scholarly journals Off-label prescribing of quetiapine in HMP Elmley, a Category B remand prison: a re-audit

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S85-S85
Author(s):  
Nosa Igbinomwanhia ◽  
Kathleen McCurdy
Keyword(s):  
Mental Health ◽  
Royal College ◽  
Health Assessment ◽  
List Type ◽  
Physical And Mental Health ◽  
Off Label ◽  
The Past ◽  
Number Of Patients ◽  
Prescribing Practice ◽  
Potential Risks

AimsThis was a re-audit of off-label prescribing of quetiapine in order to identify the number of patients on off-label quetiapine in HMP Elmley, to monitor compliance by the Mental Health Inreach Team (MHIRT) psychiatrists with the Royal College of Psychiatrists guideline on off-license prescribing, to compare findings with the baseline audit and to identify areas for improvement.MethodAll patients on quetiapine in HMP Elmley were identified and their electronic patient record was reviewed against the standards outlined in the Royal College of Psychiatrists “Use of licensed medicines for unlicensed applications in psychiatric practice (2nd edition).ResultThere were 60 residents on off-license quetiapine prescription in HMP Elmley.Of this number, four had their prescription initiated by a general practitioner, either while in prison or in the community. Two residents were on quetiapine first prescribed while they were on admission in hospital. 5 patients had been initiated by the MHIRT psychiatrists. 38 residents were commenced off-license quetiapine by another psychiatrist, either while they were in the community or in another prison. In 17 patients, electronic records were inadequate to determine who had prescribed the quetiapine.The number of inmates prescribed off-label quetiapine in HMP Elmley had dropped from 82 to 60 in the 1 year since the initial audit. Of these figures, prescriptions initiated by the MHIRT psychiatrists, had dropped from 28.1% (23/82) to 8.3% (5/60).For those prescribed quetiapine by the HMP Elmley psychiatrists, notes were audited against the RCPsych guidelines: Licensed medication was considered first in 80.0%Risks and benefits were considered and documented in 80.0%The benefits and potential risks were explained to patient in 80.0%There was documentation of informed consent in 80.0%Quetiapine was started at a low dose and monitored in 100%No residents required withdrawal of medication due to ineffectiveness or adverse effects.Baseline physical health assessment was performed in 80.0%, though all had an ECG done.ConclusionOver the past year there has been an improvement in off-label antipsychotic prescribing practice within the MHIRT.However, the number of off-label antipsychotic prescriptions still remains high throughout the prison. There should be continued effort at minimizing off-label prescribing within the MHIRT, monitored by auditing. However, work needs to be done jointly with other prescribers, such as GP colleagues, in order to avoid unnecessary prescriptions and to monitor regularly the physical and mental health of those on off-label quetiapine.

scholarly journals Diversion from custody: An update

2017 ◽  
Vol 23 (6) ◽  
pp. 375-384 ◽  
Author(s):  
Luke Birmingham ◽  
Olusola Awonogun ◽  
Howard Ryland
Keyword(s):  
Mental Health ◽  
Criminal Justice ◽  
Mental Health Problems ◽  
List Type ◽  
Mentally Disordered ◽  
The Past ◽  
Important Landmark ◽  
Justice Process ◽  
Criminal Justice Process ◽  
The Impact

SummaryLiaison and diversion services are concerned with ensuring that individuals with mental health problems and related vulnerabilities who come into contact with the criminal justice system receive appropriate support and treatment. In the past 15 years there have been significant changes in policy, legislation and the broader landscape in community, custodial and hospital settings which have shaped these services. The Bradley Report, published in 2009, represents an important landmark in this field. Bradley made 82 recommendations, from interventions to improve identification of mental illness and vulnerable individuals at risk of offending to effecting speedier transfers of mentally disordered prisoners to hospital. Some progress has been made in achieving these recommendations, and further investment is promised, but at present only half of England is covered by liaison and diversion services.LEARNING OBJECTIVES•Appreciate how services have developed over the past 15 years to provide support and treatment and divert mentally disordered people from custody at all stages in the criminal justice process•Recognise how government policy has shaped the development of liaison and diversion services over the past 15 years•Understand the impact of the 2007 amendments to the Mental Health Act on the diversion of mentally disordered people from custody

scholarly journals Elucidating Post-COVID-19 manifestations in India

2021 ◽  
Author(s):  
Ghizal Fatima ◽  
Divyansh Bhatt ◽  
Jaserah Idrees ◽  
Bushra Khalid ◽  
Farzana Mahdi
Keyword(s):  
Mental Health ◽  
Gastrointestinal Symptoms ◽  
Strong Relationship ◽  
Musculoskeletal Symptoms ◽  
Physical And Mental Health ◽  
Number Of Patients ◽  
The Status ◽  
Observational Cohort ◽  
Demographical Data ◽  
Study Participants

Background: In India, a large number of patients with coronavirus disease-2019 (COVID-19), presented with common symptoms including fever, dyspnea, cough, musculoskeletal symptoms (fatigue, myalgia, joint pain) and gastrointestinal symptoms. However, information is lacking on symptoms that persist after recovery from COVID-19. In this study we assessed symptoms that persisted in patients even after their recovery and discharged from the hospital after one month from COVID-19. Methods: This study is an observational cohort study. Participants in this study were enrolled between 30 to 40 days after recovery from COVID-19 of the age 18 years or higher, who were hospitalized with laboratory-confirmed RT-PCR COVID-19 disease. Outcomes from post COVID-19 participants were elicited through questionnaire that consisted of three main parts beginning from subjects demographical data, depicting about the status of COVID-19 and other co-morbidities of the subject, and about post-COVID-19 symptoms and manifestations. Results: All subjects have reported some manifestation after recovery from COVID-19 whereas numerous symptoms and diseases were experienced by a great percentage of participants. Fatigue (56.25%), dyspnea (74.3%) and disturbed sleep (64.3%) were among the most common symptoms. However, more critical manifestations like renal failure and pulmonary fibrosis were reported by only a few percent of the subjects. Rating of worse physical and mental health after post-COVID recovery was also reported by subjects. There was a strong relationship found in between the presence of other co-morbidities before infection like diabetes, hypertension and in disease severity after infection. A total of 280 patients were enrolled and 160 completed the survey. Conclusions: Post COVID-19 sufferers often experience symptoms that cause a disturbance in their physical health, mental health and their respiratory status for several weeks even after recovery from COVID-19. Therefore, all subjects after recovering from COVID-19 should undergo long-term monitoring programme for their symptoms and condition improvement.

scholarly journals Side by Side: Reflections on Two Lifetimes of Dance

2021 ◽  
Vol 12 ◽  
Author(s):  
Ann Kipling Brown ◽  
Anne Penniston Gray
Keyword(s):  
Mental Health ◽  
Social Inclusion ◽  
Positive Impact ◽  
Health Problems ◽  
Research Tool ◽  
Physical And Mental Health ◽  
The Past ◽  
The Arts ◽  
Arts Engagement ◽  
Key Aspects

Telling stories about our experiences in dance brings to light unconscious knowledge and memories of the past and helps us understand our own decisions and practices. Reflexivity and story telling is central in the process of remembering and embodies some of the key aspects of autoethnography as a research tool. We are directed to examine and reflect on our experiences, analyzing goals and intentions, making connections between happenings and recounting each single experience. Dance has the potential for positive impact on both physical and mental health among professional dancers as well as among dance students and has the power to connect them to culture and community in unique and important ways. Research has provided evidence that arts engagement provides positive forms of social inclusion, opportunities to share arts, culture, language, and values and points to the value of the arts in the prevention and amelioration of health problems. Together with those benefits of a dance experience there is clear evidence of what can be learned in, through and about dance. In this time of the Covid-19 pandemic it seemed more relevant and poignant to examine our own experiences in dance as well as those experiences of others that have influenced our lives.

MENTAL HYGIENE IN THE NEW PEDIATRICS

PEDIATRICS ◽  
1959 ◽  
Vol 24 (3) ◽  
pp. 355-357
Author(s):  
CHARLES D. MAY
Keyword(s):  
Mental Health ◽  
Infectious Disease ◽  
Growth And Development ◽  
Metabolic Disorders ◽  
Mental Hygiene ◽  
Physical And Mental Health ◽  
New Techniques ◽  
Endocrine Disease ◽  
The Past ◽  
New Concepts

THE PRACTICE of the New Pediatrics in the office and the home is comprised preponderantly of supervision of growth and development of well children and treatment of the less profound disturbances of physical and mental health. Pediatricians have pioneered in efforts to incorporate mental hygiene into medical practice, although with considerable hesitation and confusion. It is particularly in this area, during the past two decades, that new concepts have been introduced—with inevitable disruption of the teaching as well as the practice of pediatrics. This may be the crux of the problems presented by the New Pediatrics. Other recent advances, however impressive, have been more technical than conceptual. In general, progress in knowledge of infectious disease, nutrition, cardiology, metabolic disorders, endocrine disease and genetics has followed the natural course of discovery and increasing complexity that develops from application of new techniques to established concepts.

Comorbidity Significantly Impairs Quality Of Life In Patients After Allogeneic Hematopoietic Stem Cell Transplantation – Results From The Prospective German Multicenter Validation Trial

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2073-2073 ◽  
Author(s):  
Daniel Wolff ◽  
Philipp Y. Herzberg ◽  
Steven Z. Pavletic ◽  
Pia Heussner ◽  
Friederike Mumm ◽  
...  
Keyword(s):  
Mental Health ◽  
Cell Transplantation ◽  
Multicenter Trial ◽  
Infectious Complications ◽  
Physical And Mental Health ◽  
Hematopoietic Stem ◽  
Post Transplant ◽  
The Past ◽  
Sf 36 ◽  
Sum Score

Abstract Comorbidity after allogeneic hematopoietic stem cell transplantation (alloHSCT) significantly impairs quality of life (QoL), physical functioning (PF), and survival. Therefore, we evaluated a newly developed measure of comorbidity after transplantation, the Post-transplant Multimorbidity Index (PTMI) within a multicenter trial validating the NIH consensus criteria for severity assessment of chronic graft-versus-host disease (cGVHD). Methods 189 patients (pts) (median age 44 years, range 18-72) after alloHSCT were prospectively evaluated using the NIH consensus criteria, including the NIH-cGVHD grading form, the FACT-BMT, the Human Activity Profile (HAP), and the SF-36 v.2. The PTMI and the Hematopoietic Cell Transplantation-Comorbidity Index (HCT-CI) (Sorror et al) was retrospectively documented by chart review. Enrolment occurred a median of 275 (range: 85–4003) days after alloHSCT. Based on NIH criteria, 121 pts had cGVHD (mild n=24, moderate n=59, severe n=38). Sixty eight pts without cGVHD were included as controls. Results The most prevalent comorbidities were infections treated as outpatient during the past 3 months (n=53; 28%) followed by mild renal function impairment (n=42; 22%), osteoporosis (DEXA t-score< -1.5) (n=27; 14%) and severe infections requiring hospitalization during the past 3 months (n=23; 12%). Applying the PTMI 47 (24%) pts had no comorbidity, while 107 (56%) pts. had 1-3 comorbidities, 24 (13%) pts 4-6 comorbidities, and 11 (6%) pts > 6 comorbidities. In the subgroup of pts with cGVHD (n=72) enroled after more than 1 year post alloHSCT 12.5% of pts had > 6 comorbidities detected by the PTMI. In contrast the HCT-CI classified only 4% of the 72 pts. as multimorbid with > 6 comorbidities. Chronic GVHD and time after transplant were significantly associated with PTMI, while age was not significant in a multivariate analysis. In contrast, the HCT-CI was not associated with the presence of cGVHD. None of the single comorbidities alone were significantly associated with having cGVHD, although osteoporosis (p=0.084) and moderate infections not requiring inpatient treatment during the last 3 months (p=0.07) approached significance. Examining the association between the PTMI sum score and QoL (FACT-BMT), physical and mental health (SF-36) and activity (HAP), a significant correlation was detected between PTMI sum score with all subscales of the FACT-BMT. Similarly, significant correlations were observed between the PTMI sum score and 6 of the 8 subscales of the SF-36 (physical functioning, role limitations due to emotional problems, mental health, vitality, general health perception and change in health), while comorbidity did not impair social functioning and role limitation due to physical problems. The PTMI sum score was also correlated with the HAP adjusted activity score (AAS) but not the maximal activity score (MAS). Osteoporosis was a significant independent predictor of impairments in QoL, physical and mental health, and activity. Infectious complications treated as outpatient during the past 3 months significantly impaired social/family and emotional wellbeing as captured by the FACT, a similar effect was detected by the social functioning and general health perception subscales of the SF36. The HCT-CI score was significantly associated with FACT-BMT and HAP-AAS, and with only 2 of the 8 SF-36 subscale scores (vitality and mental health). Conclusions Comorbidity burden in alloHSCT survivors is significant, and the summative score from a new measure of post-transplant comorbidity captured a wider range of comorbid conditions and was significantly associated with the presence of cGVHD, and with impairments in QoL, physical and mental health, and PF. The HCT-CI also demonstrated associations between comorbidity and QoL, although as a measure developed primarily to predict early post-transplant mortality it missed common long term comorbidities like metabolic bone diseases and does not cover a recent history of infectious complications. Our results provide preliminary support for a new measure of comorbidity developed specifically for the post-transplant population. A multicenter trial prospectively validating the PTMI is ongoing. Disclosures: No relevant conflicts of interest to declare.

scholarly journals The evolving mental health landscape in Singapore

2014 ◽  
Vol 20 (4) ◽  
pp. 293-294
Author(s):  
Cyrus S. H. Ho ◽  
Roger C. M. Ho ◽  
Rathi Mahendran
Keyword(s):  
Mental Health ◽  
Royal College ◽  
Service Provision ◽  
Education And Training ◽  
The Past ◽  
Mental Health Funding ◽  
Health Funding ◽  
Asian Society ◽  
Economic Background ◽  
And Training

SummarySingapore is a multi-ethnic Asian society with a unique sociocultural and economic background. This is an overview of the characteristics of psychiatry in this nation in terms of service provision, mental health funding, education and training, and the challenges it faces in the midst of an evolving mental health landscape. Over the past 5 years, Singapore has maintained a closer tie with the Royal College of Psychiatrists through the the College's Membership examination.

scholarly journals Improvement of Inflammation and Pain After Three Months’ Exclusion Diet in Rheumatoid Arthritis Patients

2021 ◽  
Author(s):  
Guagnano Maria Teresa ◽  
D’Angelo Chiara ◽  
Caniglia Daniela ◽  
Celletti Eleonora ◽  
Emanuela Sabatini ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Short Form ◽  
Health Assessment ◽  
Normal Diet ◽  
Systemic Autoimmune Disease ◽  
Physical And Mental Health ◽  
Balanced Diet ◽  
Number Of Patients ◽  
Sf 36 ◽  
Exclusion Diet

Abstract Introduction: Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease affecting the synovial joints and causing severe disability. Environmental and lifestyle factors, including diet, have been proposed to play a role in the onset and severity of RA. Dietary manipulation may help, to manage the symptoms of RA, by lowering inflammation, and potentially decreasing pain.Methods: In 40 patients with long standing RA, with stable symptoms, and treated with conventional (c-) and biological (b-) Disease modifying anti-rheumatic drugs (DMARDs), the effect of 3-months’ diet avoiding meat, gluten, and lactose (privative diet) was evaluated in comparison with a control balanced diet including those foods. Patients choosing the exclusion diet were followed in parallel to an equal number of patients on their normal diet, and RA was clinically assessed at Time 0 (T0), through the Visual Analogue Scale (VAS), for pain, and the Disease Activity Score of 28 joints (DAS 28) for RA activity. Patients were also administered the Short Form Health survey (SF-36) and the Health Assessment Questionnaire (HAQ). At T0 a blood sample was collected for laboratory tests, and anthropometric measurements were recorded. These evaluations were repeated at the end of the 3 months’dietary regimens.Results: A significant decrease in VAS and the improvement of the overall state of physical and mental health, assessed through SF-36, was observed in patients following the avoidance diet. Both dietary regimens resulted in the improvement of quality of life compared to baseline values, however the change was significant only for the exclusion diet. With either diet, patients showed significant decreases of body weight and body mass index (BMI), with a reduction of waist and hips circumferences, lower basal glucose and circulating leptin levels. Exclusion diet was also able to significantly reduce systolic (SYS) (p=0.002) and diastolic (DIA) (p=0.027) arterial pressure. The number of circulating leukocytes and neutrophils, and the level of hs-C-Reactive Protein (CRP) were also significantly decreased after 3 months of the meat-, lactose, and gluten-free diet.Conclusions: Our results suggest that an exclusion diet can result in a better control of inflammation and pain in RA patients under stable optimized drug treatment.

scholarly journals Digital Therapeutics Hold a Promising Prospect in the Healthcare Sector – Explore How

2021 ◽  
Vol 4 (3) ◽  
pp. 01-02
Author(s):  
Ashish Gujrathi
Keyword(s):  
Mental Health ◽  
Mental Disorders ◽  
Digital Technologies ◽  
Health Conditions ◽  
Healthcare Sector ◽  
Physical And Mental Health ◽  
Mental Health Conditions ◽  
The Past ◽  
The World

The treatments of several diseases are evolving continuously towards a digital future indeed. Digital therapeutics use digital technologies to prevent, manage, or cure physical and mental health conditions. In the past ten years, the outcomes from digital therapeutics in a broad range of symptoms, such as cancer, ADHD, asthma, mental disorders, and insomnia have improved to a great extent, thereby making it more popular around the world.

scholarly journals Exploring the mental health impact on private flat owners in residential buildings with external combustible cladding

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S268-S269
Author(s):  
William Martin
Keyword(s):  
Mental Health ◽  
Physical Health ◽  
Residential Buildings ◽  
Health Impact ◽  
Direct Result ◽  
Free Text ◽  
List Type ◽  
Physical And Mental Health ◽  
Human Right ◽  
The Uk

AimsTo explore the mental health of private flat owners in residential buildings with external combustible cladding, which require remediation following the 2017 Grenfell tower fire.The speed at which the fire at Grenfell spread, killing 72 people, is largely attributed to external combustible cladding. It is increasingly suspected that there are ongoing profound effects on the mental health of people living in flats with external combustible cladding like Grenfell both in the UK and abroad. The issue has left flat owners facing severe financial hardship, the threat of bankruptcy and concerns about safety in their own homes.MethodAn exploratory ‘Google Forms’ online mental health survey comprising multiple choice and free text questions over 47 sections was distributed to flat owners in affected buildings. The survey remained open for 6 weeks to allow response. 550 individual responses were studied.Result550 individuals completed the survey, from 143 buildings across 45 UK councils.As a direct result of external combustible cladding: 89.5% said their mental health had deteriorated,22.5% reported having suicidal feelings or a desire to self-harm,71.1% reported having difficulty sleeping,93.8% said they were suffering from worry and anxiety,59.6% used coping strategies to deal with their situation,35.1% said that existing physical and mental health conditions had been exacerbated,84.1% said they cannot move on with their lives and57.9% of people had concerns about seeking help or treatment for mental/physical health problems caused by their situation during the pandemic.In addition, free text responses reflected feelings of anxiety and low mood attributed to the constant fear of fire, and an inability to plan families and future homes. One person said, “I have been left utterly broken by this. My mental and physical health has worsened, I have severe anxiety, depression and PTSD. I struggle each day to keep myself alive.”ConclusionSafe housing is a basic human right. The results show the current situation is having a detrimental impact on flat owners’ mental health and makes a strong case for the provision of specific services offering support - particularly given it is 3.5 years since Grenfell and a viable solution for all is yet to be found.

scholarly journals Negative attitudes towards borderline personality disorder patients in Spanish mental health and primary care services: mHealth, a possible solution? /Actituds negatives envers pacients amb trastorn límit de la personalitat als serveis de salut mental i d’assistència primària espanyols: mHealth, una possible solució?

2017 ◽  
Vol 35 (2) ◽  
pp. 23-37
Author(s):  
Eudald Castell
Keyword(s):  
Mental Health ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Mental Health Professionals ◽  
Borderline Personality ◽  
Years Of Experience ◽  
Negative Attitudes ◽  
The Past ◽  
Work Area ◽  
Number Of Patients

Summary. The purpose of this project was to study negative attitudes exhibited by mental health professionals toward patients with Borderline Personality Disorder (BPD) as a function of their work area (general health vs. mental health), profession, the quantity of patients with BPD they have treated over the past year, their number of years of experience in mental health, and their gender. The study used a sample of 310 professionals. We also explored how the professionals’ interest in using an innovative technological application (Medtep DBT) interacted with some of these variables, as well as the potential of the application to help change negative attitudes. Significant differences in attitude were found based on work area, profession, quantity of patients with BPD treated over the past and gender. Furthermore, profession, number of patients and years of experience in mental health determined significant differences in the professionals’ degree of interest in using Medtep DBT. Moreover, those with higher negative attitudes showed less interest in the application and a lesser willingness to try it. These results highlight the need to keep investigating how to improve the attitudes of healthcare professionals, especially nursing staff and family doctors, since they appear to be more susceptible to the development of negative attitudes. As a conclusion, we infer that the lack of empathy towards patients with BPD, the difficulties in their treatment and the years of experience in mental health all act as barriers to the implementation of the application. Resum. L’objectiu d’aquest estudi ha estat investigar les actituds negatives de professionals de la salut mental envers pacients amb Trastorn Límit de la Personalitat (TLP) en funció de la seva àrea de treball, la seva professió, pacients amb TLP tractats al darrer any, anys d’experiència en salut mental i sexe en una mostra de 310 professionals. A més a més s’han explorat, en base a part d’aquestes mateixes variables, el seu interès a usar una aplicació tecnològica innovadora (Medtep DBT) per al tractament d’aquests pacients així com la possibilitat que aquesta servís per a reduir les possibles actituds negatives. S’han trobat diferències significatives en les actituds en funció de l’àrea de treball, la professió, el nombre de pacients amb TLP tractats el darrer any i el sexe. La professió, el nombre de pacients i els anys d’experiència en salut mental també han determinat diferències significatives quant a l’interès a usar Medtep DBT. Aquells professionals amb majors actituds negatives han mostrat un menor interès i una menor disposició a utilitzar l’aplicació. Aquests resultats demostren la necessitat de seguir investigant com millorar les actituds d’aquests professionals, especialment dels d’infermeria i dels metges de capçalera, en ser els més vulnerables a desenvolupar-les. Com a conclusió es poden assenyalar la falta d’empatia envers pacients amb TLP, les dificultats en el seu tractament i els anys d’experiència en salut mental com a barreres en la implementació de l’aplicació. 

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