IPV and injury from sexual IPV increased the risk of consequences to the fetus. Frequency of physical and psychological IPV increased the likelihood of children's exposure. Duration of the partnership increased the risk of children's exposure to physical and sexual IPV. Finally, there was a negative linear association between children's age when exposed for the first time and frequency of physical and psychological IPV. [ABSTRACT FROM AUTHOR]

This article reports a study of the possible impact of immigration on interactional aspects of intimate partner violence (IPV) among help-seeking women. Are there differences concerning (a) IPV categories, (b) IPV severity, frequency, duration, regularity, and predictability, (c) guilt and shame, (d) partners’ ethnicity, and (e) children being exposed to interparental IPV, adjusted for sociodemographic variables? A representative sample of IPV help-seeking women (N = 157) recruited from family counseling, police, and shelters in Norway were interviewed. Multivariate analyses showed that immigrant women had lower income, were less likely to use alcohol and had increased likelihood of having an immigrant partner. No differences were found concerning IPV severity, frequency, guilt, shame, or victimization pertaining to different IPV categories. Immigrant women were better at predicting physical IPV but had an increased risk of physical injury related to sexual IPV. Children’s risk of being exposed to interparental IPV increased if parents were immigrants. Psychosocial consequences of being an immigrant such as having a lower sociodemographic rank rather than IPV aspects constituted the main difference between ethnic Norwegian and immigrant help-seeking women. [ABSTRACT FROM PUBLISHER]

The authors report on the impact of motherhood and pregnancy on interactional aspects of intimate partner violence (IPV) among help-seeking women. Is having children a protective or a risk factor for IPV severity, injury, duration, frequency, and mortal danger, controlling for sociodemographics? Regarding interactional aspects of IPV, do survivors who experience IPV during pregnancy differ from those who do not? Is IPV during pregnancy characterized by different severity, injury, frequency, and mortal danger? A representative sample of women was interviewed. Motherhood increased the risk for longer duration of physical, psychological, and sexual IPV, even controlling for duration of partnership. Combinations of main categories of IPV during pregnancy were different from when not pregnant. Duration of physical and psychological IPV was the only variable increasing the likelihood of experiencing IPV during pregnancy. All physical IPV variables were significantly lower during pregnancy. For psychological IPV, all variables but frequency were lower. Only mortal danger was significantly lower in the sexual IPV main category. [ABSTRACT FROM AUTHOR]

The article examines the effects of a ten-month team-based sport psychology service delivery aimed to enhance the coping skills of 21 professional soccer players. It covers various aspects of coping skills before and during matches. The article also determines if and how each player would seek to help a teammate with match performance problems.

Background: This study aimed to explore the internal consistency and factor validity of the 13-item self-report questionnaire Parent-Patient Activation Measure (P-PAM) in a sample of parents of children with Attention-deficit/hyperactivity disorder. Methods: In a cross-sectional study, 239 parents were recruited from four outpatient clinics of the Child and Adolescent Mental Health Services and completed the P-PAM along with demographic variables. The factor structure of the P-PAM was examined through exploratory factor analysis, and internal consistency was estimated with the use of both Cronbach's alpha and McDonald's omega. A confirmatory factor analysis was used to estimate and test individual parameters. Results: The fit indices suggest an acceptable two-factor model of P-PAM and show high internal consistency and reliability for both factors, indicating that the scale measures two concepts. Conclusions: Our findings provide evidence for an acceptable factor structure and a high reliability of P-PAM as a measure of parent activation, suggesting that the theoretical factors reflect the construct of parent activation as intuitively compiled into an inner cognitive factor and an outer behavioral factor, which are related. [ABSTRACT FROM AUTHOR]

• Our prospective design for the psychotic symptom-violence link is rare in forensic psychiatry • The use of repeated measures design we used to investigate this link is also scarce • Our study is one out of very few intensive prospective studies before and after discharge • We found clinical and statistical association between psychotic symptoms and violence • Results showed interaction effects between psychotic symptoms and criminal conviction The research evidence is very strong for high recidivism rates of violence after discharge from forensic facilities. Big data research has found that a substantial proportion of the forensic population with relapse into violence has a psychosis diagnosis and a criminal record. However, more research on the association between psychotic symptoms and violence may inform and enhance risk assessment, prevention, and treatment. We conducted a prospective naturalistic study with a repeated measures design in a sample of 22 psychotic patients during follow-up after discharge from forensic mental health facilities. We had three aims: to test the predictive validity of three psychotic symptom scales for violence, to analyze main and interaction effects between psychotic symptoms and previous criminal conviction, and to explore the feasibility and potential benefit of the repeated measures design for prospective follow-up research. Interpreted within the limitation of the small sample size, the results were promising for all scales, particularly for adjusted effects without interaction. Two scales remained significant when their interaction with criminal conviction was adjusted. This indicates that risk judgment of psychotic patients with criminal conviction can be improved by adding measurement of fluctuations in psychotic symptoms. The repeated measures design was instrumental in this research. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to gain insight into mental health staff's perception of writing progress notes in an acute and subacute psychiatric ward context in Norway. Progress notes are the staff's daily reports in the electronic patient journal. The staff represents professionals with different educational backgrounds, for instance registered nurses and social workers. The therapeutic professional-patient relationship is recognized as a key component of psychiatric care, implying models of person-centered care and recovery. At the same time, the problem and deficit-oriented medical model remains strong. Progress notes are written within this context of competing models and within a hierarchical system of professions. Research literature exploring staff's experiences with writing progress notes in psychiatric contexts, and especially the space given to staff-patient relations, is sparse. To keep and further develop efficient cooperation in inter-professional work in mental health settings oral and written reports are of paramount importance. The main aims of this presentation are to report 1 staff experiences of the role of progress notes in focusing on staff-user interactions, and 2 staff perceptions of the impact of different treatment models on the progress notes. Methods: Staff who were familiar in writing progress notes and worked in one acute and one subacute psychiatric ward were invited to participate in two focus groups. A moderator and a co-moderator facilitated the interviews. Data analysis followed Systematic text condensation, which is a systematic method for transverse thematic analysis within a qualitative design. Results: The analysis revealed two themes: The position of the professional as an expert and distant observer in the progress notes, and The weak position of professional-patient interactions in progress notes. Reporting neutral observations of the patient for diagnostic purposes was considered most important. Though the participants told stories about challenging staff-patient situations where they drew on advanced communication skills to attune to the patient, they did not prioritize to document these interactions. In addition, the participants found it difficult to report patient resources in the reporting system. Discussions: The discussion of the results addresses the issue of progress notes in relation to different perspectives of recovery and person-centered care, and traditional medical models, respectively. The role of progress notes in inter-professional care and coordination is also discussed. Conclusions: The participants did not perceive that the current recording model supported a focus on patients' resources or reporting professional-patient interactions. This model appeared to put staff in an expert position in relation to patients, which made it challenging to involve patients in the recording process. Lessons learned: Essential aspects of care related to recovery and person-centered perspectives were not prioritized for documentation. Limitations: The focus groups covered two different contexts of psychiatric inpatient wards. The small sample may limit the findings' generalizability. Suggestions for future research: Our findings reflect staff's point of view. Studies designed to explore patients' perceptions of the use and content of progress notes are called for. [ABSTRACT FROM AUTHOR]

Background: Therapeutic staff-patient interaction is fundamental in psychiatric care. It is recognized as a key to healing in and of itself, or a premise to enhance psychiatric treatment adherence. Still, little is known about how these interactions are recorded in nursing documentation. The purpose of the study was to assess the quality and quantity of staff-patient interactions as recorded in progress notes in nursing documentation. Methods: The study has an observational registry study design. A random sample of 3858 excerpts was selected from progress notes in 90 patient journals on an acute psychiatric unit and an open inpatient district psychiatric centre (DPC) in Norway. The Scale for the Evaluation of Staff-Patient Interactions in progress notes (SESPI) was used to assess the progress note excerpts. It is developed to assess the quality and quantity in excerpt descriptions of staff-patient interactions in terms of empathic attunement. Descriptive statistics were calculated for the total sample and for each ward separately. Ordinal and multinomial logistic regression were used to estimate control for shift type, staff education level, and type of hospital ward. Results: Only 7.6% of the total number of excerpts (N = 3858) described staff-patient interactions sufficiently to analyze them in terms of attunement. Compared to the DPC, the acute ward reported more staff-patient interactions. The evening excerpts reported more successful types of attunement than those from the night shifts. Education level did not contribute significantly to our models. Conclusion: These findings present a unique insight into the quality and quantity of mental health nursing documentation regarding staff-patient interactions. Therapeutic interactions where staff tried to attune to the patients were rarely described. However, this is the first study measuring nursing documentation with the SESPI, and more studies are required to validate the scale and our findings. One potential clinical implication of this research is the development of a scale that personnel in psychiatric wards can have for evaluation of the quality of their reporting practice with emphasis on staff-patient interactions. By regular use this may help keeping up emphasis on emphatic attunement in milieu treatment contexts. [ABSTRACT FROM AUTHOR]

Background Facilities providing health- and social services for youth are commonly faced with the need for assessment and management of violent behavior. These providers often experience shortage of resources, compromising the feasibility of conducting comprehensive violence risk assessments. The Violence Risk Assessment Checklist for Youth aged 12–18 (V-RISK-Y) is a 12-item violence risk screening instrument developed to rapidly identify youth at high risk for violent behavior in situations requiring expedient evaluation of violence risk. The V-RISK-Y instrument was piloted in acute psychiatric units for youth, yielding positive results of predictive validity. The aim of the present study was to assess the interrater reliability of V-RISK-Y in child and adolescent psychiatric units and acute child protective services institutions. Methods A case vignette study design was utilized to assess interrater reliability of V-RISK-Y. Staff at youth facilities (N = 163) in Norway and Sweden scored V-RISK-Y for three vignettes, and interrater reliability was assessed with the intraclass correlation coefficient (ICC). Results Results indicate good interrater reliability for the sum score and Low-Moderate-High risk level appraisal across staff from the different facilities and professions. For single items, interrater reliability ranged from poor to excellent. Conclusions This study is an important step in establishing the psychometric properties of V-RISK-Y. Findings support the structured professional judgment tradition the instrument is based on, with high agreement on the overall risk assessment. This study had a case vignette design, and the next step is to assess the reliability and validity of V-RISK-Y in naturalistic settings. [ABSTRACT FROM AUTHOR]

Objectives: Compulsory mental health care includes compulsory hospitalisation and outpatient commitment with medication treatment without consent. Uncertain evidence of the effects of compulsory care contributes to large geographical variations and a controversy on its use. Some argue that compulsion can rarely be justified and should be reduced to an absolute minimum, while others claim compulsion can more frequently be justified. The limited evidence base has contributed to variations in care that raise issues about the quality/appropriateness of care as well as ethical concerns. To address the question whether compulsory mental health care results in superior, worse or equivalent outcomes for patients, this project will utilise registry‐based longitudinal data to examine the effect of compulsory inpatient and outpatient care on multiple outcomes, including suicide and overall mortality; emergency care/injuries; crime and victimisation; and participation in the labour force and welfare dependency. Methods: By using the natural variation in health providers' preference for compulsory care as a source of quasi‐randomisation we will estimate causal effects of compulsory care on short‐ and long‐term trajectories. Conclusions: This project will provide valuable insights for service providers and policy makers in facilitating high quality clinical care pathways for a high risk population group. [ABSTRACT FROM AUTHOR]

Are victims of intimate partner violence (IPV) by multiple partners (MP) different from victims of IPV by one partner? Are there different victim-related risk factors for IPV by MP? This systematic literature review identified seven empirical studies that related to these issues. The review findings indicated that (1) empirical research on IPV by MP appears to be scarce, with only limited recent development; (2) there were significant differences between women who had been subjected to IPV in a single relationship and women with IPV by MP; (3) IPV by MP was significantly associated with childhood domestic trauma, drug abuse, IPV characteristics, and attachment style; (4) regarding PTSD and personality disorders, the results were mixed and inconclusive; and (5) depression did not appear as a salient risk factor for IPV by MP. Interpretations must be made cautiously because of the wide diversity in measurement approaches. It is important that service personnel and researchers attend with increased awareness to women with IPV by MP. [ABSTRACT FROM AUTHOR]

The Violence Risk Screening - Police Version (V-RISK-POL) is a seven-item screening tool for use at police stations by police officers and law enforcement officials to assist in the process of decision making regarding release, restrictive measures or arrest for apprehended individuals where the risk of future violence must be considered. The screen is based on the V-RISK-10, originally developed for emergency psychiatry. We examined psychometric properties and the prospective predictive validity of future violent convictions for the V-RISK-POL in a sample of 111 persons arrested for suspicion of violent crimes. Seventeen persons were convicted for a new violent crime committed during the 24-40months follow-up. The V-RISK-POL demonstrated good internal consistency; Cronbach's alpha=0.81 (95% CI=0.75-0.86) and moderate predictive validity; the area under the curve of the receiving operator characteristics (AUC)=0.753 (95% CI=0.644-0.843). Further research on larger and more heterogeneous samples is necessary to examine whether the screen may be useful in the police context. [ABSTRACT FROM AUTHOR]