scholarly journals LO029: Undetected serious medical illness in mental health patients seen in an academic emergency department

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S39-S40
Author(s):  
C. Poss ◽  
C. Fernandes ◽  
M. Columbus ◽  
K. Wood
Keyword(s):  
Mental Health ◽  
Chart Review ◽  
Primary Outcome ◽  
Average Length ◽  
Health Concern ◽  
Medical Illness ◽  
Health Concerns ◽  
Number Of Patients ◽  
The Mean ◽  
Mental Health Concerns

Introduction: Mental health concerns make up 5-10% of all adult presentations to Canadian emergency departments (ED). One challenge for the emergency physician (EP) is determining if a patient with a mental health concern has concomitant underlying medical illness. We defined “serious medical illness” (SMI) as a pathological condition that requires inpatient treatment on a medical or surgical ward. SMI undetected by emergency physicians in patients presenting with mental health concerns may result in adverse patient outcomes. The aim of this study was to determine the prevalence, timing, and etiology of undetected SMI in the ED among adult patients presenting with mental health concerns. Methods: A retrospective chart review was performed on all patients age 18 and older who presented to the ED at Victoria Hospital, London Health Sciences Centre between October 1, 2014 and April 30, 2015, who were subsequently referred to psychiatry by the EP. The primary outcome was the number of patients transferred to a medicine or surgery inpatient unit for treatment of their SMI within seven days of psychiatry admission from the ED. Results: 1,255 patients were referred to psychiatry during the study period. 803 patients were admitted and 452 were discharged. Of the admitted patients, 14/803 patients (1.7%) met our primary outcome. The mean age of patients in the SMI group (n=14) was 64 years. The mean age in the non-SMI group (n=1,241) was 38. In the SMI group, 3/14 patients died, 2/14 patients required an ICU admission, and 2/14 patients underwent a surgery for their missed SMI. The average length of psychiatry admission prior to transfer was 3.7 days. The average length of medical/surgical admission after transfer from psychiatry was 8.3 days. Undetected diagnoses included NSTEMI, serotonin syndrome, lithium toxicity, thoracic aortic aneurysm, gastrointestinal stromal tumour, forearm abscess, Parkinsonian crisis, and others. Conclusion: This chart review demonstrated a 1.7% rate of undetected serious medical illness in patients who presented to the ED with mental health concerns. Adverse outcomes included death, ICU admissions, and surgeries. This rate is similar to other studies on the topic. The SMI group tended to be older than the non-SMI group. This research may have implications on the appropriate workup and disposition of elderly patients presenting to the ED with mental health concerns.

scholarly journals Educational needs of practice nurses in mental health

2011 ◽  
Vol 3 (2) ◽  
pp. 142 ◽  
Author(s):  
Anne Prince ◽  
Katherine Nelson
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Health Assessment ◽  
Behavioural Therapy ◽  
Postal Survey ◽  
Health Concern ◽  
Health Concerns ◽  
Practice Nurses ◽  
Mental Health Concern ◽  
Mental Health Concerns

INTRODUCTION: Large numbers of patients see practice nurses (PNs) daily for their health care. Many of these patients will have a mental health need. International research suggests that practice nurses are undertaking mental health assessment and interventions without the requisite skills and knowledge. AIM: To describe the needs of PNs in mental health education and to explore any involvement with patients with mental health concerns. METHODS: Postal survey of PNs in Hawkes Bay and Tairawhiti regions. Analysis was by descriptive, correlation and inferential statistics and content analysis for open questions. RESULTS: Fifty-two respondents completed the survey (response rate 36%) and the results demonstrate that these PNs are caring for patients with an extensive range of mental health concerns daily. Most common are people with depression and anxiety. The nurses perform a variety of mental health interventions such as counselling and advice on medication and have minimal confidence in their skill level. Their expressed learning needs included education on many mental health conditions including suicidal ideation, all types of depression and bipolar disorder, and of therapies such as cognitive behavioural therapy and family therapy. DISCUSSION: PNs require education and support specifically designed to meet their identified needs in mental health to help improve care to patients. This will require collaboration between secondary mental health services, primary mental health nurses and tertiary institutions. With targeted education these nurses should become more confident and competent in their dealings with people who present to their practice with a mental health concern. KEYWORDS: Education; mental health; practice nurse; survey; primary health care

Fears, Depression, and Anxieties of Patients With Diabetic Retinopathy and Implications for Education and Treatment

2020 ◽  
Vol 4 (6) ◽  
pp. 484-489
Author(s):  
Jeffrey M. Bloom ◽  
John O. Mason ◽  
Lauren Mason ◽  
Thomas A. Swain
Keyword(s):  
Mental Health ◽  
Diabetic Retinopathy ◽  
Patient Population ◽  
Self Report ◽  
Depression And Anxiety ◽  
Health Concerns ◽  
Number Of Patients ◽  
Patients With Diabetes ◽  
Mental Health Concerns ◽  
Patients Experience

Objective: This study investigates undiagnosed depression and anxiety related to diabetes in patients with diabetic retinopathy and identifies commonly feared complications that these patients experience. Methods: The 74 consecutive individuals with diabetes were recruited for this investigation from the office of a retina specialist, and data were obtained from the participants through a self-report survey given to the patients before their appointment. Results: The most feared complication reported by patients surveyed was blindness (38.36%). When asked about depression and anxiety related to their diabetes, 20.27% of patients stated they have depression related to their diabetes, whereas 18.92% had anxiety related to their diabetes. Only 17.57% of the patients said they were being treated for their depression and/or anxiety at the time of the survey. Conclusions: This study demonstrates that many patients with diabetic retinopathy have coexisting fears and mental health concerns. Because most retina specialists treat a high number of patients with diabetes, it is crucial to understand the barriers and comorbidities related to this patient population. Retina specialists may play a role in identifying the hidden and underlying fears, depression, and anxieties in patients with diabetes so that these patients can get the necessary help and counseling they need.

scholarly journals Mental health pharmacists as interim prescribers

2017 ◽  
Vol 7 (3) ◽  
pp. 111-115 ◽  
Author(s):  
Matthew Gibu ◽  
Jeffrey Clark ◽  
Jeffrey Gold
Keyword(s):  
Mental Health ◽  
Primary Outcome ◽  
Emergency Services ◽  
Medication Management ◽  
Mood Stabilizers ◽  
Outpatient Mental Health ◽  
Number Of Patients ◽  
Change In The Mean ◽  
The Mean ◽  
Excessive Stress

Abstract Introduction: Turnover leading to fluctuations in prescriber availability presents many challenges, most notably in access to and continuity of care. In 2015, the Veterans Affairs Eastern Colorado Healthcare System (VA ECHCS) experienced a period of significant mental health prescriber turnover leading to patient utilization of psychiatric emergency services (PES) for nonemergent medication management. The resulting increase in volume placed excessive stress on PES prescribers. Mental health pharmacists have opportunities to provide interim medication management while patients are between prescribers. Methods: This study was a retrospective, cohort study of patients unassigned to an outpatient mental health prescriber due to prescriber turnover, receiving care at VA ECHCS between October 1, 2015, and February 28, 2016. The primary outcome was the number of pharmacist interventions performed. Secondary outcomes characterize the interventions performed and describe the change in the mean monthly volume of patients presenting to PES. Results: In this veteran population, 152 interventions were performed in 81 unique patients. The most common intervention was prescription renewals (80%). Interventions most commonly involved antidepressants (28%), antipsychotics (10%), and mood stabilizers (10%). Before initiation of the clinic, Denver VA PES experienced a mean of 300 monthly visits. After clinic implementation, PES visits decreased significantly to a mean of 237 visits per month (P = .041). Discussion: The pharmacist interim prescriber clinic was associated with a significant decrease in mean number of patients seen per month in PES. The success of the clinic also contributed to interest by the mental health service to expand clinical pharmacy services.

Muslim Mental Health Concerns Survey

2019 ◽  
Author(s):  
Ahmet Tanhan ◽  
Vincent T. Francisco
Keyword(s):  
Mental Health ◽  
Health Concerns ◽  
Mental Health Concerns
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