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J J Stolker

Publications and source records attributed to J J Stolker.

10 recordsLinked to original sources
PubMed2005

Fifteen years of research with the Staff Observation Aggression Scale: a review.

OBJECTIVE: Research on the prevalence and causes of in-patient aggression has been hindered by the use of different methods for measuring aggression. Since Palmstierna and Wistedt presented the Staff Observation Aggression Scale (SOAS) in 1987, this data collection method has been used in various studies, which may make comparisons more useful. METHOD: Studies with SOAS aggression data were compiled using MEDLINE, the Internet, and references from SOAS papers. RESULTS: Reviews of studies on psychometric properties suggest fair to good inter-rater reliability and validity for SOAS assessments. The number of aggressive incidents per patient per year found on acute admissions wards (n = 38) considerably varied, with a range of 0.4-33.2 incidents (mean = 9.3). CONCLUSION: Although the aggression data included in the present review were obtained in highly comparable ways, substantial differences in aggression rates between wards were still found. Some countries (e.g. the Netherlands) appear to have a relatively high incidence of aggression on acute wards.

Acute Disease↗
PubMed2003

[Seclusion of admitted psychotic patients: later in the case of antipsychotic use and also possibly less often].

OBJECTIVE: To establish the incidence and determinants of seclusion and to gain insights into the use of antipsychotics before and after the seclusion of acutely admitted patients. DESIGN: Retrospective cohort analysis. METHOD: We collected data from a consecutive sample of 996 patients in adult psychiatric admission wards for the period 1997-1999. Secluded patients were compared with non-secluded patients and the correlations between antipsychotic use and seclusion were calculated. RESULTS: The average age of the 996 patients (507 men and 489 women) was 38.0 years (median: 37.0; range: 16-84). Seclusion was applied in the case of 285 patients (28.6%). Young age (< 30 years), low Global Assessment of Functioning score (< 55), involuntary hospitalisation and bipolar disorder (manic episode) were significantly associated with seclusion. For patients with psychotic disorders who used antipsychotics during the first week, the median time from admission to seclusion was 7 days (in patients not using antipsychotics this was 2.5 days). Furthermore, the use of antipsychotics was, although not significant, associated with a lower risk of seclusion (relative risk: 0.7; 95% CI: 0.5-1.2). In a substantial number of the psychotic patients, antipsychotic treatment was initiated during or shortly after seclusion; they used these drugs more often than psychotic non-secluded patients (relative risk: 2.0; 95% CI: 1.2-3.4). CONCLUSION: The use of antipsychotics is associated with a later application of seclusion as well as its possible delay. For a considerable number of patients, treatment with antipsychotics was started either during or shortly after seclusion.

Adolescent↗
PubMed2002

Psychotropic drug use in intellectually disabled group-home residents with behavioural problems.

Little is known about psychiatric and behavioural factors associated with psychotropic drug use and how appropriately these drugs are prescribed in settings for people with intellectual disabilities. The aim of this study was to measure the point prevalence of psychotropic drug use in a problem-behaviour group (PBG) consisting of intellectually disabled residents of group homes compared to a random group (RG), and to gain insight in possible factors that are associated with group membership. From all group homes in the Netherlands, 573 problematic residents were selected by the staff (one resident from each home) and 1479 residents were randomly sampled from all of the homes. Mental health problems were measured using the Reiss Screen for Maladaptive Behaviour and the Psychopathology Instrument for Mentally Retarded Adults. The response rate in the PBG was 68.9 % and in the RG 71.7 %. Psychotropics (excluding anticonvulsants) were used by 52.6 % of the PBG and by 22.8 % of the RG. Young age, psychotic, anxiety, and aggression symptoms were significantly associated with the PBG, as was the use of antipsychotics and antidepressants. The PBG more often used multiple (three or more) drugs (17.3 %) than the RG (7.3 %). A low prevalence of antidepressants or mood stabilisers, antipsychotics, and anxiolytics was found in residents with affective, psychotic, or anxiety symptoms. We conclude that psychotropic drug use in the PBG compared to the RG was high. It is likely that the group-home staff finds it difficult to deal with young people with socially disruptive behaviour, which is underlined by our finding of high prevalence of antipsychotics and multiple-drug therapy in the PBG. Finally, our findings suggest that a considerable number of residents with psychiatric or behavioural symptoms are undertreated.

Adolescent↗
PubMed2001

ECT in mental retardation: a review.

The use of electroconvulsive therapy (ECT) in patients with mental retardation and a psychiatric disorder seems to be infrequent, and controlled studies are not available. We reviewed the literature on the use of ECT in mental retardation, using Medline, Embase, and the Cochrane Library. References were checked and ECT experts consulted. The reported case studies were examined on patients' characteristics and illness, treatment, and outcome variables. Forty-four patients, mostly with a diagnosis of psychotic depression, were found. In 84% (n = 37) of them, ECT was effective and without important side effects. However, relapse occurred frequently, in 48% (n = 21) of the patients. In 16% (n = 7), side effects and/or no improvement were noted. The reported case studies suggest that ECT may be of value in treating severe psychiatric disorders in mentally retarded patients, with similar indications as in general psychiatry. However, the lack of strong scientific evidence, besides complicated psychiatric assessment as well as ethical and legal issues, probably cause an unnecessarily limited use of ECT in these patients. Further controlled trails are needed to firmly establish the efficacy and safety of ECT in mental retardation.

Adolescent↗
PubMed1999

[Psychiatric consultation and treatment for mentally handicapped persons exhibiting behavioral changes].

In three mentally handicapped people, two women aged 47 and 68 years respectively and a man aged 68, who suffered from behavioural changes that were not understood by the staff of the institution where the people lived, a psychiatric diagnosis was made by a consulting psychiatrist. The first woman had Down syndrome, she suffered from weight loss, loss of enjoyment and severe hallucinations. She was treated for a depressive disorder and recovered. The second woman yelled and threatened to hit the nursing staff. A bipolar condition was diagnosed and after unsuccessful drug treatment she was treated with electroconvulsion therapy upon which she recovered. The man had developed restlessness and verbal aggression with megalomanic episodes. A mood disorder was diagnosed which responded to valproic acid. In people with a mental handicap psychiatric disorders can be easily missed. The disorder can be complicated by an atypical presentation of symptoms, difficulty in obtaining information and limited knowledge and organization of the psychiatric services. Psychiatric consultation in people with mental retardation may lead to diagnosis and treatment of a psychiatric disorder.

Aged↗
PubMed1998

Determinants of psychotropic drug usage in a general intensive care unit.

During a 3-month period, determinants of psychotropic drug utilization (sex, age, length of stay, reason for admission, disease severity) and data on psychotropic consumption (type of medication--antidepressants, benzodiazepines and antipsychotics--dosage and length of treatment) were retrospectively collected in a general intensive care unit of a Dutch university hospital. Daily exposure to psychotropics was standardized in number of Defined Daily Doses (DDD). Benzodiazepines were used by 35.8% of all patients (137) during their stay in the ICU whereas 17.5% of all patients used a neuroleptic agent. Antidepressants were hardly prescribed. High doses of benzodiazepines (9.9 DDDs) and low doses of antipsychotics (0.5 DDDs) were prescribed, which probably reflect the unusual nature of this critically ill group of patients compared with the reference group for DDD's. Clear patterns of determinants of psychotropic drug use in ICU patients were found and both benzodiazepines, antipsychotics and combined use of these agents could be associated with the determinants assessed. The time patterns we found in terms of length of stay give clues for further investigations in order to rationalize psychotropic drug use in the management of severely ill and complex patients.

APACHE↗
PubMedDate not supplied

Determinants of multiple psychotropic drug use in patients with mild intellectual disabilities or borderline intellectual functioning and psychiatric or behavioral disorders.

Prevalence rates of psychotropic drug use in people with intellectual disabilities are high and pharmacotherapy is often attempted with multiple drugs. The presence of disruptive behavior is an important factor associated with the use of psychotropic drugs in this population. We wanted to gain insight into prevalence and determinants of multiple psychotropic drug use among patients with mild intellectual disabilities or borderline intellectual functioning with psychiatric or behavioral disorders. Therefore, data on psychotropics and possible determinants of use were retrospectively collected during 1992-1997 in a specialized closed ward of a Dutch general psychiatric hospital. We defined multiple drug use as concomitant prescription (regular or as needed) of a combination of benzodiazepines/tranquilizers/antipsychotics/anticonvulsants/anti-depressants. Multiple drug use, seen in 48% of the patients, was associated with a long duration of stay, psychosis, aggressive, bizarre, attention-seeking behavior and involuntary measures. We conclude that it is likely that difficulties in the management of socially disruptive behavior are often countered by multiple drug prescription.

Adolescent↗