title: What does the PANSS mean? Therapeutic Touch and Agitation in Individuals With Alzheimer's Disease Components of variance and intraclass correlations for the design of community-based surveys and intervention studies: data from the Health Survey for England 1994. Benzodiazepines for psychosis-induced aggression or agitation. [The effect of lavender aromatherapy on cognitive function, emotion, and aggressive behavior of elderly with dementia]. A comparison of two treatments of agitated behavior in nursing home residents with dementia: simulated family presence and preferred music. Prevention of aggressive incidents on a closed psychiatric ward. Unpublished rating scales: a major source of bias in randomised controlled trials of treatments for schizophrenia.
abstract: OBJECTIVE Despite the frequent use of the Positive and Negative Syndrome Scale ( PANSS ) for rating the symptoms of schizophrenia , the clinical meaning of its total score and of the cut-offs that are used to define treatment response ( e.g. at least 20 % or 50 % reduction of the baseline score ) are as yet unclear . We therefore compared the PANSS with simultaneous ratings of Clinical Global Impressions ( CGI ) . METHOD PANSS and CGI ratings at baseline ( n = 4091 ) , and after one , two , four and six weeks of treatment taken from a pooled data base of seven pivotal , multi-center antipsychotic drug trials on olanzapine or amisulpride in patients with exacerbations of schizophrenia were compared using equipercentile linking . RESULTS Being considered " mildly ill " according to the CGI approximately corresponded to a PANSS total score of 58 , " moderately ill " to a PANSS of 75 , " markedly ill " to a PANSS of 95 and severely ill to a PANSS of 116 . To be " minimally improved " according to the CGI score was associated with a mean percentage PANSS reduction of 19 % , 23 % , 26 % and 28 % at weeks 1 , 2 , 4 and 6 , respectively . The corresponding figures for a CGI rating " much improved " were 40 % , 45 % , 51 % and 53 % . CONCLUSIONS The results provide a better framework for underst and ing the clinical meaning of the PANSS total score in drug trials of schizophrenia patients with acute exacerbations . Such studies may ideally use at least a 50 % reduction from baseline cut-off to define response rather than lower thresholds . In treatment resistant population s , however , even a small improvement can be important , so that a 25 % cut-off might be appropriate Limited effective strategies exist to alleviate or treat disruptive behaviors in people with Alzheimer 's disease . Fifty-one residents of a long-term care facility with Alzheimer 's disease were r and omly assigned to one of three intervention groups . A multiple time series , blinded , experimental design was used to compare the effectiveness of therapeutic touch , simulated therapeutic touch , and usual care on disruptive behavior . Three forms of disruptive behavior comprised the dependent variables : physical aggression , physical nonaggression , and verbal agitation . Physical nonaggressive behaviors decreased significantly in those residents who received therapeutic touch compared with those who received the simulated version and the usual care . No significant differences in physically aggressive and verbally agitated behaviors were observed across the three study groups . The study provided preliminary evidence for the potential for therapeutic touch in dealing with agitated behaviors by people with dementia . Research ers and practitioners must consider a broad array of strategies to deal with these behaviors The authors estimated components of variance and intraclass correlation coefficients ( ICCs ) to aid in the design of complex surveys and community intervention studies by analyzing data from the Health Survey for Engl and 1994 . This cross-sectional survey of English adults included data on a range of lifestyle risk factors and health outcomes . For the survey , households were sample d in 720 postal code sectors nested within 177 district health authorities and 14 regional health authorities . Study subjects were adults aged 16 years or more .  ICCs and components of variance were estimated from a nested r and om-effects analysis of variance . Results are presented at the district health authority , postal code sector , and household levels . Between-cluster variation was evident at each level of clustering . In these data , ICCs were inversely related to cluster size , but design effects could be substantial when the cluster size was large . Most ICCs were below 0.01 at the district health authority level , and they were mostly below 0.05 at the postal code sector level . At the household level , many ICCs were in the range of 0.0 - 0.3 . These data may provide useful information for the design of epidemiologic studies in which the units sample d or allocated range in size from households to large administrative areas BACKGROUND Acute psychotic illness , especially when associated with agitated or violent behaviour , can require urgent pharmacological tranquillisation or sedation . In several countries , clinicians often use benzodiazepines ( either alone or in combination with antipsychotics ) for this outcome . OBJECTIVES To estimate the effects of benzodiazepines , alone or in combination with antipsychotics , when compared with placebo or antipsychotics , alone or in combination with antihistamines , to control disturbed behaviour and reduce psychotic symptoms . SEARCH METHODS We search ed the Cochrane Schizophrenia Group 's register ( January 2012 ) , inspected reference lists of included and excluded studies and contacted authors of relevant studies . SELECTION CRITERIA We included all r and omised clinical trials ( RCTs ) comparing benzodiazepines alone or in combination with any antipsychotics , versus antipsychotics alone or in combination with any other antipsychotics , benzodiazepines or antihistamines , for people with acute psychotic illnesses . DATA COLLECTION AND ANALYSIS We reliably selected studies , quality assessed them and extracted data . For binary outcomes , we calculated st and ard estimates of relative risk ( RR ) and their 95 % confidence intervals ( CI ) using a fixed-effect model . For continuous outcomes , we calculated the mean difference ( MD ) between groups . If heterogeneity was identified , this was explored using a r and om-effects model . MAIN RESULTS We included 21 trials with a total of n = 1968 participants . There was no significant difference for most outcomes in the one trial that compared benzodiazepines with placebo , although there was a higher risk of no improvement in people receiving placebo in the medium term ( one to 48 hours ) ( n = 102 , 1 RCT , RR 0.62 , 95 % CI 0.40 to 0.97 , very low quality evidence ) . There was no difference in the number of participants who had not improved in the medium term when benzodiazepines were compared with antipsychotics ( n = 308 , 5 RCTs , RR 1.10 , 95 % CI 0.85 to 1.42 , low quality evidence ) ; however , people receiving benzodiazepines were less likely to experience extrapyramidal effects ( EPS ) in the medium term ( n = 536 , 8 RCTs , RR 0.15 , 95 % CI 0.06 to 0.39 , moderate quality of evidence ) . Data comparing combined benzodiazepines and antipsychotics versus benzodiazepines alone did not yield any significant results . When comparing combined benzodiazepines/antipsychotics ( all studies compared haloperidol ) with the same antipsychotics alone ( haloperidol ) , there was no difference between groups in improvement in the medium term ( n = 155 , 3 RCTs , RR 1.27 , 95 % CI 0.94 to 1.70 , very low quality evidence ) but sedation was more likely in people who received the combination therapy ( n = 172 , 3 RCTs , RR 1.75 , 95 % CI 1.14 to 2.67 , very low quality evidence ) . However , more participants receiving combined benzodiazepines and haloperidol had not improved by medium term when compared to participants receiving olanzapine ( n = 60,1 RCT , RR 25.00 , 95 % CI 1.55 to 403.99 , very low quality evidence ) or ziprasidone ( n = 60 , 1 RCT , RR 4.00 , 95 % CI 1.25 to 12.75very low quality evidence ) . When haloperidol and midazolam were compared with olanzapine , there was some evidence the combination was superior in terms of improvement , sedation and behaviour . AUTHORS ' CONCLUSIONS The evidence from trials for the use of benzodiazepines alone is not good . There were relatively little good data and most trials are too small to highlight differences in either positive or negative effects . Adding a benzodiazepine to other drugs does not seem to confer clear advantage and has potential for adding unnecessary adverse effects . Sole use of older antipsychotics unaccompanied by anticholinergic drugs seems difficult to justify . Much more high quality research is needed in this area PURPOSE This study was to develop an aromatherapy h and massage program , and to evaluate the effects of lavender aromatherapy on cognitive function , emotion , and aggressive behavior of elderly with dementia of the Alzheimer 's type . METHOD The Research design was a nonequivalent control group non-synchronized quasiexperimental study . Lavender aromatherapy was administrated to experimental group I for 2 weeks , jojoba oil massage was administrated to experimental group II for 2 weeks , and no treatment was administrated to the control group for 2 weeks . Data was analyzed using the chi(2)-test , ANOVA , repeated measures of ANCOVA and ANCOVA in the SPSS program package . RESULT 1 . Experimental group I did not show significant differences in cognitive function in relation to the experimental group II and control group . 2 . Experimental group I showed significant differences in emotion and aggressive behavior in relation to the experimental group II and control group . CONCLUSION A Lavender aromatherapy h and massage program is effective on emotions and aggressive behavior of elderly with dementia of the Alzheimer 's type OBJECTIVE The objective of this study was to compare the effectiveness of two individualized psychosocial treatments in reducing the frequency of physically and verbally agitated behaviors in nursing home residents whose dementia was complicated by marked behavioral disturbance . METHODS Thirty nursing home residents with frequent , severe behavioral disturbances were observed by research staff before , during , and after multiple , r and omized , single-blind exposures to 15-minute audiotapes of simulated family presence ( a conversation prepared by a family member about positive experiences from the past ) , music preferred by the resident in earlier life , and a placebo condition of a reading from a horticultural text . Selected ( usually multiple ) physical and verbal behaviors were counted as present or absent at regular intervals . All three treatment conditions were compared with usual care . RESULTS Simulated presence and preferred music both proved effective in reducing counts of physically agitated behaviors .  Simulated presence , but not music , result ed in significantly reduced counts of verbally agitated behaviors . The placebo tape proved more effective than expected . Participants ' responses to simulated presence and music varied widely . Behavior counts fell by one-half or more in many cases . Other residents became more agitated . CONCLUSION Participants ' better-than-expected responses to the placebo tape suggest that even the simplest technology can improve the lives of confused , disturbed nursing home residents . Of the two psychosocial treatments , preferred music tapes were easier to make and were clearly helpful in many instances . By contrast , family members often struggled to recall enough happy memories to compile a simulated presence tape . Simulated presence might prove just as effective if relatives speak on topics of their own choosing . Although not all residents were helped by these treatments , adverse effects were mild and shortlived OBJECTIVE This study examined whether staff members ' use of interventions for preventing patients ' aggression  reduced the number of incidents of aggression on a closed acute admissions ward of a psychiatric hospital in the Netherl and s. METHODS The number and severity of incidents of aggression on three closed wards were measured using the Dutch version of the Staff Observation Aggression Scale ( SOAS ) . Measurements were made for three months before and after staff implemented interventions for preventing aggression on one of the wards . Interventions included a protocol for talking to patients who exhibited aggressive behavior , discussing treatment goals with the patient shortly after admission , explaining why the ward 's door was locked and the exit rules , providing a schedule of staff meetings to explain staff members ' absence from the ward , and clarifying the procedure for making an appointment with the psychiatrists . RESULTS The frequency of aggressive incidents was reduced on all three wards , with no significant difference between the ward where the interventions were implemented and the two control wards . A marginally significant difference in the severity of aggressive incidents was found between experimental and control wards after the introduction of the preventive measures , with incidents in the experimental ward tending to be less severe . CONCLUSIONS This study failed to find a robust effect of specific intervention measures on aggressive incidents . However , it did find evidence suggesting that st and ardized reporting by staff of aggressive incidents on closed psychiatric wards may in itself result in straightforward reduction of violent incidents BACKGROUND A recent review suggested an association between using unpublished scales in clinical trials and finding significant results . AIMS To determine whether such an association existed in schizophrenia trials . METHOD Three hundred trials were r and omly selected from the Cochrane Schizophrenia Group 's Register . All comparisons between treatment groups and control groups using rating scales  were identified . The publication status of each scale was determined and cl aims of a significant treatment effect were recorded . RESULTS Trials were more likely to report that a treatment was superior to control when an unpublished scale was used to make the comparison ( relative risk 1.37 ( 95 % CI 1.12 - 1.68 ) ) . This effect increased when a ' gold-st and ard ' definition of treatment superiority was applied ( RR 1.94 ( 95 % CI 1.35 - 2.79 ) ) . In non-pharmacological trials , one-third of ' gold-st and ard ' cl aims of treatment superiority would not have been made if published scales had been used . CONCLUSIONS Unpublished scales are a source of bias in schizophrenia trials
target: Using de-escalation techniques  for people with psychosis induced aggression or agitation appears to be accepted as good clinical practice but is not supported by evidence from r and omised trials .
background: BACKGROUND Aggression is a disposition , a willingness to inflict harm , regardless of whether this is behaviourally or verbally expressed and regardless of whether physical harm is sustained .
  De-escalation is a psychosocial intervention for managing people with disturbed or aggressive behaviour .
  Secondary management strategies such as rapid tranquillisation , physical intervention and seclusion should only be considered once de-escalation and other strategies have failed to calm the service user .
  OBJECTIVES To investigate the effects of de-escalation techniques in the short-term management of aggression or agitation  thought or likely to be due to psychosis .
  It is unclear why it has remained such an under- research ed area .