Zoekresultaten

Effect of nocturnal sound reduction on the incidence of delirium in intensive care unit patients

INTRODUCTION: Delirium in critically-ill patients is a common multifactorial disorder that is associated with various negative outcomes. It is assumed that sleep disturbances can result in an increased risk of delirium. This study hypothesized that implementing a protocol that reduces overall nocturnal sound levels improves quality of sleep and reduces the incidence of delirium in Intensive Care Unit (ICU) patients.METHODS: This interrupted time series study was performed in an adult mixed medical and surgical 24-bed ICU. A pre-intervention group of 211 patients was compared with a post-intervention group of 210 patients after implementation of a nocturnal sound-reduction protocol. Primary outcome measures were incidence of delirium, measured by the Intensive Care Delirium Screening Checklist (ICDSC) and quality of sleep, measured by the Richards-Campbell Sleep Questionnaire (RCSQ). Secondary outcome measures were use of sleep-inducing medication, delirium treatment medication, and patient-perceived nocturnal noise.RESULTS: A significant difference in slope in the percentage of delirium was observed between the pre- and post-intervention periods (-3.7% per time period, p=0.02). Quality of sleep was unaffected (0.3 per time period, p=0.85). The post-intervention group used significantly less sleep-inducing medication (p<0.001). Nocturnal noise rating improved after intervention (median: 65, IQR: 50-80 versus 70, IQR: 60-80, p=0.02).CONCLUSIONS: The incidence of delirium in ICU patients was significantly reduced after implementation of a nocturnal sound-reduction protocol. However, reported sleep quality did not improve.

Perspectives of underweight people with eating disorders on receiving Imagery Rescripting trauma treatment: a qualitative study of their experiences

"A proportion of those with eating disorders have also experienced traumatic events and ongoing symptoms of PTSD such as re-experiencing of the trauma and nightmares. We implemented an innovative trauma intervention called Imagery Rescripting (ImRs) to explore whether for those undergoing inpatient treatment for an eating disorder (in an underweight phase), it would be possible to treat the various trauma-related symptoms as well as the eating problems. Since this has not been investigated before, we asked the participants in this study to recount their experiences. Twelve participants who were underweight, reported a past history of trauma and were in an inpatient eating disordertreatment program participated in ImRs therapy intervention. One of these participant did not engage in the ImRs therapy because she discontinued the inpatient ED treatment. Analysis of interviews with these participants found that -although they were reluctant before the start of the treatment- the ImRs treatment during their inpatient admission had given them hope again. They added that it was important to have support from group members, sociotherapists and therapists. They shared a number of ways that the ImRs treatment could be adapted to people with eating disorders. Their experiences indicated that given these factors it was possible to treat PTSD during an underweight phase. This is important: until now, treatment for eating disorders has not specifically been trauma-focused and these tips have scope to improve the ImRs intervention and eating disorder treatment more broadly in the future."

Arts and psychomotor therapies in the treatment of personality disorders

This special theme issue of the Journal of Clinical Psychology: In Session, edited by Dr. Suzanne Haeyen and Dr. Giancarlo Dimaggio, is devoted to arts and psychomotor therapies in patients with personality disorders (PD). The issue starts with an introduction and concludes with a commentary by the guest editors. The content of the special issue consists of seven papers, each based on a clinical case coming from different modalities, countries and continents. The papers focus on therapeutic working methods from the arts, dance movement, drama, music therapies and body based/psychomotor therapy with the aim of personal development, finding an appropriate therapeutic entrance, coping with grief, post traumatic nightmares, personal integration, interpersonal functioning and making meaning of one’s own life story in words and images. The case studies cover people diagnosed with various PDs such as narcissistic, dependent and borderline PD, in mental health care and forensic settings. With these case descriptions, we offer a multicolored palette of possibilities, knowing that there is so much more to know and explore.

On socialist cybernetics, accelerationist dreams and Tiqqun's nightmares

Drawing your way out: Imagery rehearsal based art therapy (IR‐AT) for post‐traumatic nightmares in borderline personality disorder

Posttraumatic nightmares (PTN) are a frequent symptom after a traumatic event and often play part in the psychopathology of patients with borderline personality disorder (BPD). Imagery rehearsal therapy (IRT) currently offers the best evidence for an effective treatment to reduce PTNs, although high drop‐out rates are common. Art therapy in IRT may counteract this, by its indirect, nonverbal, and often playful approach that helps to break through avoidance. This case study focusses on the perception of a patient with BPD in an art therapy based IRT treatment for patients with PTNs. It tells the story of Aurelia, a 40‐year‐old woman who, within this treatment, processes traumatic contents of her childhood like physical and sexual violence, but also current interactional problems that manifest themselves in her nightmares. Following the IR‐AT treatment for PTNs Aurelia noticed a reduction in her nightmares, was less afraid of them and felt calmer towards her trauma. She expressed herself in the art medium and by this developed more self‐efficacy. Her process resulted in an integration of the trauma and a perceived decrease in borderline symptoms. Future research can build on this basis to further explore the mechanisms and effects of IR‐AT for PTNs.

Imagery rehearsal based art therapy

Imagery Rehearsal Therapy (IRT) is effective for trauma-related nightmares and is also a challenge to patients in finding access to their traumatic memories, because these are saved in non-verbal, visual, or audiovisual language. Art therapy (AT) is an experiential treatment that addresses images rather than words. This study investigates the possibility of an IRT-AT combination. Systematic literature review and field research was conducted, and the integration of theoretical and practice-based knowledge resulted in a framework for Imagery Rehearsal-based Art Therapy (IR-AT). The added value of AT in IRT appears to be more readily gaining access to traumatic experiences, living through feelings, and breaking through avoidance. Exposure and re-scripting take place more indirectly, experientially and sometimes in a playlike manner using art assignments and materials. In the artwork, imagination, play and fantasy offer creative space to stop the vicious circle of nightmares by changing theme, story line, ending, or any part of the dream into a more positive and acceptable one. IR-AT emerges as a promising method for treatment, and could be especially useful for patients who benefit least from verbal exposure techniques. This description of IR-AT offers a base for further research.