Risk assessment of violent, suicidal and self-injurious behaviour in acute psychiatry – a bio-psycho-social approach
Thesis for the degree of Philosophiae Doctor Trondheim, December 2010
Norwegian University of Science and Technology Faculty of Medicine
Department of Neuroscience
John Olav Roaldset
NTNU
Norwegian University of Science and Technology Thesis for the degree of Philosophiae Doctor Faculty of Medicine
Department of Neuroscience
© John Olav Roaldset
ISBN 978-82-471-2492-5 (printed ver.) ISBN 978-82-471-2493-2 (electronic ver.) ISSN 1503-8181
Doctoral theses at NTNU, 2010:248 Printed by NTNU-trykk
Vurdering av risiko for vold, suicidalitet og selvskading i akuttpsykiatrisk sammenheng – en bio-psyko-sosial tilnærming
”Risikoprosjektet” ved Psykiatrisk avdeling, Ålesund sjukehus, hadde to siktemål; (i) å undersøke ulike metoder til å vurdere risikoen for vold, suicudalitet og selvskade, og (ii) så tidlig som mulig etter akuttinnleggelser å kunne identifisere de som trenger videre utredning av risikoen for suicidaltet, selvskade eller vold.
Forskjellige metoder ble prøvet i et prospektivt, naturalistisk design. Denne avhandlingen tar for seg resultater fra deler av ”risikoprosjektet”; (i) serotonin målt i blodplater og lipider målt i blod, (ii) pasientenes egen risikovurdering (SRS), samt (iii) et strukturert screening instrument for volds-risiko (V-RISK-10, utviklet for bruk i akuttpsykiatrien).
Målgruppen var alle akutt innlagte pasienter gjennom ett år, fra 2006 -07. SRS og V- RISK-10 ble skåret ved innleggelse og utskriving. Blodprøver ble tatt ved innleggelse.
Risikovurderingene og blodprøvesvarene ble sammenliknet med suicidalitet, selvskading og vold registrert under oppholdet og 3 og 12 måneder etter utskriving.
Vold og sucidalatferd under innleggelsen, og vold de tre første månedene etter utskriving, ble predikert av lave verdier av total kolesterol. Noen få pasienter med flere innleggelser og gjentatte voldshandlinger var kjennetegnet ved lave verdier av HDL.
Høye triglyceridverdier predikerte selvskade i løpet av oppholdet, og også suicidalitet og selvskade etter utskriving. I vårt materiale ble det ikke funnet noen sammenheng mellom serotonin og aggresjon.
Pasientense egne risikovurderinger (SRS) predikerte vold, suicidalitet og selvskade.
SRS var mest presis for suicidalitet og selvskade under innleggelsen og mest nøyaktig for vold etter utskriving. Vi har ikke funnet andre rapporter om pasienters egne risikovurderinger.
Valideringen av V-RISK-10, som også ble gjennomført ved Akuttpsykiatrisk avdeling, Aker Universitetssykehus, var like god eller bedre sammenliknet med andre etablerte risikoinstrumenter. Funnene var gyldige både for kvinner og menn og nøyaktigheten størst ved alvorlige voldsepisoder. V-RISK-10 predikerte vold også for pasienter uten kjent voldshistorie.
Resultatene for lipider og SRS var ikke gode nok til at disse metodene kan anbefales å bli brukt alene som screening instrumenter. De kan imidlertid vise seg nyttige som tillegg til etablerte prosedyrer. V-RISK-10 viste gode egenskaper som screeninginstrument.
Resultatene bør bekreftes av annen forskning før metodene kan bli brukt med ønsket sikkerhet ved akuttpsykiatriske enheter.
Navn kandidat: John Olav Roaldset Institutt: Institutt for nevromedisin
Veileder(e): Are Holen (KG Gøtestam fram til 01.06.2009), Stål Bjørkly, Petter Laake Finansieringskilde: Samhandlingsorganet Helse Midt-Norge/NTNUogHelse Sunnmøre HF
Ovennevnte avhandling er funnet verdig til å forsvares offentlig for graden PhD. Disputas finner sted i Auditoriet, Ålesund sjukehus, fredag 10.12.2010 kl 1215.
CONTENTS
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List of papers
Roaldset, J.O., Bakken A.M., Bjørkly, S. (2010)
Psychiatry Research doi:10.1016/j.psychres.2010.07.029
Roaldset, J.O., Bjørkly, S.
158,
Hartvig, P., Roaldset, J.O., Moger, T.A., Østberg, B., Bjørkly, S.
Roaldset, J.O., Hartvig, P., Bjørkly, S
Abbreviations and acronyms
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Risk assessment of violent, suicidal and self-injurious behaviour in acute psychiatry - a bio-psycho-social approach
av John Olav Roaldset
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SYNOPSIS (QJOLVK
Risk assessment of violent, suicidal and self-injurious behaviour in acute psychiatry - a bio-psycho-social approach
by John Olav Roaldset
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2. INTRODUCTION
2.1. Topic
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2.2 Perspective
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2.3 Human aggression
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2.3.1 Conceptualising aggression
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2.3.2 Psychology of aggression –three theories
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2.3.3 Neurobiology of aggression
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4. METHODS
4.1 Design and sample size
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4.2 Participants
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Table 1
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