Let op het is Open Access maar met speciale Elsevier user rights, zie https://www.elsevier.com/about/policies/open-access-licenses/elsevier-user-license Background The presence of a comorbid borderline personality disorder (BPD) may be associated with an increase of suicidal behaviors in patients with depressive and anxiety disorders. The aim of this study is to examine the role of borderline personality traits on recurrent suicide attempts. Methods The Netherlands Study on Depression and Anxiety included 1838 respondents with lifetime depressive and/or anxiety disorders, of whom 309 reported at least one previous suicide attempt. A univariable negative binomial regression analysis was performed to examine the association between comorbid borderline personality traits and suicide attempts. Univariable and multivariable negative binomial regression analyses were performed to identify risk factors for the number of recurrent suicide attempts in four clusters (type and severity of axis-I disorders, BPD traits, determinants of suicide attempts and socio-demographics). Results In the total sample the suicide attempt rate ratio increased with 33% for every unit increase in BPD traits. A lifetime diagnosis of dysthymia and comorbid BPD traits, especially the symptoms anger and fights, were independently and significantly associated with recurrent suicide attempts in the final model (n=309). Limitations The screening of personality disorders was added to the NESDA assessments at the 4-year follow-up for the first time. Therefore we were not able to examine the influence of comorbid BPD traits on suicide attempts over time. Conclusions Persons with a lifetime diagnosis of dysthymia combined with borderline personality traits especially difficulties in coping with anger seemed to be at high risk for recurrent suicide attempts. For clinical practice, it is recommended to screen for comorbid borderline personality traits and to strengthen the patient's coping skills with regard to anger.
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Purpose Incidents of self-injury by forensic psychiatric patients often have a deleterious impact on all those involved. Moreover, self-injurious behaviour is an important predictor for violence towards others during treatment. The aim of this study is to analyse methods and severity of incidents of self-injury of patients admitted to forensic psychiatry, as well as the diagnoses of self-injuring patients. Design/methodology/approach All incidents of self-injury during treatment in a forensic psychiatric centre recorded between 2008 and 2019 were analysed and the severity was coded with the modified observed aggression scale+ (MOAS+). Findings In this period, 299 incidents of self-injury were recorded, displayed by 106 patients. Most of these incidents (87.6%) were classified as non-suicidal. Methods most often used were skin cutting with glass, broken plates, a razor or knife and swallowing dangerous objects or liquids. Ten patients died by suicide, almost all by suffocation with a rope or belt. The majority of the incidents was coded as severe or extreme with the MOAS+. Female patients were overrepresented and they caused on average three times more incidents than male patients. Practical implications More attention is warranted for self-injurious behaviour during forensic treatment considering the distressing consequences for both patients themselves, supervisors and witnesses. Adequate screening for risk of self-injurious behaviour could help to prevent this behaviour. Further research is needed in different forensic settings into predictors of self-injurious behaviour, more specifically, if there are distinct predictors for aggression to others versus to the self. Originality/value Incidents of self-injury occur with some regularity in forensic mental health care and are usually classified as severe. The impact of suicide (attempts) and incidents of self-injurious behaviour on all those involved can be enormous. More research is needed into the impact on all those involved, motivations, precipitants and functions of self-injurious behaviour and effective treatment of it.
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Psychiatrisch verpleegkundigen hebben in hun werk regelmatig te maken met mensen die ernstig lijden. Voor een aantal van deze mensen is dit lijden dusdanig ondraaglijk dat zij overwegen om hun leven te beëindigen, een aantal mensen doet dit ook daadwerkelijk. Gemiddeld plegen in Nederland 1600 mensen per jaar suïcide (CBS). Het aantal mensen dat een suïcidepoging doet is rond 94.000 per jaar en 410.000 mensen in de Nederlandse bevolking hebben weleens suïcidegedachten (Ten Have et al. 2006). Hoewel suïcide niet voorbehouden is aan mensen met een psychiatrische diagnose, blijkt uit onderzoek dat bij 47% tot 74% van alle mensen de suïcide is toe te schrijven aan psychiatrische problematiek (Cavanagh et al. 2003). Het uitvragen en bespreken van suïcidaal gedrag is een belangrijk aandachtspunt in elke psychiatrische behandeling. In aansluiting op de internationale term 'suicidal behavior' wordt suïcidaal gedrag gedefinieerd als het geheel aan gedachten, voorbereidingshandelingen en pogingen die een zekere intentie uitdrukken om zichzelf te doden (Hemert et al. 2012). Verpleegkundigen hebben een belangrijke functie in het signaleren, monitoren en behandelen van suïcidaal gedrag.
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The Kennedy Axis V is a routine outcome measurement instrument which can assist the assessment of the short-term risk for violence and other adverse patient outcomes. The purpose of this study was to evaluate the interrater reliability and clinical utility of the instrument when used by mental health nurses in daily care of patients with mental illness. This cross-sectional study was conducted in inpatient and outpatient adult psychiatric care units and in one adolescent inpatient unit at a university hospital in the Netherlands. Interrater reliability was measured based on the independent scores of two different nurses for the same patients. The clinical utility of the instrument was evaluated by means of a clinical utility questionnaire. To gain a deeper understanding of rating difficulties at the adolescent unit, additional data were collected in two focus group interviews. The overall results revealed a substantial level of agreement between nurses (intraclass correlation coefficient and Pearson 0.79). Some rating challenges were identified, including difficulties with scoring the instrument and using tailor-made interventions related to the scores. These challenges can be resolved using refined training and implementation strategies. When the Kennedy Axis V is accompanied by a solid implementation strategy in adult mental health care, the instrument can be used for short-term risk assessment and thereby contribute in efforts to reduce violence, suicide, self-harm, severe selfneglect, and enhanced objectivity in clinical decision-making.
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Artikel in Cliëntveiligheid: Bij euthanasie of hulp bij zelfdoding faciliteert een arts een patiënt bij het uitvoeren van een zelfgekozen dood. Tegelijk willen we in de GGZ suïcidale patiënten beschermen voor een zelfgekozen dood. Suïcidaal gedrag komt veel voor en is een complex probleem. In Nederland hebben naar schatting jaarlijks 410.000 mensen gedachten over suïcide. 94.000 mensen doen een suïcidepoging.1 In 2020 werden 88 patiënten geëuthanaseerd op basis van een psychiatrische aandoening. 2 Wat zijn globaal de verschillen en overeenkomsten tussen suïcidaal gedrag en het uiten van een wens tot euthanasie? Dit artikel spitst zich bij het beantwoorden van deze vragen toe op patiënten in de GGZ die om euthanasie vragen, of zich suïcidaal uiten
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In a large body of research the influence of contextual information on decisions made in a broad range of disciplines has been studied. To date, the influence of these expectancy effects on the crime scene investigation has not been studied. In the present study we explored the effect of prior information given to crime scene investigators on their perception and interpretation of an ambiguous crime scene. Participants (N=58) were experienced crime scene investigators who were provided with a panoramic photograph of an ambiguousmock crime scene. The victimmay have committed suicide orwasmurdered. Participants either received prior information indicating suicide, prior information indicating a violent death, or they received no prior information. Participants were asked about what they thought had happened at the scene of the crime, both at the initial assessment of the scene and at the end of the investigation when they were asked to describe the most likely scenario. They were also asked which traces they wanted to secure and why. Results showed that participants interpreted the crime scene differently dependent on how it was presented to them. Both the initial assessment of the scene and the most likely scenario that was described after the investigation were influenced by the prior information the participants were provided with, even though roughly the same traces were secured by all, independent of the prior information. Results demonstrate that prior information indeed influences the interpretation of the crime scene, but since the present study was exploratory further research is needed.
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Background: Information is scarce concerning the perceived needs and the amount of health-care utilization of persons with suicidal ideation (SI) compared to those without SI. Aims: To describe the needs and health care use of persons with and without SI and to investigate whether these differences are associated with the severity of the axis-I symptomatology. Method: Data were obtained from 1,699 respondents with a depressive and/or anxiety disorder who participated in the Netherlands Study of Depression and Anxiety. Persons with and without SI were distinguished. Outcome variables were perceived needs and health-care utilization. We used multivariate regression in two models: (1) adjusted only for sociodemographic variables and (2) adjusted additionally for severity of axis-I symptomatology. Results: Persons with SI had higher odds for both unmet and met needs in almost all domains and made more intensive use of mental-health care. Differences in needs and health-care utilization of persons with and without SI were strongly associated with severity of axis I symptomatology. Conclusions: Our results validate previous findings about perceived needs and health-care use of persons with SI. The results also suggest that suicidal persons are more seriously ill, and that they need more professional care, dedication, and specialized expertise than anxious and depressed persons without SI, especially in the domains of information and referral.
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A large body of research has described the influence of context information on forensic decision-making. In this study, we examined the effect of context information on the search for and selection of traces by students (N = 36) and crime scene investigators (N = 58). Participants investigated an ambiguous mock crime scene and received prior information indicating suicide, a violent death or no information. Participants described their impression of the scene and wrote down which traces they wanted to secure. Results showed that con- text information impacted first impression of the scene and crime scene behavior, namely number of traces secured. Participants in the murder condition secured most traces. Furthermore, the students secured more crime-related traces. Students were more confident in their first impres- sion. This study does not indicate that experts outperform novices. We therefore argue for proper training on cognitive processes as an integral part of all forensic education.
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Het pakket bestaat uit twee delen en meerdere praktische bijlage die u in de praktijk meteen kan toepassen: Deel A: Theoretische onderbouwing en aanbevelingen: hierin wordt u een theoretische onderbouwing van de richtlijn gegeven, dat resulteert in aanbevelingen voor hulpverleners. Deze gegevens zijn van belang om goed met de richtlijn te kunnen werken. Deel B: Gegevensverzameling en interventies: in dit deel worden de aanbevelingen specifiek uitgewerkt voor de verpleegkundige beroepsgroep. Het effectief gebruik van de richtlijn, de wijze van gegevensverzameling en het kiezen van interventies komen aan bod.
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Selbstverletzendes Verhalten von Patienten der forensischen Psychiatrie hinterlässt bei allen Beteiligten oft einen starken Eindruck und ist ein wichtiger Prädiktor für Gewalt gegen andere während der Behandlung. Ziel dieser Studie ist es, Selbstverletzungen von Patienten zu beschreiben, die in die forensische Psychiatrie eingewiesen wurden. Im Zeitraum von 2008 bis 2019 wurden insgesamt 299 Selbstverletzungen registriert, die von 106 Patienten während der Behandlung in einem Zentrum für forensische Psychiatrie begangen wurden. Alle aufgezeichneten Vorfälle von Selbstverletzung wurden analysiert und nach Schweregrad kodiert mit Hilfe der MOAS+. Bei der Mehrheit der Vorfälle (87,6 %) handelte es sich um selbstverletzendes Verhalten ohne Suizidabsicht. Die häufigsten Methoden waren das Schneiden mit Glas, zerbrochenem Geschirr oder einem (Rasier-)Messer und das Verschlucken gefährlicher Flüssigkeiten oder Gegenstände. Es gab 10 Selbsttötungen, die fast alle durch Erhängen mit einem Seil oder Gürtel erfolgten. Die Mehrzahl der Vorfälle wurde auf der MOAS+ als schwer oder äußerst schwer eingestuft. Weibliche Patienten verursachten im Durchschnitt dreimal so viele Vorfälle wie männliche Patienten. Die Studie zeigt, dass selbstverletzendes Verhalten in der forensischen Psychiatrie regelmäßig vorkommt und in der Regel schwerwiegend ist. Die Auswirkungen auf die Betroffenen und Zeugen der Vorfälle, die Motive und Auslöser für das selbstverletzende Verhalten und eine wirksame Behandlung sind noch zu erforschen.
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