This 8-week study was designed to explore any correlation between a passive data collection approach using a wearable device (i.e., digital phenotyping), active data collection (patient's questionnaires), and a traditional clinical evaluation [Montgomery-Åsberg Depression Rating Scale (MADRS)] in patients with major depressive disorder (MDD) treated with trazodone once a day (OAD). Overall, 11 out of 30 planned patients were enrolled. Passive parameters measured by the wearable device included number of steps, distance walked, calories burned, and sleep quality. A relationship between the sleep score (derived from passively measured data) and MADRS score was observed, as was a relationship between data collected actively (assessing depression, sleep, anxiety, and warning signs) and MADRS score. Despite the limited sample size, the efficacy and safety results were consistent with those previously reported for trazodone. The small population in this study limits the conclusions that can be drawn about the correlation between the digital phenotyping approach and traditional clinical evaluation; however, the positive trends observed suggest the need to increase synergies among clinicians, patients, and researchers to overcome the cultural barriers toward implementation of digital tools in the clinical setting. This study is a step toward the use of digital data in monitoring symptoms of depression, and the preliminary data obtained encourage further investigations of a larger population of patients monitored over a longer period of time.
- Publikační typ
- časopisecké články MeSH
- MeSH
- agorafobie diagnóza etiologie komplikace MeSH
- anxiolytika aplikace a dávkování klasifikace škodlivé účinky MeSH
- diferenciální diagnóza MeSH
- fobie diagnóza MeSH
- lidé MeSH
- obsedantně kompulzivní porucha diagnóza etiologie komplikace MeSH
- panická porucha diagnóza etiologie MeSH
- sociálně-úzkostná porucha diagnóza etiologie MeSH
- úzkostné poruchy * diagnóza etiologie farmakoterapie klasifikace komplikace terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
BACKGROUND: Previous studies have highlighted risks for depression and suicide in medical cohorts, but evidence regarding psychiatric residents is missing. This study aimed to determine rates of depression, suicide ideation and suicide attempt among psychiatric residents and to identify associated individual, educational and work-related risk factors. METHODS: A total of 1980 residents from 22 countries completed the online survey which collected data on depression (PHQ-9), suicidality (SIBQ), socio-demographic profiles, training, and education. Generalized linear modeling and logistic regression analysis were used to predict depression and suicide ideation, respectively. RESULTS: The vast majority of residents did not report depression, suicide ideation or attempting suicide during psychiatric training. Approximately 15% (n = 280) of residents met criteria for depression, 12.3% (n = 225) reported active suicide ideation, and 0.7% (n = 12) attempted suicide during the training. Long working hours and no clinical supervision were associated with depression, while more completed years of training and lack of other postgraduate education (e.g. PhD or psychotherapy training) were associated with increased risk for suicide ideation during psychiatric training. Being single and female was associated with worse mental health during training. LIMITATIONS: Due to the cross-sectional nature of the study, results should be confirmed by longitudinal studies. Response rate was variable but the outcome variables did not statistically significantly differ between countries with response rates of more or less than 50%. CONCLUSION: Depression rates among psychiatric residents in this study were lower than previously reported data, while suicide ideation rates were similar to previous reports. Poor working and training conditions were associated with worse outcomes. Training programmes should include effective help for residents experiencing mental health problems so that they could progress through their career to the benefit of their patients and wider society.
- MeSH
- deprese epidemiologie psychologie MeSH
- dospělí MeSH
- duševní poruchy epidemiologie psychologie MeSH
- duševní zdraví statistika a číselné údaje MeSH
- lidé středního věku MeSH
- lidé MeSH
- pokus o sebevraždu psychologie MeSH
- průřezové studie MeSH
- rizikové faktory MeSH
- sebevražda psychologie MeSH
- sebevražedné myšlenky MeSH
- služby péče o duševní zdraví organizace a řízení MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Deeskalace je způsob chování a komunikace, který vede ke snížení napětí u pacienta i u ošetřujícího personálu. Vždy je třeba mít na paměti, že bezpečnost zdravotníka je prvořadá. Prvním krokem deeskalace je vyhodnocení situace a zjištění anamnestických informací o pacientovi. V počáteční fázi diagnostického procesu není nutné stanovit přesnou psychiatrickou diagnózu, ale vyloučit somatické komorbidity ohrožující pacientův život. Zjišťujeme důvody, stadia a rizikové faktory konfliktu. Důležité je uvědomit si vlastní reakce, zachovat klid a nedat impulsivní odpověď. Druhým krokem je správná komunikace, která obnáší informovanost pacienta o tom, co se s ním děje a bude dít, což podporuje jeho důvěru. Podstatný je soulad mezi verbální a neverbální komunikaci. V neverbální komunikaci je důraz kladen na proxemiku, kineziku a adekvátní prozodii. Třetím krokem je vyjednávání, jehož základním cílem je změnit konfrontaci na diskusi. S pacientem potřebujeme dosáhnout shody. Pro ulehčení komunikace je vhodné zajistit i násilně se chovajícímu pacientovi alespoň jistou míru kontroly nad situací. Usilujeme ale o jasné nastavení hranic. Použitím správného postupu deeskalace násilí dokážeme předcházet stupňování konfliktů a vyhneme se tak další traumatizaci pacienta.
Deescalation is the way of behavior and communication which leads to a decrease of tension in the patient as well as caregivers. The first important step is an assessment of the situation which consists of finding out patients anamnestic data. In the initial phase of diagnostic process, it is not necessary to set the right psychiatric diagnosis, but to exclude the somatic comorbidities threatening patients life and identify the reasons, states and risk factors of the conflict. It is important to be aware of our own reactions,stay calm, don´t give an impulsive answer and identify the reason of patients agitation. The second step is a correct communication based on informing patient about what happens and will happen which enhances his trust. The consistency of verbal and nonverbal communication is of most importance. In nonverbal communication, the emphasis is on proxemics, kinesis and adequate prosody. The third step is a negotiation, which primary aim is to change the confrontation to the discussion. We have to reach a consensus with the patient. To facilitate communication, it is advisable to provide the patient with at least some degree of control, even if he behave violently; however we should always try to set limits. The proper use of the deescalation of violence can prevent escalation of the conflict and avoid a patients traumatization.
- Klíčová slova
- deeskalace,
- MeSH
- agitované chování MeSH
- duševně nemocní * MeSH
- kinezika MeSH
- komunikace MeSH
- lidé MeSH
- násilí * MeSH
- neverbální komunikace MeSH
- vyjednávání MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
Purpose: To prevent violence among persons with psychosis, further knowledge of the correlates and risk factors is needed. These risk factors may vary by nation. Patients and methods: This study examined factors associated with violent assaults in 158 patients with psychosis and in a matched control sample of 158 adults without psychosis in the Czech Republic. Participants completed interviews and questionnaires to confirm diagnoses, report on aggressive behavior, current and past victimization, and substance use. Additional information was collected from collateral informants and clinical files. Multiple regression analyses were conducted to identify factors that were independently associated with committing an assault in past 6 months. Results: The presence of a psychotic disorder was associated with an increased risk of assaults (OR =3.80; 95% CI 2.060-7.014). Additional risk factors in persons with and without psychosis included recent physical victimization (OR =7.09; 95% CI 3.922-12.819), childhood maltreatment (OR =3.15; 95% CI 1.877-5.271), the level of drug use (OR =1.13; 95% CI 1.063-1.197), and the level of alcohol use (OR =1.04; 95% CI 1.000-1.084). Increasing age (OR =0.96; 95% CI 0.942-0.978) and employment (OR =0.30; 95% CI 0.166-0.540) were protective factors. Except for drug use, which appeared to have greater effect on violence in the group without psychosis, there were no major differences between patients and controls in these risk and protective factors. To our knowledge, this is the first published comparison of assault predictors between schizophrenia patients and matched controls. Conclusion: Recent physical victimization was the strongest predictor of assaults. Our findings are consistent with the emerging empirical evidence pointing to the very important role of victimization in eliciting violent behavior by the victims. Some current prediction instruments may underestimate the risk of violent behavior as they take little account of current victimization. Although psychosis per se elevates the risk of violence, other risk and protective factors for violence in persons with psychosis and comparison group are largely similar.
- Publikační typ
- časopisecké články MeSH
- MeSH
- bipolární porucha farmakoterapie MeSH
- lidé MeSH
- mobilní aplikace * MeSH
- následné studie MeSH
- nežádoucí účinky léčiv diagnóza MeSH
- psychiatrické posuzovací škály MeSH
- psychotropní léky škodlivé účinky MeSH
- schizofrenie farmakoterapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Chorvatsko MeSH
- Srbsko MeSH
Většina psychiatrických pacientů se nechová agresivně. Mnohem častěji se stávají oběťmi násilných činů. Násilí se objevuje především u pacientů s psychotickým onemocněním, bipolární afektivní poruchou nebo s organickým poškozením mozku. V psychiatrické péči se s agresivním pacientem setká téměř každý zdravotnický pracovník a zdůrazňujeme, že bezpečnost zdravotníka je v této situaci prioritou. I když se toto chování odehrává na našem území, tj. v nemocnici, nejsme na ně vždy adekvátně připraveni. V textu shrnujeme možnosti primární prevence násilného chování a strategie, jak předcházet stupňování konfliktů.
Most patients with stable mental illness do not present an increased risk of aggressive behavior; however, they are frequently victims of violent acts. The aggression by patients predominantly occurs in patients with psychotic disorder, bipolar affective disorder or in patients with organic brain damage. Almost every healthcare worker meets patients with aggressive behavior and -under these conditions - it is always necessary to keep in mind that the health of the healthcare professional is essential. Although this behavior takes place in our territory, ie in a hospital, we are not always fully prepared for dealing it. In the current article we summarize the possibilities of primary prevention of violent behavior and strategies to prevent conflict escalation.
- MeSH
- agitované chování * psychologie MeSH
- agrese psychologie MeSH
- bezpečnost MeSH
- lidé MeSH
- primární prevence * klasifikace MeSH
- prostředí zdravotnických zařízení MeSH
- rizikové faktory MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
