Showing papers in "Journal of Nervous and Mental Disease in 2007"

A meta-analytic review of adult cognitive-behavioral treatment outcome across the anxiety disorders.

Abstract: The efficacy of cognitive behavioral treatments (CBT) for anxiety in adults has been supported by multiple meta-analyses. However, most have focused on only 1 diagnosis, thereby disallowing diagnostic comparisons. This study examined the efficacy of CBT across the anxiety disorders. One hundred eight trials of CBT for an anxiety disorder met study criteria. Cognitive therapy and exposure therapy alone, in combination, or combined with relaxation training, were efficacious across the anxiety disorders, with no differential efficacy for any treatment components for any specific diagnoses. However, when comparing across diagnoses, outcomes for generalized anxiety disorder and posttraumatic stress disorder were superior to those for social anxiety disorder, but no other differences emerged. CBT effects were superior to those for no-treatment and expectancy control treatments, although tentative evidence suggested equal effects of CBT when compared with relaxation-only treatments.

Psychometric properties of the Early Trauma Inventory-Self Report

Abstract: Childhood trauma is an important public health problem, but there are limitations in our ability to measure childhood abuse. The purpose of this study was to develop a self-report instrument for the assessment of childhood trauma that is valid but simple to administer. A total of 288 subjects with and without trauma and psychiatric disorders were assessed with the Early Trauma Inventory-Self Report (ETI-SR), an instrument for the assessment of physical, emotional, and sexual abuse, as well as general traumas, which measures frequency, onset, emotional impact, and other variables. Validity and consistency of the ETI-SR using different methods of scoring was assessed. The ETI-SR was found to have good validity and internal consistency. No method was found to be superior to the simple method of counting the number of items endorsed as having ever occurred in terms of validity. Some items were found to be redundant or not necessary for the accurate measurement of trauma severity within specific domains. Subsequent analyses with a shortened checklist of items showed acceptable validity and internal consistency. These findings suggest that the ETI-SR is a valid measure of early trauma, and suggest future directions for a shortened version of the ETI-SR that could be more easily incorporated into clinical research studies and practice settings.

Comparing psychological distress, traumatic stress reactions, and experiences of unaccompanied refugee minors with experiences of adolescents accompanied by parents.

Abstract: The objective of this study is to make comparisons of the severity of the psychological distress, behavioral problems and traumatic stress reactions, and experiences of unaccompanied refugee minors (URMs) with immigrant/refugee (I/R) and Dutch (native) adolescents with parental caregivers (N = 3273). Self-report questionnaires were administered. Most assessments took place at school. URMs consistently reported significantly higher scores for internalizing problems, traumatic stress reactions, and stressful life events than all other groups. Gender appears to play an important role in the native and I/R samples in reporting psychological distress, behavioral problems, and traumatic stress reactions. Older age was significantly related to higher scores only in the URM group. Natives scored higher on externalizing problems than the other groups. URMs reported to have experienced twice as many stressful life events than I/Rs and natives. URMs appear to be at significantly higher risk for the development of psychopathology than refugee adolescents living with a family member, immigrants, or Dutch adolescents.

Physiologic correlates of perceived therapist empathy and social-emotional process during psychotherapy.

Abstract: The present study was designed to investigate the rela tionship among physiologic concordance, patient-perceived therapist empathy, and social-emotional process during psychotherapy. Simultaneous measures of skin conductance (SC) were obtained from 20 unique and established patient-therapist dyads during a live therapy session followed by patient ratings of therapist empathy. Paired SC data of hypothetical dyads were used to test the reliability of the proposed measure of SC concordance. Observer microanalyses of social-emotional process were used to compare short segments of high versus low physiologic concordance. Results show a significant positive correlation (r = 0.47, p = 0.03) between SC concordance and patient ratings of perceived therapist empathy. Microanalyses suggest that during moments of high versus low SC concordance, there were significantly more positive social-emotional interactions for both patients and therapists (p = 0.01). The results support a biological model of perceived patient empathy and patient-therapist social-emotional process during psychotherapy.

Lifetime and 12-month prevalence of DSM-IV psychiatric disorders among Korean adults.

Abstract: :The objective was to estimate the prevalence and correlates of psychiatric disorders in a nationwide sample of Korean adults. Face-to-face interviews were conducted with the Korean version of Composite International Diagnostic Interview 2.1/DSM-IV (N = 6275, response rate 79.8%). The lifeti

Factors involved in outcome and recovery in schizophrenia patients not on antipsychotic medications: a 15-year multifollow-up study.

Abstract: :This prospective longitudinal 15-year multifollow-up research studied whether unmedicated patients with schizophrenia can function as well as schizophrenia patients on antipsychotic medications If so, can differences in premorbid characteristics and personality factors account for this? On

Acupuncture for posttraumatic stress disorder: a randomized controlled pilot trial.

Abstract: The purpose of the study was to evaluate the potential efficacy and acceptability of accupuncture for posttraumatic stress disorder (PTSD). People diagnosed with PTSD were randomized to either an empirically developed accupuncture treatment (ACU), a group cognitive-behavioral therapy (CBT), or a wait-list control (WLC). The primary outcome measure was self-reported PTSD symptoms at baseline, end treatment, and 3-month follow-up. Repeated measures MANOVA was used to detect predicted Group X Time effects in both intent-to-treat (ITT) and treatment completion models. Compared with the WLC condition in the ITT model, accupuncture provided large treatment effects for PTSD (F [1, 46] = 12.60; p < 0.01; Cohen's d = 1.29), similar in magnitude to group CBT (F [1, 47] = 12.45; p < 0.01; d = 1.42) (ACU vs. CBT, d = 0.29). Symptom reductions at end treatment were maintained at 3-month follow-up for both interventions. Accupuncture may be an efficacious and acceptable nonexposure treatment option for PTSD. Larger trials with additional controls and methods are warranted to replicate and extend these findings.

Gender differences in young adults with first-episode schizophrenia spectrum disorders at baseline in the Danish OPUS study.

Abstract: Gender differences in age at first onset, duration of untreated psychosis, psychopathology, social functioning, and self-esteem were investigated in a group of 578 young adults with a first-episode schizophrenia spectrum disorder. The mean age at first-onset of symptoms, age at first contact, and duration of untreated psychosis were similar for men and women. Men had more severe negative symptoms, poorer premorbid functioning, and poorer social networks, whereas women had more severe hallucinations. More men than women were substance abusers, were unemployed, and lived alone. Women had poorer self-esteem than men, in spite of better scores in functioning. Premorbid social adjustment was significantly related to the level of negative symptoms and number of friends. Conclusion is that men and women with first-episode psychosis showed different psychopathological characteristics and different social functioning, which cannot be explained by older age of onset for women. Women make more suicide attempts and experience lower self-esteem in spite of better social functioning.

Risk for psychiatric disorder among immigrants and their US-born descendants: evidence from the National Comorbidity Survey Replication.

Abstract: Although previous research has consistently documented that immigrants to the United States have better mental health than US natives, little is known about why this difference occurs. DSM-IV anxiety, mood, impulse control, and substance use disorders were assessed in a nationally representative survey of the US household population, the National Comorbidity Survey Replication. Differences in risk for disorder between immigrants (N = 299) and 5124 natives (N = 5124) were examined using discrete time survival models. Differences were estimated by generation, age of immigration, and duration of residence in the United States. Immigrants had lower lifetime risk of disorder than natives (OR = 0.7; 95% CI, 0.5-0.9). Risk was equally large for natives who were children of immigrants as for natives of subsequent generations. For mood and impulse control disorders, risk equal to that of natives was also found among immigrants who arrived in the United States as children (12 years of age or younger). Immigrants had lower risk than natives prior to arrival in the United States, but there was a trend toward equalization of risk with longer duration of residence in the United States. Differences in risk for disorder emerge within a single generation following immigration, consistent with a strong effect of environmental factors on changes in risk among immigrant populations. This pattern is consistent with either of two causal processes, one involving early socialization in the United States and the other involving postmigration experiences among immigrants who arrive in the United States as adults.

Racial and ethnic disparities in mental illness stigma.

Abstract: The present study sought to examine whether racial/ethnic differences exist in stigmatizing attitudes towards people with mental illness among community college students. Multiple regression models were used to investigate racial/ethnic differences in students' perceived dangerousness and desire for segregation from persons with mental illness both before and after participation in an antistigma intervention. At baseline, African Americans and Asians perceived people with mental illness as more dangerous and wanted more segregation than Caucasians, and Latinos perceived people with mental illness as less dangerous and wanted less segregation than Caucasians. Similar patterns emerged postintervention, except that Asians' perceptions changed significantly such that they tended to perceive people with mental illness as least dangerous of all the racial/ethnic groups. These findings suggest that racial/ethnic background may help to shape mental illness stigma, and that targeting antistigma interventions to racial/ethnic background of participants may be helpful.

Structured group psychotherapy in adults with attention deficit hyperactivity disorder: results of an open multicentre study.

Abstract: Attention deficit hyperactivity disorder (ADHD) is a serious mental disorder that often persists in adulthood. In a pilot study, a structured skills training group program for adult ADHD led to significant symptomatic improvements. The present study evaluated the program's effectiveness, feasibility, and patient acceptability in a multicenter setting. Seventy-two adult ADHD patients were assigned to 13 two-hour weekly sessions at 4 different therapy sites. The therapy was well tolerated and led to significant improvements of ADHD, depressive symptoms, and personal health status (p < 0.001). The factors treatment site and medication did not contribute to the overall improvement. Patients regarded the program topics "behavioral analyses," "mindfulness," and "emotion regulation" as the most helpful. In this multicenter study, the therapy program showed therapist-independent effects and seemed to be disorder-specific. This warrants the effort of organizing further controlled studies.

Self-awareness, affect regulation, and relatedness: Differential sequels of childhood versus adult victimization experiences.

Abstract: This study examined abuse and trauma exposure as it predicted identity problems, affect dysregulation, and relational disturbance in 620 individuals from the general population. Multivariate analyses indicated that maternal (but not paternal) emotional abuse was uniquely associated with elevations on all 7 scales of the Inventory of Altered Self-Capacities (IASC): Interpersonal Conflicts, Idealization-Disillusionment, Abandonment Concerns, Identity Impairment, Susceptibility to Influence, Affect Dysregulation, and Tension Reduction Activities. Low paternal (but not low maternal) emotional support was associated with Interpersonal Conflicts, Abandonment Concerns, and Tension Reduction Behaviors. Paternal emotional support did not significantly decrease the negative effects of maternal emotional abuse. Sexual abuse was predictive of all IASC scales except for Interpersonal Conflicts and Identity Impairment. Noninterpersonal traumas and adult traumas were typically unrelated to IASC scales. Childhood emotional and sexual maltreatment--perhaps especially maternal emotional abuse--may be critical factors in the development of disturbed self-capacities.

Psychological distress and burden among female partners of combat veterans with PTSD.

Abstract: Psychological distress among cohabitating female partners of combat veterans with posttraumatic stress disorder (PTSD) was examined in a cross-sectional study using a modified version of the Health Belief Model. A convenience sample of 89 cohabitating female partners of male veterans in outpatient PTSD treatment was interviewed by telephone using a structured interview. Partners endorsed high levels of psychological distress with elevations on clinical scales at or exceeding the 90th percentile. Severe levels of overall psychological distress, depression, and suicidal ideation were prevalent among partners. Multivariate analyses revealed that perceived threat, recent mental health treatment, and level of involvement with veterans predicted global partner psychological distress. Partner burden was predicted by partner self-efficacy, perceived threat, barriers to mental health treatment, and partner treatment engagement. These findings are compelling since they demonstrate that partners of veterans with combat-related PTSD experience significant levels of emotional distress that warrant clinical attention. Psychological distress and partner burden were each associated with a unique combination of predictors, suggesting that although these constructs are related, they have distinct correlates and potentially different implications within the family environment. Future research should examine these constructs separately using causal modeling analyses to identify modifiable targets for interventions to reduce psychological distress among partners of individuals with PTSD.

Cortisol, dehydroepiandrosterone, and estradiol measured over 24 hours in women with childhood sexual abuse-related posttraumatic stress disorder.

Abstract: Preclinical studies have shown long-term alterations in several hormonal systems including cortisol, dehydroepiandrosterone (DHEA) and DHEA-Sulfate, and estradiol. The purpose of this study was to assess cortisol, DHEA, and estradiol over a 24-hour period in women with early childhood sexual abuse and posttraumatic stress disorder (PTSD); with early abuse and without PTSD; and women without early abuse or PTSD. Forty-three women with early childhood sexual abuse and PTSD, early abuse without PTSD, and without abuse or PTSD, underwent a comprehensive assessment of hormones in plasma at multiple time points over a 24-hour period. Abused women with PTSD had lower concentrations of cortisol during the afternoon hours (12-8 p.m.) compared with women with abuse without PTSD and women without abuse or PTSD. DHEA-Sulfate was elevated throughout the 24-hour period in PTSD women, although this was of marginal statistical significance. There were no differences between groups in DHEA or estradiol. PTSD women also had increased cortisol pulsatility compared with the other groups. These findings suggest that a resting hypocortisolemia in the afternoon hours with increased cortisol pulsatility is associated with childhood abuse-related PTSD in women.

Religion and remission of depression in medical inpatients with heart failure/pulmonary disease

Abstract: The impact of religious involvement on time to remission of depression was examined in older medical inpatients with heart failure and/or chronic pulmonary disease (CHF/CPD). Inpatients older than 50 years with CHF/CPD were systematically diagnosed with depressive disorder using a structured psychiatric interview. Cox proportional hazards regression was used to examine the effects of religious involvement on time to remission, controlling for covariates. Of 1000 depressed patients identified at baseline, follow-up data on depression course were obtained on 87%. Patients involved in group-related religious activities experienced a shorter time to remission. Although numerous religious measures were unrelated by themselves to depression outcome, the combination of frequent religious attendance, prayer, Bible study, and high intrinsic religiosity, predicted a 53% increase in speed of remission (HR 1.53, 95% CI 1.20-1.94, p = 0.0005, n = 839) after controls. Patients highly religious by multiple indicators, particularly those involved in community religious activities, remit faster from depression.

Spousal bereavement in older adults: common, resilient, and chronic grief with defining characteristics.

Abstract: The purpose of this study was to identify empirically patterns of grief among 141 older bereaved spouses. A longitudinal hierarchical cluster procedure with the Ward agglomeration method was used to identify distinct clusters based on grief scores. Three clusters were identified: common (49%), resilient (34%), and chronic (17%) grief. Members of the common grief cluster experienced elevated levels of grief and depressive symptoms that decreased over time. Members of the resilient cluster experienced the lowest levels of grief and depression and the highest quality of life. The chronic grief cluster experienced the highest levels of grief and depression, more sudden deaths, the lowest self-esteem, and the highest marital dependency. The majority in this chronic cluster also met proposed criteria for a diagnosis of complicated grief. Five out of every six bereaved spouses adjusted well over time, and about a third of these showed considerable resilience without negative consequences. One out of six experienced a chronic grief syndrome. Early identification of this syndrome can lead to referral to newly emergent treatments specific for grief.

Child abuse and health-related quality of life in adulthood.

Abstract: Past research has indicated that child abuse is related to mental and physical health conditions and that mental and physical health conditions are related to decreased health-related quality of life (HRQOL). However, little is known about the independent relationship between child abuse and HRQOL. For the current analysis, data were from the nationally representative Netherlands Mental Health Survey and Incidence Study. Multiple linear regression analyses tested the relationships between child abuse and current HRQOL (SF-36) after adjusting for the effects of sociodemographic variables and numerous psychiatric disorders and physical health conditions. Neglect, psychological abuse, physical abuse, severe sexual abuse, and number of types of child abuse experienced were associated with reduced mental HRQOL. Psychological abuse, physical abuse, and number of types of child abuse experienced were associated with reduced physical HRQOL. Child abuse is an important determinant of HRQOL. The ability to successfully reduce the occurrence of child abuse or provide early intervention after child abuse occurs may help to improve HRQOL in the general population.

Gender differences in the symptoms of major depressive disorder.

Abstract: Data from the Canadian Community Health Survey 1.2 were used for a gender analysis of individual symptoms and overall rates of depression in the preceding 12 months. Major depressive disorder was assessed using the Composite International Diagnostic Interview in this national, cross-sectional survey. The female to male ratio of major depressive disorder prevalence was 1.64:1, with n = 1766 having experienced depression (men 668, women 1098). Women reported statistically more depressive symptoms than men (p < 0.001). Depressed women were more likely to report "increased appetite" (15.5% vs. 10.7%), being "often in tears" (82.6% vs. 44.0%), "loss of interest" (86.9% vs. 81.1%), and "thoughts of death" (70.3% vs. 63.4%). No significant gender differences were found for the remaining symptoms. The data are interpreted against women's greater tendency to cry and to restrict food intake when not depressed. The question is raised whether these items preferentially bias assessment of gender differences in depression, particularly in nonclinic samples.

Association between exposure to childhood and lifetime traumatic events and lifetime pathological gambling in a twin cohort.

Abstract: :The present study seeks to estimate the strength of the association between exposure to lifetime traumatic events and gambling problems while accounting for the potential contribution of psychiatric disorders, genetic factors, and family environmental influences. In 2002, structured diagnos

Relationship satisfaction and psychological distress among concerned significant others of pathological gamblers.

Abstract: This study explores correlates of psychological distress and relationship satisfaction among concerned significant others (CSOs) of pathological gamblers. CSOs often seek help in dealing with the gambling problem and are influential in recovery, but little is known about the sources of their distress. A sample of 186 CSOs responded to media announcements offering telephone and bibliotherapy support. In multivariate models, CSOs who were spouses and who were younger reported more personal distress, and higher distress was associated with a greater number of CSO emotional and behavioral consequences. Lower relationship satisfaction was associated with more CSO emotional consequences, fewer gambler consequences, and greater severity of gambling problem. Implications for treatment are discussed.

The role of intense affective states in signaling a suicide crisis.

Abstract: We explore the extent to which intense affective states in depressed patients may signal a suicide crisis, i.e., an acute risk for suicide. Therapists for 36 patients who died by suicide while in treatment completed questionnaires and wrote detailed structured narratives. Nine affects--desperation, hopelessness, rage, anxiety, feelings of abandonment, loneliness, guilt, humiliation, and self-hatred were evaluated as to their intensity in the patient before the suicide. Comparable information was obtained on 26 depressed, nonsuicidal patients treated by the same therapists. The suicide patients had a significantly greater number of intense affects than did the comparison patients. The affect that most distinguished the 2 groups was desperation, which was intense in 30 (83%) of the suicide patients but in none of the comparison patients. Recognizing intense affective states and the interaction among them may help clinicians identify a suicide crisis in depressed patients.

A Measure of State Persecutory Ideation for Experimental Studies

Abstract: Experimental research is increasingly important in developing the understanding of paranoid thinking. An assessment measure of persecutory ideation is necessary for such work. We report the reliability and validity of the first state measure of paranoia: The State Social Paranoia Scale. The items in the measure conform to a recent definition in which persecutory thinking has the 2 elements of feared harm and perpetrator intent. The measure was tested with 164 nonclinical participants and 21 individuals at high risk of psychosis with attenuated positive symptoms. The participants experienced a social situation presented in virtual reality and completed the new measure. The State Social Paranoia Scale was found to have excellent internal reliability, adequate test-retest reliability, clear convergent validity as assessed by both independent interviewer ratings and self-report measures, and showed divergent validity with measures of positive and neutral thinking. The measure of paranoia in a recent social situation has good psychometric properties.

Depersonalization, mindfulness, and childhood trauma

Abstract: Depersonalization (DP), i.e., feelings of being detached from one's own mental processes or body, can be considered as a form of mental escape from the full experience of reality. This mental escape is thought to be etiologically linked with maltreatment during childhood. The detached state of consciousness in DP contrasts with certain aspects of mindfulness, a state of consciousness characterized by being in touch with the present moment. Against this background, the present article investigates potential connections between DP severity, mindfulness, and childhood trauma in a mixed sample of nonpatients and chronic nonmalignant pain patients. We found a strong inverse correlation between DP severity and mindfulness in both samples, which persisted after partialing out general psychological distress. In the nonpatient sample, we additionally found significant correlations between emotional maltreatment on the one hand and DP severity (positive) and mindfulness (negative) on the other. We conclude that the results first argue for an antithetical relationship between DP and certain aspects of mindfulness and thus encourage future studies on mindfulness-based interventions for DP and second throw light on potential developmental factors contributing to mindfulness.

Screening for Depression and PTSD in a Cambodian Population Unaffected by War: Comparing the Hopkins Symptom Checklist and Harvard Trauma Questionnaire With the Structured Clinical Interview

Abstract: The Hopkins Symptom Checklist depression scale (HSCL-D) and the Harvard Trauma Questionnaire (HTQ) have been used extensively in international studies, particularly among refugees and conflict-affected populations. Like many other screening measures, however, the HSCL-D and HTQ have not been subjected to extensive epidemiologic testing, particularly among communities not affected by war. The present study examined the psychometric properties of the HSCL-D and HTQ by comparing the measures with the Structured Clinical Interview for DSM-IV (SCID) among ethnic Cambodians living in Surin, Thailand, a community that was spared the long period of mass violence that affected Cambodia proper. The PTSD data of the HTQ were then contrasted with those obtained from a refugee clinic. The main finding was that in the Surin study, the screening measures showed greater agreement with the SCID in identifying noncases (negative prediction) than cases (positive prediction). In contrast, in the earlier clinic study, the HTQ showed high positive and moderately low negative prediction. The results support previous observations that clinical interviews such as the SCID may be more conservative in identifying cases. We raise the possibility, however, that structured interviews may perform differently across clinic and community populations. In particular, clinicians may be more accurate in identifying cases than noncases in highly symptomatic clinic populations, with the converse applying in low prevalence community populations. These issues warrant further investigation to specify more clearly the value of using the two approaches to case identification.

Impact of supported housing on clinical outcomes: analysis of a randomized trial using multiple imputation technique.

Abstract: In 1992, the US Department of Housing and Urban Development (HUD) and the US Department of Veterans Affairs (VA) established the HUD-VA Supported Housing (HUD-VASH) Program to provide integrated clinical and housing services to homeless veterans with psychiatric and/or substance abuse disorders at 19 sites. At four sites, 460 subjects were randomly assigned to one of the three groups: (1) HUD-VASH, with both Section 8 vouchers and intensive case management; (2) case management only; and (3) standard VA care. A previous publication found HUD-VASH resulted in superior housing outcomes but yielded no benefits on clinical outcomes. Since many participants missed prescheduled visits during the follow-up period and follow-up rates were quite different across the groups, we reanalyzed these data using multiple imputation statistical methods to account for the missing observations. Significant benefits were found for HUD-VASH in drug and alcohol abuse outcomes that had not previously been identified.

A randomized controlled clinical treatment trial for World Trade Center attack-related PTSD in disaster workers.

Abstract: :This article describes a controlled clinical trial of cognitive-behavioral treatment (CBT) for disaster workers. Despite high rates of PTSD in disaster workers worldwide, there have been no randomized trials of PTSD treatment. Participants were randomly assigned to a 12-week cognitive-behav

Television watching and the risk of incident probable posttraumatic stress disorder: a prospective evaluation.

Abstract: The relation between viewing television coverage of a mass disaster and the development of posttraumatic stress disorder (PTSD) is poorly understood. A cohort of New Yorkers without baseline probable PTSD (N=1787) was assessed 1 year following the September 11, 2001, attacks. The primary outcome was new-onset probable PTSD assessed through a validated scale, and the primary exposure was number of hours of September 11 anniversary news coverage viewed. A total of 99 (5.6%) of participants had developed probable PTSD at the 1-year follow-up. Watching 12 or more hours of September 11 attack anniversary news coverage was associated with a 3.4-fold increased risk of new-onset probable PTSD (p=0.004). Exposure to television coverage of the September 11 anniversary was associated with new-onset probable PTSD among a cohort of New Yorkers with no probable PTSD at baseline.

Longitudinal study of posttraumatic stress disorder, depression, and changes in traumatic memories over time in Bosnian refugees.

Abstract: This longitudinal study examined traumatic memory consistency over a 3-year period among a sample of highly traumatized Bosnian refugees, focusing on demographic factors, types of trauma, and posttraumatic stress disorder (PTSD) and depression. In 1996 and 1999, 376 Bosnian refugees were interviewed about 54 wartime trauma and torture events, and symptoms of PTSD and depression. Reports were compared for both time periods, and changed responses were analyzed for significance. Overall, there was consistency in reporting over time; when change occurred it was in the direction of decreased reports at follow-up. This downward trend was not associated with any particular diagnosis. However, PTSD alone, without comorbid symptoms of depression, was uniquely associated with the group that exhibited an upward trend. This implies that increased reporting is related specifically to the presence of PTSD symptoms, and that PTSD may be distinctly associated with the failed extinction of traumatic memories.

Seclusion and restraint in patients with schizophrenia: Clinical and biographical correlates.

Abstract: Seclusion and restraint represent adverse experiences that cause negative attitudes against psychiatric treatment and psychopathologic sequels such as posttraumatic stress disorder. We examined 117 consecutive admissions with schizophrenia, with an average of 8.7 previous admissions. Positive and Negative Syndrome Scale and Global Assessment of Functioning were obtained at admission and discharge, and traumatic events in the biography were recorded using the Posttraumatic Diagnostic Scale. Twenty-four men (42.9%) and 18 women (29.0%) had experienced seclusion or restraint in their psychiatric history. Seclusion or restraint during the present admission was best predicted in a logistic regression model by physical aggressive behavior [odds ratio (OR), 11.5] and the Positive and Negative Syndrome Scale hostility item at admission (OR, 23.6). Seclusion or restraint ever in the psychiatric history, however, was mostly associated with lifetime exposure to life-threatening traumatic events (OR, 7.2). We conclude that exposure to traumatic events in the biography severely enhances the risk of revictimization and retraumatization during inpatient treatment.