Hrozící či již manifestní násilné jednání plynoucí z duševního onemocnění je jednou z příčin hospitalizace. Syndrom násilného jednání zahrnující psychotické, impulzivní a predační násilí vyžaduje správnou diagnostiku daného konání a specifické intervence k zabránění manifestace násilí. V současné době převažuje posouzení míry rizika násilného jednání prostým klinickým hodnocením, na druhou stranu se nabízí široká paleta diagnostických škál. Tyto nástroje ulehčují diagnostiku a zefektivňují kroky léčby násilného jednání i přístup celého ošetřovatelského týmu. Zavádění takových nástrojů dává naději na tzv. patient-tailored medicine, ve smyslu ovlivnění konkrétních symptomů, interakcí či organizace péče. Cílem našeho nesystematického přehledového článku je poskytnout základní přehled efektivních škál pro hodnocení rizika násilného jednání.
The threat or manifestation of violent behaviour as a result of mental illness is one of the reasons for hospitalisation. The syndrome of violent behaviour, including psychotic, impulsive and predatory violence, requires a correct diagnosis of the behaviour and specific interventions to prevent the manifestation of violence. At present, the assessment of the risk of violent behaviour is mainly based on a simple clinical assessment, but a number of diagnostic scales are available. These tools facilitate diagnosis and make the treatment of violent behaviour and the approach of the whole care team more effective. The introduction of such tools offers the hope of patient-tailored medicine, in the sense of influencing the specific symptoms, interactions or organisation of care. The aim of our text is to provide a nonsystematic review of effective scales for assessing the risk of violent behaviour.
BACKGROUND: Secure forensic hospital treatments are resource-intensive, aiming to rehabilitate offenders and enhance public safety. While these treatments consume significant portions of mental health budgets and show efficacy in some countries, their effectiveness in Czechia remains underexplored. Previous research has highlighted various factors influencing the likelihood of discharge from these institutions. Notably, the role of sociodemographic variables and the length of stay (LoS) in the context of forensic treatments has presented inconsistent findings across studies. METHODS: The study, part of the 'Deinstitutionalization project' in Czechia, collected data from all inpatient forensic care hospitals. A total of 793 patients (711 male, 79 female and 3 unknown) were included. Data collection spanned 6 months, with tools like HoNOS, HoNOS-Secure, MOAS, HCR-20V3 and AQoL-8D employed to assess various aspects of patient health, behaviour, risk and quality of life. RESULTS: The study revealed several determinants influencing patient discharge from forensic hospitals. Key assessment tools, such as HoNOS secure scores and the HCR-20 clinical subscale, showed that higher scores equated to lower chances of release. Furthermore, specific diagnoses like substance use disorder increased discharge odds, while a mental retardation diagnosis significantly reduced it. The type of index offense showed no influence on discharge decisions. CONCLUSION: Factors like reduced risk behaviours, absence of mental retardation diagnosis, social support and secure post-release housing plans played significant roles. The results underscored the importance of using standardized assessment tools over clinical judgement. A standout insight was the unique challenges faced by patients diagnosed with mental retardation, emphasizing a need for specialized care units or tailored programmes.
- MeSH
- deinstitucionalizace MeSH
- délka pobytu * MeSH
- dospělí MeSH
- duševní poruchy * terapie MeSH
- kvalita života MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- propuštění pacienta * MeSH
- soudní psychiatrie MeSH
- ústavy pro duševně nemocné * MeSH
- zločinci psychologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
Progress in psychiatric treatment has led to important improvements in the quality of life of patients with severe mental illness (SMI). Nevertheless, the life expectancy of patients with SMI remains two decades shorter than that of the general population, and the most prevalent cause of death is cardiovascular disease. Given that the delivery of somatic care to a population of individuals with mental illness is specific, we developed a screening and intervention programme aimed at this vulnerable population. The "SOMA" programme is a complex somatic health intervention system consisting of screening and a set of interventions. Risk screening is evaluated automatically; the interventions include dietary intervention, healthy lifestyle education (HSE), physiotherapy, kinesiotherapy, and occupational therapy (KOP). The programme was introduced into the practice of the hospital, and its outcomes were monitored with a pilot population divided into 2 subprogrammes. CV risk factor prevalence study (n= 5481) as the most common CV risk factors identified hypertension (56.6 %) and smoking (55.7 %), high-risk patients proportion was 1364 (27 %). HSE (n=40) enrolled patients improved their body weight. KOP results show that patients with schizophrenia preferred physical activity less than others; 53 % of patients have no physical activity during hospitalization, and spontaneous physical activity depends on BMI in our sample. We observed improvement in cognitive functioning, perception of physical functions, or perceived limitations was comparable to the general population. Results show the usability of the program design; initial screening with two intervention branches can increase motivation for physical activity and adoption of health-promoting behaviors and support a recovery process in SMI patients. SOMA project is unique in the Czech environment, however, larger sample with longer observation period is needed.
- MeSH
- dospělí MeSH
- duševní poruchy * terapie epidemiologie MeSH
- ergoterapie metody MeSH
- kardiovaskulární nemoci prevence a kontrola epidemiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- pilotní projekty MeSH
- plošný screening MeSH
- rizikové faktory MeSH
- schizofrenie terapie epidemiologie MeSH
- techniky fyzikální terapie MeSH
- zdravý životní styl MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Cíl: Výkon ústavního ochranného léčení (OL) je vykonáván psychiatrickými nemocnicemi s regionální odpovědností. Cílem šetření / současného výzkumu je zmapovat a popsat populaci nemocných ve výkonu ochranného léčení, prezentovat data o nařízených OL, počtech nemocných v jednotlivých nemocnicích a ošetřovací době. Materiál a metoda: V rámci projektu "Deinstitucionalizace služeb pro duševně nemocné" probíhá pravidelný sběr dat, jehož součástí jsou i data nemocných s nařízeným OL. Další data byla získána z Centrální evidence statistických listů a výkaznictví (CSLAV) vedené Ministerstvem spravedlnosti ČR. Výsledky: Ke konci roku 2020 bylo za účelem výkonu OL hospitalizováno 839 pacientů, (82 žen a 757 mužů). V přepočtu na 100 000 obyvatel spádové oblasti existuje značná rozdílnost počtu nemocných, která mezi nemocnicemi kolísá v rozmezí 3-24 nemocných. Celostátní průměrná ošetřovací doba ústavních OL je 2, 6 roku, kdy mezi nemocnicemi jsou také značné rozdíly, a ošetřovací doba se pohybuje v rozmezí od několika měsíců po 6 let. Nejvyšší počet nemocných ve výkonu ústavního OL je z Karlovarského, Ústeckého a Moravskoslezského kraje. V diagnostickém složení se ukazuje nejvyšší podíl nemocných z okruhu psychotických poruch (F2) 47 %, 17 % nemocných je z okruhu F62-F69, který zahrnuje i parafilní poruchy, 16 % má diagnózu z okruhu F10-F19, tedy poruchy způsobené užíváním psychoaktivních látek. Závěr: V mezinárodním srovnání lze počet nemocných umístit do nižšího průměru evropských zemí, průměr ošetřovací doby se také jeví být v nižším průměru. Struktura a podrobnost dat z pravidelných cenzů neumožňují podrobnější popis populace z pohledu jejich rizikovosti pro společnost či spáchaného jednání.
Objective: Psychiatric hospitals with designated catchment areas are responsible for inpatient forensic treatment. We aim to present descriptive data concerning the inpatient forensic treatment population, patient numbers in hospitals, and treatment lengths. Method: As a part of the "Deinstitutionalization of Services for the Mentally Ill" project, regular data collection is performed, including collection of data on patients with a sentenced forensic treatment. Further data were obtained from the Central Register of Statistical Sheets and Reporting (CSLAV) kept by the Ministry of Justice of the Czech Republic. Results: The number of forensic patients at the end of the year 2020 was 839 (82 women and 757 men). There is a difference in patients ́ numbers in terms of 100,000 inhabitants of the catchment area, which varies between hospitals between 3 up to 24 patients. The national average treatment length of inpatient forensic treatment is 2.6 years, but there are differences between hospitals, and the treatment length varies from several months up to six years. The highest number of patients in inpatient forensic treatment is from regions: Karlovy Vary, Ústí nad Labem and Moravian-Silesian region. The diagnostic spectrum shows that the highest proportion of patients are diagnosed with psychotic disorders F2; (47%), 17% of patients are diagnosed with F62-F69 disorders, which also include paraphilic disorders, 16% have as the main diagnosis substance abuse; F10-F19. Conclusion: In an international comparison, patient numbers seem to be lower than in other European countries; the average treatment length also appears to be lower. The data structure from regular censuses has certain limitations as they do not allow a more detailed description of the population regarding risk for the society or the conduct committed.
- Klíčová slova
- ochranné léčení,
- MeSH
- délka pobytu statistika a číselné údaje MeSH
- hospitalizace statistika a číselné údaje MeSH
- lidé MeSH
- ústavní terapie * statistika a číselné údaje MeSH
- ústavy pro duševně nemocné MeSH
- vystavení násilí MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
Objectives: The length of forensic stay (LoS) is a subject to country-specific legal and service systems. Therefore, the identification of common factors targetable by treatment is at the forefront of forensic psychiatric research. In this study, we present the first reports of forensic characteristics of patients from the Czechia. Methods: We conducted a retrospective analysis of data from 260 inpatients discharged from the Bohnice Hospital (Prague) and obtained a set of sociodemographic and clinical variables as well as the Health of the Nation Outcome Scale (HoNOS) and HoNOS-secure scores. Results: The following variables were identified as significantly associated with a longer LoS: older age, length of previous psychiatric hospitalization, olanzapine equivalent, clozapine treatment, psychosocial dysfunction, psychotic or paraphilic disorder diagnosis, and sexual offense. A shorter LoS was associated with being in a relationship, being employed before hospitalization, receiving personal support, and committing an index offense under the influence of substance. While the HoNOS score and HoNOS symptom subscale predicted a longer LoS, the HoNOS-secure subscale predicted a shorter stay. Conclusion: In the European context, our hospital has a relatively low LoS. The results are consistent with findings linking psychotic disorders and paraphilia with a longer LoS in forensic treatment. Higher doses of antipsychotic medication or clozapine prescriptions were associated with a longer LoS. The results show a high level of unmet needs in this population, highlighting the importance of the availability of follow-up service.
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Adolescents are most at risk of engaging in violent interaction. Targeting violence risk and protective factors is essential for correctly understanding and assessing their role in potential violence. We aimed to use the Structured Assessment of Violence Risk in Youth (SAVRY) tool within the sample of adolescents to capture violence risk and protective factors and personality variables related to risk and protective factors. We further aimed to identify which violence risk and protective factors were positively or negatively related to violence within personal history and if any personality traits are typical for violent and non-violent adolescents. Identifying broader or underlying constructs within the SAVRY tool factor analysis can enable appropriate therapeutic targeting. METHODS: We used the Czech standardized version of the SAVRY tool. The study sample comprised 175 men and 226 women aged 12-18 years divided into two categories according to the presence or absence of violence in their personal history. Mann-Whitney U test was used to compare numerical variables between the two groups. SAVRY factor analysis with varimax rotation was used to determine the item factors. We administered the High School Personality Questionnaire (HSPQ) to capture adolescents' personality characteristics. RESULTS: In our sample, there were 151 participants with violence in their personal histories and 250 non-violent participants. Non-violent adolescents had higher values for all six SAVRY protective factors. The strongest protective factor was P3, Strong attachment and bonds across gender or a history of violence. Using factor analysis, we identified three SAVRY internal factors: social conduct, assimilation, and maladaptation. The SAVRY protective factors were significantly positively related to several factors in the HSPQ questionnaire. CONCLUSION: The results highlight the significance of protective factors and their relationship with violence prevalence. HSPQ diagnostics could be helpful in clinically targeting personality-based violence risks and protective factors. The therapeutic focus should be on tension, peer rejection, and anxiety. It is also essential to foster positive attitudes toward authority, prosocial behavior, and attitudes toward school. These strategies can help strengthen protective factors of the SAVRY.
- Publikační typ
- časopisecké články MeSH
