Involuntary admissions were associated with statistically significant higher levels of restraint and seclusion in this patient sample. Strategies that will enhance patients' follow-up are expected to prevent involuntary admissions and reduce the use of coercive measures.

BackgroundPatients’ informed consent prior to treatment initiation is an essential component of contemporary clinical practice, but sometimes, patients lack decision-making capacity for treatment. Such capacity can be reliably assessed with standardized tools used, and the MacArthur competence assessment tool for treatment (MacCAT-T) is one of the most widely used instruments.MethodsThe objective of this study was to translate the MacCAT-T into Greek and evaluate the Greek version’s reliability and validity in psychiatric patients. Thirty-nine psychiatric inpatients were examined with the MacCAT-T, and results showed an excellent inter-rater reliability.ResultsIntraclass correlations ranged from 0.93 to 1 for the individual items of the tool. Severity of psychopathology was negatively correlated with reasoning, appreciation, and expressing a choice (Pearson’s r 0.36, 0.539, and 0.338, respectively), but there were no associations with demographic characteristics of the patients. Of the five factors derived from the brief psychiatric rating scale, anergia was significantly correlated with appreciation, reasoning, and expressing a choice (Pearson’s r 0.46, 0.45, and 0.37, respectively).ConclusionsThe Greek version of the MacCAT-T is a reliable and valid instrument that can provide a standardized measure for assessing treatment decision capacity in Greek psychiatric patients and can be used for evaluation in the clinical practice.

BackgroundThere is a dearth of studies regarding chemical restraint in routine clinical psychiatric practice. There may be wide variations between different settings and countries.MethodsA retrospective study on chemical restraint was performed in the 11-bed psychiatric ward of the General Hospital of Arta, in northwestern Greece. All admissions over a 2-year-period (from March 2008 to March 2010) were examined.ResultsChemical restraint was applied in 33 cases (10.5% of total admissions). From a total of 82 injections, 22 involved a benzodiazepine and/or levomepromazine, whereas 60 injections involved an antipsychotic agent, almost exclusively haloperidol (96.7% of cases), usually in combination with a benzodiazepine (61.7% of cases). In 36.4% of cases the patient was further subjected to restraint or seclusion.ConclusionsIn our unit, clinicians prefer the combined antipsychotic/benzodiazepine regimen for the management of patients' acute agitation and violent behaviour. Conventional antipsychotics are administrated almost exclusively and in a significant proportion of cases further coercive measures are applied. Studies on the practice of chemical restraint should be regularly performed in clinical settings.

No abstract

Neuroleptic malignant syndrome is an uncommon but potentially fatal side effect of antipsychotic drug treatment. Several serious complications have been associated with neuroleptic malignant syndrome, such as acute renal failure, deep venous thrombosis, pulmonary embolism and aspiration pneumonia. Reports on infections other than aspiration pneumonia appear, from the literature, to be uncommon. Four cases of infection (three cases of upper respiratory tract infection and one case of urinary tract infection) which developed during the course of neuroleptic malignant syndrome are reported and pathophysiological mechanisms underlying their presentation are suggested.