To reduce coercion in acute inpatient child and adolescent psychiatric units, a better understanding of individuals at risk for seclusion and/or restraint (S/R) is needed. We report data on the proportion of patients secluded/restrained and factors associated with higher risk of S/R. Identifying preventative mechanisms through risk stratification upon inpatient admission can aid the training of mental health professionals, and support shaping specific workflows for at-risk populations for example by joint crisis plans or post-coercion review sessions.
METHODS: A case-control study included all admissions (n = 782) to a department of child and adolescent psychiatry within 36 months between 2019 and 2022. Data on age, sex, out of home care, primary and comorbid ICD-10 diagnoses, length of stay, prior/multiple admissions were compared between admissions with and without S/R using chi square tests for categorical and t-tests for continuous variables. Uni- and multivariate binary logistic regression models were computed.
RESULTS: The overall proportion of S/R was 12.8% (n = 100). Females (p = 0.001), patients in out of home care (p < 0.001), with prior admission (p < 0.001), Post-traumatic stress disorder (PTSD; p < 0.001) and Borderline personality disorder (BPD; p < 0.001) were at a significantly higher risk of S/R. Length of stay in days (OR 1.01), out of home care (OR 3.85), PTSD (OR 6.20), BPD (OR 15.17), Attention deficit hyperactivity disorder (ADHD)/conduct disorder (OR 4.29), and manic episode/bipolar disorder (OR 36.41) were significantly associated with S/R in multivariate regression.
CONCLUSIONS: Child and adolescent psychiatric staff should consider risk factors when using coercive measures. Patients with PTSD and/or BPD are the most vulnerable subgroups. Training of professionals and clinical practice need to be adapted in order to prevent the use of S/R and its potential hazards.

In 1962, Ontario\'s Addiction Research Foundation launched the first double-blind randomized controlled trial of LSD therapy as a treatment for alcoholism. The study, which found that LSD was not effective, was heavily criticized by other therapists working with the drug. These critics argued that the Toronto researchers who carried out the study were biased against LSD and used an anti-therapeutic method that was destined to produce negative results. Instead of creating a comfortable and supportive environment, they stressed, the Toronto group restrained patients to a bed in a hospital ward, used an unusually large dose of LSD, and hardly provided any careful therapeutic support. Some even compared this method to a \"form of torture.\" Historians have paid little attention to the study, mentioning it only as an example of flawed or naïve LSD therapy that contrasted with the more advanced \"psychedelic\" approach developed in Saskatchewan. In this paper, I take a closer look at the Toronto psychiatrists who carried out the study and created the unique method that was employed. I show that they were actually quite excited about LSD and were more sophisticated in their approach to its use than has been appreciated by historians and critics. In many ways, they had their own brand of LSD expertise that differed from that of the Saskatchewan group. Some of the problems with the ARF study, then, did not stem from negative bias or a lack of competency, but instead resulted from the awkward relationship between LSD therapy and controlled trials.
Résumé. En 1962, la Fondation pour la recherche sur la toxicomanie de l’Ontario lançait son premier test aléatoire et contrôlé en double aveugle de thérapie par le LSD pour traiter l’alcoolisme. L’étude, qui concluait que le LSD n’était pas efficace, a fait l’objet de critiques sévères de la part d’autres thérapeutes qui utilisaient cette drogue. Ces thérapeutes soutenaient que le groupe de recherche torontois avait un parti pris défavorable au LSD et avait employé des méthodes antithérapeutiques dans le but de produire des résultats négatifs. Ainsi, selon eux, au lieu de créer un environnement offrant un réel soutien, le groupe de Toronto attachait les patients à leur lit d’hôpital, employait des doses inhabituellement élevées de LSD et ne fournissait à peu près aucun soutien thérapeutique. La méthode a même été comparée à « une forme de torture ». Les historiennes et les historiens ont accordé peu d’attention à l’étude, sauf pour la citer comme exemple déficient ou naïf de thérapie par le LSD, en l’opposant à l’approche « psychédélique » plus avancée mise au point en Saskatchewan. Dans cet article, je m’intéresse aux psychiatres qui ont mené l’étude de Toronto et conçu la méthode originale employée à la Fondation. Je montre que l’usage du LSD suscitait beaucoup d’enthousiasme dans le groupe et que son utilisation de cette drogue était plus complexe que l’ont reconnu jusqu’ici l’histoire et la critique. À plusieurs égards, le groupe de Toronto disposait de sa propre expertise en matière de LSD, différente de celle de ses collègues de la Saskatchewan. J’en conclus qu’une partie des problèmes attribués à l’étude conduite par la Fondation ne provient pas d’un préjugé défavorable ou d’un manque de compétence, mais plutôt des liens complexes entre la thérapie par le LSD et les essais cliniques.

Physical restraint is usually used when trying to control and terminate a violent episode. Many causes are possible behind aggressive, agitated, and violent behavior. Some of these are such factors that can either be detected in forensic autopsies or can be evident from the person\'s medical records. Various causes for deaths during physical restraint have been suggested. In this study, we wanted to review all incidents in which physical restraint was employed, ending in death of the restrained person, whether the restraint was applied by police officers, security guards, police custody personnel, health care personnel or ordinary civilians. The main aim was to see if this new kind of study design would increase our knowledge in circumstances and causes leading to death in restraint situations. Data was collected retrospectively from all forensic autopsies performed in the Southern Finland area during 2010-2015. We went through 21,036 forensic autopsy cases and found 12 cases (0.06 %) in which a physical restraint was employed before death. Police officers were involved in the physical restraint in 7/12 of the cases: in two of these cases, police alone; in three cases, police and guards; and in two cases, police and health care personnel. Civilians carried out the restraint in 5/12 cases. With civilians responsible for the restraint, the cause of death was more likely considered to be a result of the restraint itself than in cases where police and other authorities were responsible for the restraint. This could be because civilians aren\'t educated about safe restraint methods, and they might themselves be intoxicated. Alcohol was the most common psychoactive substance found in this study and could be a risk factor for not only aggressive behavior but also death, since alcohol use can provoke cardiac arrhythmias and even sudden death. Based on this study, and previously published studies, we see restraint deaths as a varying spectrum of deaths, in which the death is often possibly a result of many factors, including the effects of agitation and restraint, intoxication, and cardiac and other illnesses.

OBJECTIVE: Aggressive behavior is common on psychiatric inpatient units. Seclusion and restraint interventions to manage patients\' aggressive behavior may have the consequence of being traumatizing for patients. Pediatric psychiatric patients\' perspective on the use of seclusion and restraint interventions is not present in the literature.
METHODS: This hermeneutic nursing research study asked the question, \"How might we understand children\'s experiences of seclusion and restraints on an inpatient psychiatric unit?\" Four past pediatric psychiatric inpatients shared their hospitalization experiences that occurred within the previous year when they were 10 years old. The texts of the research interviews were compared to Attachment Theory for a deeper understanding of the meaning of the message.
RESULTS: Participants commonly described experiences with seclusion and restraints as feeling trapped and alone in a dark room. They recommended the nurses step into the room with them to help them heal. Interpretively, the rooms on inpatient units could be considered as actual and metaphorical spaces of possible harm or healing.
CONCLUSIONS: The participant\'s voices expand understanding of nurse\'s use of discernment at the doorway of a patient room to ensure the most therapeutic care is provided to the patient in these spaces through a secure nurse-patient relationship.

OBJECTIVE: The main purpose of this review was to (1) identify thematic elements within definitions used by recently published literature to describe the constructs of physical/mechanical restraint, seclusion and chemical restraint in adult mental health inpatient units.
METHODS: We conducted a comprehensive literature search of six databases (Scopus, MEDLINE, PsycINFO, Web of Science, Embase, and CINAHL-Plus). In this review, we conducted content analysis to synthesize evidence to understand and compare the commonalities and discrepancies in conceptual elements that were incorporated within the definitions of different forms of restrictive care practices.
RESULTS: A total of 95 studies that provided definitions for different forms of restrictive care practices [physical/mechanical restraint (n = 72), seclusion (n = 65) and chemical restraint (n = 19)] were included in this review. Significant variations existed in the conceptual domains presented within the applied definitions of physical/mechanical restraint, seclusion, and chemical restraint. Conceptual themes identified in this review were methods of restrictive care practice, reasons and desired outcomes, the extent of patient restriction during restrictive care practice episodes, timing (duration, frequency, and time of the day), the level of patient autonomy, and the personnel implementing these practices.
CONCLUSIONS: Inconsistencies in the terminologies and conceptual boundaries used to describe the constructs of different forms of restrictive care practices underscore the need to move forward in endorsing consensus definitions that reflect the diverse perspectives, ensuring clarity and consistency in practice and research. This will assist in validly measuring and comparing the actual trends of restrictive care practice use across different healthcare institutions and jurisdictions.

Care, management, and statute each mandate restraint-reporting in psychiatric settings in England. PROD-ALERT in this journal (\"PA1\") correlated log incidence of restraint, log institutional size, and log detention. The period was September 2020 to August 2021. It showed a clear trend among reporters. Restraint correlated with institutional size and use of legal detention. Some large detaining providers reported no restraints per month despite that trend. Inference from size suggested that non-complete reporters restrained 1,774 people per month. This paper \"PA2\" develops analysis repeating it for September 2021 to August 2022. PA2 shows how to count L-information, i.e., questionable information, added by null reports, by applying an L-test to data sets. PA2 uses illustrative vignettes about human height to ground L-information scores from English restraint reporting. In PA2, reported restraint again correlates with size and detention as in PA1. PA2 shows evolving data. Providers still follow a trend in restraint by size and detention. Providers which newly report restraint are on trend. Inference suggests that non-complete reporters restrained 1,305 people per month (536-3233), 95% CI, a large but reduced number since PA1. English restraint data have an L-test L-information score of increase in information by a factor of L = 145. This is as surprising as claiming that an average English man of 1.72 m is 2.64 m tall. Persons restrained per month is a robust measure continuing to log-correlate with size and legal compulsion. Providers over a certain size who report null restraint probably have some. Restraint remains underreported in England. Imputation of incomplete reporters shows a large shrinking cohort of patients detained by incomplete reporters. Knowledge of this may promote reporting. Improved reporting, and the infrastructure and integrity it demands, may help providers measure and reduce restraint. PA1 remains unrefuted. L-test can measure L-information in intuitively representable ways. The informational effect of nulls on the reliable data set is similar to a claim that an average-heighted man is as tall as people with clinical gigantism.

The plasma bacterial killing ability (BKA) is modulated by the stress response in vertebrates, including amphibians. The complement system is an effector mechanism comprised of a set of proteins present in the plasma that once activated can promote bacterial lysis. Herein, we investigated whether changes in plasma BKA as a result of the acute stress response and an immune challenge are mediated by the complement system in Rhinella diptycha toads. Additionally, we investigated whether the observed changes in plasma BKA are associated with changes in plasma corticosterone levels (CORT). We subjected adult male toads to a restraint or an immune challenge (with three concentrations of Aeromonas hydrophila heat inactivated), and then evaluated the plasma BKA against A. hydrophila, in vitro. We determined the complement system activity on plasma BKA, by treating the plasma (baseline, 1 h and 24 h post-restraint, and after the immune challenge) with ethylenediaminetetraacetic acid, heat, or protease. Our results showed increased CORT 1 h and 24 h after restraint and decreased plasma BKA 24 h post-restraint. The inhibitors of the complement system decreased the plasma BKA compared with untreated plasma at all times (baseline, 1 h, and 24 h after restraint), demonstrating that the plasma BKA activity is partially mediated by the complement system. The immune challenge increased CORT, with the highest values being observed in the highest bacterial concentration, compared with control. The plasma BKA was not affected by the immune challenge but was demonstrated to be partially mediated by the complement system. Our results demonstrated that restraint and the immune challenge activated the hypothalamus-pituitary-interrenal axis, by increasing plasma CORT levels in R. diptycha. Also, our results demonstrated the complement system is participative in the plasma BKA for baseline and post-stress situations in these toads.

The basolateral amygdala (BLA), a brain center of emotional expression, contributes to acoustic communication by first interpreting the meaning of social sounds in the context of the listener\'s internal state, then organizing the appropriate behavioral responses. We propose that modulatory neurochemicals such as acetylcholine (ACh) and dopamine (DA) provide internal-state signals to the BLA while an animal listens to social vocalizations. We tested this in a vocal playback experiment utilizing highly affective vocal sequences associated with either mating or restraint, then sampled and analyzed fluids within the BLA for a broad range of neurochemicals and observed behavioral responses of adult male and female mice. In male mice, playback of restraint vocalizations increased ACh release and usually decreased DA release, while playback of mating sequences evoked the opposite neurochemical release patterns. In non-estrus female mice, patterns of ACh and DA release with mating playback were similar to males. Estrus females, however, showed increased ACh, associated with vigilance, as well as increased DA, associated with reward-seeking. Experimental groups that showed increased ACh release also showed the largest increases in an aversive behavior. These neurochemical release patterns and several behavioral responses depended on a single prior experience with the mating and restraint behaviors. Our results support a model in which ACh and DA provide contextual information to sound analyzing BLA neurons that modulate their output to downstream brain regions controlling behavioral responses to social vocalizations.

Deep vein thrombosis is a condition in which a thrombus forms in one of the deep veins of the body, most often in the legs. It may manifest with pain, swelling, redness, or increased temperature of the limb, potentially leading to fatal complications such as pulmonary embolism. This is a case of a 15-year-old psychiatric patient diagnosed with deep vein thrombosis of the left lower limb of uncertain etiology. The patient presented few risk factors associated with venous thromboembolism disorder such as immobilization, antipsychotic treatment, and obesity. Even though psychiatry deals primarily with the mind of a patient, somatic complications occur very often and should not be underestimated. One of those complications is deep vein thrombosis, which is worth remembering, especially when applying procedures during which patients are immobilized for a long period.

The incidence of aggression within healthcare environments has exhibited a discernible rise. As a response, restrictive measures, including restraints, are enforced. Due to the safety and ethical concerns associated with using restraint, de-escalation measures are regarded as the most efficient course of action. The paper posits that it is critical to identify the causes of aggression before employing restraint through a multidisciplinary risk assessment. In addition, the reasonableness and proportionality of administering restraint must be carefully measured. The significance of cultivating a therapeutic and compassionate environment is emphasised. The paper will exclusively examine physical restraint as a form of restriction intervention.