scholarly journals Mortality rates are higher in lewy body and parkinson's disease dementia compared to Alzheimer's dementia in patients referred into a secondary care mental health service. Why?

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S262-S262
Author(s):  
Anne K ◽  
John O'Brien ◽  
Annabel Price ◽  
Rudolph Cardinal ◽  
Sinead Moylett
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Lewy Body ◽  
Alzheimer’S Dementia ◽  
Alzheimer's Dementia ◽  
Risk Of Death ◽  
Recurrent Falls ◽  
Males And Females

AimsWe compared survival in four cohorts of dementia patients– Lewy body (LBD), Parkinson's (PDD), Vascular (VD) and Alzheimer's dementia (AD) - in patients referred into Cambridge and Peterborough NHS Foundation Trust (CPFT) mental health services.Additionally, we investigated reasons for variation in survival in the four cohorts.MethodUsing electronic records we identified retrospective cohorts of patients referred into services from 2013 onwards. Cases of LBD and PDD were identified using text searches, and comparison cohorts with AD or VD identified using ICD10 diagnosis codes ((F00.*) or (F01.*) respectively).We collected referral (date of referral and service referred into), demographic (date of birth and gender) and diagnosis data on the patients in the four cohorts. Dates of death were available, through central NHS reporting to Trusts.We used date of first referral as start of the follow-up and end of follow-up, death or 31/12/19. We used Kaplan-Meier and Cox survival analysis to compare survival in the four cohorts.The cohorts were crossed with Hospital Episode Statistics (HES) data to extract hospital admission diagnoses. We extracted diagnoses of pneumonia due to aspiration and recurrent falls from hospital admissions data using ICD codes (J69.0 and R29.6 respectively). We calculated prevalence of these diagnoses in the dementia groups, in males and females separately.ResultIn Cox analysis (controlling for age at referral, gender and service referred into), the hazard ratio (HR) for death was highest for the PDD group (HR 2.0 (95% CI 1.7–2.4)), followed by LBD (HR 1.4 (95% CI 1.3–1.6)), then VD (HR 1.2 (95% CI 1.0–1.3)), with the AD group as reference. In the same analysis repeated separately for males and females, the highest HR was found in males with PDD (HR 2.3 (95% CI 1.8–2.8)).Referrals to liaison psychiatry were associated with reduced survival compared to other mental health services (HR 1.7 (95% CI 1.5–2.0)).The AD cohort showed the lowest rates of pneumonia due to aspiration and recurrent falls in males and in females. The highest rate of pneumonia due to aspiration was found in the male PDD group (27%).ConclusionIn patients with dementia referred into mental health services, those with AD survive longer compared to other dementia groups, with PDD patients at highest risk of death. Physical frailty including risk of aspiration, is likely to account for some of this difference in survival.

Transdiagnostic versus Diagnosis-Specific Group Cognitive Behavioral Therapy for Anxiety Disorders and Depression: A Randomized Controlled Trial

2021 ◽  
pp. 1-14
Author(s):  
Nina Reinholt ◽  
Morten Hvenegaard ◽  
Anne Bryde Christensen ◽  
Anita Eskildsen ◽  
Carsten Hjorthøj ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Well Being ◽  
Major Depressive ◽  
Outpatient Mental Health ◽  
End Of Treatment

<b><i>Introduction:</i></b> The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) delivered in a group format could facilitate the implementation of evidence-based psychological treatments. <b><i>Objective:</i></b> This study compared the efficacy of group UP and diagnosis-specific cognitive behavioral therapy (dCBT) for anxiety and depression in outpatient mental health services. <b><i>Methods:</i></b> In this pragmatic, multi-center, single-blinded, non-inferiority, randomized controlled trial (RCT), we assigned 291 patients with major depressive disorder, social anxiety disorder, panic disorder, or agoraphobia to 14 weekly sessions in mixed-diagnosis UP or single-diagnosis dCBT groups. The primary test was non-inferiority, using a priori criteria, on the World Health Organisation 5 Well-Being Index (WHO-5) at the end of the treatment. Secondary outcomes were functioning and symptoms. We assessed outcomes at baseline, end-of-treatment, and at a 6-month follow-up. A modified per-protocol analysis was performed. <b><i>Results:</i></b> At end-of-treatment, WHO-5 mean scores for patients in UP (<i>n</i> = 148) were non-inferior to those of patients in dCBT (<i>n</i> = 143; mean difference –2.94; 95% CI –8.10 to 2.21). Results were inconclusive for the WHO-5 at the 6-month follow-up. Results for secondary outcomes were non-inferior at end-of-treatment and the 6-month follow-up. Client satisfaction and rates of attrition, response, remission, and deterioration were similar across conditions. <b><i>Conclusions:</i></b> This RCT demonstrated non-inferior acute-phase outcomes of group-delivered UP compared with dCBT for major depressive disorder, social anxiety disorder, panic disorder, and agoraphobia in outpatient mental health services. The long-term effects of UP on well-being need further investigation. If study findings are replicated, UP should be considered a viable alternative to dCBT for common anxiety disorders and depression in outpatient mental health services.

A Twelve Month Follow-Up Study of Psychogeriatric Admissions to Mental Health Services and Geriatric Service Hospitals

1970 ◽  
Vol 4 (3) ◽  
pp. 131-136 ◽  
Author(s):  
P. W. Burvill
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Western Australia ◽  
Hospital Admissions ◽  
Public Health Department ◽  
Home Setting ◽  
Geriatric Service ◽  
Psychogeriatric Patients

Eighty-five (100 per cent) consecutive psychogeriatric patients admitted to the Public Health Department Geriatric Service of Western Australia and eighty (94 per cent) of the original 85 psychogeriatric patients admitted to the Mental Health Services of Western Australia were re-examined by the author 12 months after admission. Twenty-five Geriatric Service patients had died, 19 were alive in the community, and 41 alive in hospital; the corresponding Mental Health Services figures were 15, 33 and 32. Differences in movement pattern and outcome between the two services, and between mental hospital admissions in the United Kingdom and Western Australia, were documented. There was a considerable number of repeated transfers from one hospital or nursing home setting to another during the 12 months among those patients living in hospital at follow-up, and to a less extent among those who died. Outcome of the patients was related to a number of factors for each service.

Developing methods that really do value the ‘Q’ in the QALY

2008 ◽  
Vol 3 (1) ◽  
pp. 69-77 ◽  
Author(s):  
PAUL DOLAN
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Services ◽  
Health Services ◽  
General Public ◽  
Full Health ◽  
Risk Of Death ◽  
Ration Health Care ◽  
Good Guide

AbstractMost health economists recommend that improvements in health be valued by asking members of the general public to imagine themselves in different states of health and then to think about how many years of life they would give up or what risk of death they would be willing to accept in order to be in full health. In this paper, I argue that preferences are not a very good guide to future experiences and a more suitable way to value health is to ask people in different states of health how they think and feel about their lives. Valuing health in this way may result in greater priority being given to mental health services. Whatever the precise implications, it is my contention that it is much better to ration health care according to real experiences rather than according to hypothetical preferences.

The first 30 months of the MindSpot Clinic: Evaluation of a national e-mental health service against project objectives

2016 ◽  
Vol 51 (12) ◽  
pp. 1227-1239 ◽  
Author(s):  
Nickolai Titov ◽  
Blake F Dear ◽  
Lauren G Staples ◽  
James Bennett-Levy ◽  
Britt Klein ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Public Awareness ◽  
Treatment Options ◽  
Service Utilisation ◽  
Clinical Effects ◽  
Post Traumatic Stress ◽  
Project Objectives

Objective: The MindSpot Clinic provides online mental health services to Australian adults with anxiety and depression. This paper describes users of MindSpot between January 2013 and June 2015. Outcomes are considered against three key objectives: improving access to mental health services, improving public awareness of how to access services and providing evidence-based treatments. Method: Website traffic data were examined to determine patterns of use. Demographic characteristics, past service utilisation and reasons for contacting MindSpot were analysed. Outcomes for patients enrolled in a MindSpot treatment course were also analysed. Primary outcomes were scores on the 9-Item Patient Health Questionnaire, Generalised Anxiety Disorder 7-Item, Yale–Brown Obsessive Compulsive Scale and Post-Traumatic Stress Disorder Checklist–Civilian Version, administered at assessment, post-treatment and 3-month follow-up. Results: The website was visited by almost 500,000 Australians, of which 33,990 adults started assessments, and 25,469 people completed assessment and were eligible for analysis. Mean age was 36.4 years (standard deviation = 13.3 years; range = 18–94 years), and 72% were female. The proportion living in rural or remote regions and who identified as Aboriginal and Torres Strait Islander closely matched national statistics. The majority (82%) reported that they were not currently in contact with mental health services. Most patients sought an assessment, information about treatment options, or referral to another service, and only 24% of those completing an assessment commenced a MindSpot treatment course. Of these, large clinical effects ( d: 0.7–2.4; average symptom reductions: 25.5% to 61.6%) were found from assessment to follow-up on all outcome measures. Deterioration ranged from 1.0% to 4.3%. Conclusion: Based on the number of website visits, completed assessments and treatment outcomes, MindSpot achieved its three programme objectives. This model of service provision has considerable value as a complement to existing services, and is proving particularly important for improving access for people not using existing services.

scholarly journals Screening and Referral is Not Enough: A Qualitative Exploration of Barriers to Access and Uptake of Mental Health Services in Patients With Cardiovascular Diseases

2020 ◽  
Author(s):  
Catherine M Collopy ◽  
Suzanne M Cosh ◽  
Phillip J Tully
Keyword(s):  
Mental Health ◽  
Cardiovascular Diseases ◽  
Mental Health Services ◽  
Health Services ◽  
Peer Support ◽  
Service Use ◽  
Information Provision ◽  
Cardiac Events ◽  
Structured Interviews

Abstract Background: Cardiovascular diseases (CVD) are commonly comorbid with mental health disorders, portending poorer cardiac prognosis. Despite the high prevalence of depression and anxiety, and guidelines recommending routine depression screening and referral, uptake of mental healthcare in CVD populations remains low. Reasons for the underutilisation of mental health and psychological services for this population remain largely unknown.Methods: Thirteen CVD patients with clinically significant psychological symptoms (depression, anxiety and/or stress) participated in one-on-one in-depth semi-structured interviews. Data were analysed using inductive thematic analysis.Results: Barriers to uptake included the timing of referral and screening, with patients reporting a need for longer term follow-up. A lack of information provision and understanding around mental health and services, especially following cardiac-events were further barriers. A reluctance to report mental health or engage in services was also identified, with patients indicating a preference for informal peer support networks. A range of practical barriers such as mobility, transport and cost were also reported. Conclusions: Longer term follow-up and routine mental health assessment may be beneficial to facilitate use of mental health services. Upskilling of practitioners around mental health may be a further avenue to promote information provision and enhance service use. Further focus on enhancing informal peer support may be a valuable initial approach for the CVD population. The implications for improving services and enhancing service use are discussed.

scholarly journals Association of Timely Outpatient Mental Health Services for Youths After Psychiatric Hospitalization With Risk of Death by Suicide

2020 ◽  
Vol 3 (8) ◽  
pp. e2012887
Author(s):  
Cynthia A. Fontanella ◽  
Lynn A. Warner ◽  
Danielle L. Steelesmith ◽  
Guy Brock ◽  
Jeffrey A. Bridge ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Psychiatric Hospitalization ◽  
Outpatient Mental Health ◽  
Risk Of Death

scholarly journals Service and treatment engagement of people with very late-onset schizophrenia-like psychosis

2016 ◽  
Vol 40 (4) ◽  
pp. 185-186 ◽  
Author(s):  
Chun Chiang Sin Fai Lam ◽  
Suzanne J. Reeves ◽  
Robert Stewart ◽  
Robert Howard
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Late Onset ◽  
Treatment Engagement ◽  
Antipsychotic Treatment ◽  
Clinical Implications ◽  
Electronic Patient Records ◽  
Lost To Follow Up

Aims and methodElectronic patient records were used to investigate the level of engagement and treatment that patients with very late-onset schizophrenia-like psychosis (VLOSLP) had with mental health services.ResultsOf 131 patients assessed and diagnosed, 63 (48%) were taking antipsychotic treatment at 3 months, 46 (35%) at 6 months and 36 (27%) at 12 months. At discharge from mental health services, 54% of patients had failed to engage with services or became lost to follow-up, 18% had engaged with services but were not taking antipsychotic medication and only 28% were taking treatment.Clinical implicationsResults showed that less than half of the patients with VLOSLP were commenced on antipsychotic treatment and less than a third remained on treatment at 1 year or at point of discharge. This highlights the need for services to consider being more assertive in taking potentially effective treatment to this patient group.

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