Token economies are an effective way of changing various behaviors including acquiring new skills, reducing undesired behaviors, reducing aggression, increasing treatment compliance, and improving psychiatric unit management. This study examines the long‐term effect of a token economy on an acute care, inpatient psychiatric unit. The two years following the implementation of a unit based token economy are compared with the 12 months prior to implementation. The results show a significant reduction in total assaults as well as fewer staff injuries resulting in loss of time from work. Copyright © 2003 John Wiley & Sons, Ltd.

ObjectiveThis study evaluated the effectiveness and safety of subanesthetic doses of ketamine using an off-label, transmucosal administration route in patients with treatment-resistant depression.MethodsA retrospective chart review was conducted to identify patients who met the inclusion criteria for treatment-resistant major depressive disorder. Seventeen such patients who received subanesthetic doses of ketamine were included. Patient demographics, efficacy (drug refill, clinician notes), side effects, and concurrent medications were assessed.ResultsBenefit from low-dose transmucosal ketamine was noted in 76% of subjects (average age 48 years, 88% female), with a dose duration lasting 7–14 days. No notable side effects were noted. The most common classes of concurrent medications to which ketamine was added were serotonin–norepinephrine reuptake inhibitors (59%), stimulants (47%), folate replacement (47%), and benzodiazepines (47%).ConclusionOur results provide preliminary evidence of the effectiveness and safety of low-dose transmucosal ketamine in treatment-resistant patients. A controlled, prospective pilot study is warranted to validate these findings.

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Age has been shown to contribute to aggression in inpatient settings. Studies that examine violence in inpatient settings have shown that younger patients have a higher tendency of aggressive behavior toward staff and other patients (Aquilina, 1991; Hillbrand, Foster, & Spitz, 1996; James, Fineberg, Shah, & Priest, 1990; Nijman, Allerti, Merckelbach, a Campo, & Rovelli, 1997; Owen, Tarantello, Jones, & Tennant, 1998). However, though younger age has been associated with higher rates of violence, no studies have been conducted to assess the impact of multiple young adults on the functioning of an inpatient unit. This study evaluates the effect of the number of young adults on unit functioning and whether young adults mix poorly with other age groups.