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At least 19 recordsLinked to original sources
PubMed1978

The role of physical restraint in the treatment of psychiatric illness.

Although physical restraint is a widely used and possibly hazardous form of treatment, few guidelines for its use appear in the recent psychiatric literature. An approach is described in which physical restraint is considered to be a specific therapeutic technique with definable indications, "dosages", contra-indications, and side effects. A method of initiating and terminating this treatment modality is presented and the indications for its use are discussed. These include the presence of violent behavior during a psychotic illness; the presence of agitation or confusion when the use of antipsychotic medication is limited by physical illness; the presence of severe psychotic symptoms in conjunction with severely regressed, socially aversive behavior; the need to reduce excessive external stimuli; and the request for restraint by the patient. Possible side effects and contra-indications are also discussed and criteria for evaluating the duration and effectiveness of the treatment are proposed.

Evaluation Studies as Topic↗
PubMed1978

Chemical and physical restraint of nonhuman primates.

Numerous publications on primate restraint and anesthesiology have appeared in recent years. This reflects the striking growth of interest in medical primatology and of efforts to improve restraint agents and methods to facilitate humane use of primates in research. For access to earlier literature, readers should consult recent textbooks [12; 29, pp. 469--474], reviews on chemical or physical restraint [3, 4, 16, 27, 30, 37], and other valuable publications on these subjects that have appeared since 1965 [1, 20, 23, 36, 40, 42]. In this brief review we consider publications, principally since 1971, that deal with chemical or physical restraint. We also present previously unpublished data on the clinical use in primates of CI 744 (Telazol), a new dissociative anesthetic that until recently has been available only for investigational use.

Alfaxalone Alfadolone Mixture↗
PubMed1978

The use of physical restraint in the treatment of self-injury and as positive reinforcement.

Two experiments investigated the effects of a treatment package on the self-injurious behavior of three profoundly retarded persons who appeared to enjoy the physical restraints used to prevent their self-injury. The treatment package included physically restraining subjects contingent on increasing periods of time during which no self-injury occurred, and providing them with toys and attention during intervals between restraints. A reversal and multiple-baseline analysis documented that the rapid and complete reduction in self-injury by all subjects was due to this treatment package. Because these results suggested that physical restraint might function as a positive reinforcer, in a third experiment physical restraint was applied contingent on a marble placement response with one subject. A reversal design demonstrated that toy play systematically increased when each response resulted in restraint. The experiments have implications for the nonaversive remediation of self-injury in individuals who are restrained, as well as for the development and maintenance of self-injury in natural settings.

Adolescent↗
PubMed1977

Physiologic measures of nonhuman primates during physical restraint and chemical immobilization.

The arterial acid-base balance and other selected physiologic measures of physically restrained and chemically immobilized nonhuman primates from the families Callithricidae, Cebidae, Cercopithecidae, and Pongidae were compared. The physically restrained primates had significantly lower pH, pCO2, and base excess values, but they had significantly higher pO2 values, rectal temperatures, and pulse and respiration rates. Of 56 physically restrained primates, 30 (54%) experienced severe metabolic acidosis, with pH values less than 7.2; 15 (27% of total) had pH values less than 7.1. Two types of behavior were observed during the physical restraint of golden marmosets. Some of the marmosets were excited during restraint, with a great deal of struggling and vocalizing. The other marmosets were quiet and calm, with minimal struggling. The excited group had significantly lower pH, pCO2, and base excess values, but significantly higher pO2 values, rectal temperatures, and pulse and respiration rates. Primates immobilized with ketamine or tiletaminezolazepam had a near normal acid-base balance and were handled more easily than the physically restrained animals.

Animals↗
PubMed1976

Preparing students for physical restraint.

While not encouraging the use of physical restrains on mental patients, the author presents a statement of its continuing use and underscores the need for preparing students for a group of traditional procedures that in some ways are increasingly out of step with our times and aesthetically offensive. Two specific clinical indications for restraint are discussed.

Acting Out↗
PubMed1979

Physical restraint and the nonpsychotic patient: clinical and legal perspectives.

Recent legal challenges to the use of therapeutic seclusion in the treatment of the mentally ill have forced psychiatrists to defend this practice in court. The clinical characteristics of 10 nonpsychotic inpatients who required restraint are reviewed. These patients are characterized by intense labile affect, impulsive, manipulative behavior and transient micropsychotic episodes in the context of immature personality patterns suggestive of the borderline syndrome. Restraint was precipitated by transient micropsychotic episodes or impulsive behavior during sustained regression. Physical control in these cases is required to defend the social milieu more often than to prevent injury to self or others. The legal implications of these clinical findings are discussed.

Adult↗
PubMed1978

Early maternal separation increases gastric ulcer risk in rats by producing a latent thermoregulatory disturbance.

Rat pups that are separated early from their mothers, at postnatal day 15, become hypothermic when subjected to physical restraint on postnatal day 30. Restraint of separated pups also elicits an unusually high incidence of gastric erosions, as well as insomnia and an increase in quiet wakefulness. If hypothermia during restraint is prevented, neither the erosions nor the behavioral responses occur. Rat pups separated at the customary age (postnatal day 22) do not become hypothermic during restraint, and the restraint of such pups is not associated with either gastric erosion or insomnia.

Animals↗
PubMed1979

The effects of cold and restraint on the glucose level, bilirubin level and the production of stressed ulcers in rats.

The effect of restraint and cold on the glucose level, bilirubin level and production of stress ulcers were studied in white, adult male, Sprague-Dawley rats of the Holtzman strain. In addition, the role of mucin in reducing incidence of gastric lesions produced by stress was investigated. The highest incidence and depth of ulceration was produced by the stress factor combination of fasting for 24 h followed by physical restraint and cold exposure for 2 h. Under these conditions only one of the experimental rats died throughout the experimentation period. Fasting alone did not produce ulceration. The stress factor combination of fasting for 24 h, followed by physical restraint and cold exposure for 2 h resulted in an increase in glucose level. Increase in bilirubin level was highest in the stress factor combination of fasting, physical restraint and cold exposure acting synergistically. It can thus be hypothesized that the higher the bilirubin level the greater is the rate of red blood cell destruction. Introduction of 2 ml mucin directly into the stomach of the stressed rats reduced ulceration incidence by more than 50%.

Animals↗
PubMed2025

Patient Ethnicity and Staff Use of Restraints and Restrictive Practice in Inpatient Psychiatric Services: A Systematic Review.

Restrictive practices such as restraints, seclusion, and forced medication are only intended to be used when the threat is at a level whereby an individual is likely to inflict harm on themselves or another individual. Demographic variations, including ethnicity, may be associated with the use of these practices. However, there is no systematic review on patient ethnicity specifically. The review therefore aimed to establish whether a patient's ethnic identity was associated with staff use of restrictive practices in inpatient psychiatric services. The systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Four databases were searched (PsycINFO, Medline, Embase, and CINAHL). Methodological quality was assessed using the Critical Appraisal Skills Program Checklists. Fifteen studies met the inclusion criteria. A variety of ethnicities were identified within the studies. These were driven by the location of the study. Seclusion (14 studies), forced medication (4), and physical restraint (4) were explored. There were mixed findings, with ethnicity shown to predict restrictive practices in studies having larger participant numbers, longer follow-up periods and less methodological bias. It remains unclear whether ethnicity is a genuinely independent predictor of restraint and coercive practices or interacts with other risk factors. Staff working in inpatient settings should be aware of how unconscious biases might affect clinical practice. Recruiting a diverse workforce from minority ethnic groups into inpatient psychiatric services would be a positive step. However, support for these staff members is important, and all staff should be equipped to respond to ethnic diversity. Future research should explore beyond patient-level factors.

Humans↗
PubMed1976

Interrelationships between the thyroid gland and adrenal cortex during fear, cold and restraint in the sheep.

To examine the relationship between the functioning of the adrenal and thyroid glands in sheep, plasma cortisol concentration, concentration of protein-bound 125I from thyroid vein plasma, heart rate and blood pressure were measured in ewes bearing exteriorized thyroid glands. During these measurements stresses were imposed on the animals: fear induced by pistol shots or by a barking dog, cold by cooling and wetting, and physical restraint by a loose harness. Increases in plasma cortisol concentration of 2-6 mug/100 ml were observed with each type of stressor, the response rapidly decreasing with habituation of the animal. Increases in the concentration of protein-bound 125I from thyroid vein plasma were also observed repeatedly during cooling and wetting, occasionally after the introduction of a barking dog, and during continued restraint. Cooling and wetting was the only stress causing consistent parallel activation of the adrenal cortex and thyroid gland; the other stressors resulted in independent fluctuations of secretions, as indicated by plasma cortisol concentration and concentration of protein-bound 125I from thyroid vein plasma. No reciprocal relationship between thyroid gland and adrenal cortex activity was detected. It was concluded taht these ewes, which had been accustomed to normal experimental procedures for a period of 2 years, demonstrated functional independence of thyroid and adrenal cortical secretions when subjected to stress.

Animals↗