scholarly journals Co-prescribing of atypical and typical antipsychotics – prescribing sequence and documented outcome

2002 ◽  
Vol 26 (5) ◽  
pp. 170-172 ◽  
Author(s):  
D. Taylor ◽  
S. Mir ◽  
S. Mace ◽  
E. Whiskey
Keyword(s):  
Mental Health ◽  
Adverse Effect ◽  
Psychotic Symptoms ◽  
Clinical Implications ◽  
Considerable Evidence ◽  
Single Drug ◽  
Minimal Evidence ◽  
Health Trust ◽  
Improved Outcome ◽  
Typical Antipsychotics

AIMS AND METHODTo evaluate patterns of antipsychotic co-prescription and to establish documented outcome, we reviewed 1441 in-patient and community prescriptions written in a large mental health trust. For patients co-prescribed regular atypical and typical antipsychotics for longer than 6 weeks, medication histories were taken and case notes examined to determine sequence of prescribing, documented outcome and reasons for co-prescription.RESULTSFifty-three patients had been co-prescribed aytpical and typical antipsychotics for more than 6 weeks. In 62% of cases the atypical drug had been prescribed first and a typical drug added later. The most frequently documented reason for co-prescription was that symptoms persisted when prescribed a single antipsychotic. Clinical outcome was documented for 64% of patients: 45% of the total number treated showed some improvement, with seven of 53 patients noted to have shown improvements in psychotic symptoms.CLINICAL IMPLICATIONSCo-prescription of aytpical and typical antipsychotics often occurs as a consequence of poor outcome with single drug treatment. In this study there was minimal evidence to suggest that co-prescription improved outcome to an important extent. There remains little support for co-prescription of antipsychotics but considerable evidence to suggest that such practice worsens adverse effect burden. Co-prescription of atypical and typical antipsychotics should be avoided in all but very exceptional circumstances.

scholarly journals Complaints about care in a mental health trust

2000 ◽  
Vol 24 (10) ◽  
pp. 372-376 ◽  
Author(s):  
Iris Pitarka-Carcani ◽  
George Szmukler ◽  
Claire Henderson
Keyword(s):  
Mental Health ◽  
Quality Of Care ◽  
Psychiatric Services ◽  
Disciplinary Action ◽  
Psychotic Symptoms ◽  
Clinical Aspects ◽  
Clinical Implications ◽  
Equal Split ◽  
Health Trust

Aims and MethodA retrospective review of a random sample of written complaints made by, or on behalf of, users of psychiatric services to determine: (a) the number and nature of written complaints against clinical aspects of services in a mental health trust over a 1-year period; and (b) what information complaints provide about deficiencies in the quality of care.ResultsOut of 325 recorded complaints in 1997, 192 concerned clinical aspects of services; 89% of complainants complained once. There was a roughly equal split between complaints about technical v. interpersonal aspects of care. Complaints were far higher from in-patient than from out-patient settings. Evidence that the complaints related to psychotic symptoms was rare. All complaints were resolved locally, but 28 responses by the team were judged unsatisfactory. In 39 cases further action was taken as a result of the complaint, but no disciplinary action was taken against medical staff.Clinical ImplicationsPoor communication is likely to be at the root of many complaints. Room for improvement was found with respect to responses to complaints.

scholarly journals The impact of first COVID-19 peak on patient referrals to Liaison Psychiatry Service and staff perception about service provision in Birmingham and Solihull Mental Health Trust Birmingham - a service evaluation project

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S329-S329
Author(s):  
Saima Jehanzeb ◽  
Muhammad Suleman ◽  
Ella Tumelty ◽  
Joanne Okusanya ◽  
Laxsan Karunanithy ◽  
...  
Keyword(s):  
Mental Health ◽  
Focus Groups ◽  
Quantitative Methods ◽  
Service Evaluation ◽  
Psychotic Symptoms ◽  
Healthcare Provision ◽  
Liaison Psychiatry ◽  
Clinical Databases ◽  
The Impact ◽  
Health Trust

AimsBased on recommendations from the Royal College of Psychiatrists, this project aimed to evaluate the impact of the first peak of the COVID-19 pandemic on referral patterns to the Queen Elizabeth Hospital Birmingham (QEHB) Liaison Psychiatry (LP) service. Additionally, we aimed to explore staff experiences in LP services across Birmingham and Solihull Mental Health Trust (BSMHFT) in order to generate Trust recommendations promoting optimal healthcare provision amidst the on-going pandemic.MethodA mixed method service evaluation was conducted using quantitative and qualitative analysis. Quantitative methods involved reviewing referrals made to the QEHB LP service from March to June 2020, compared with the equivalent time period in 2019. Data were retrospectively extracted from the electronic clinical databases RIO and PICS, and subsequently analysed using Microsoft Office. The number of, and reasons for referrals to LP were identified, whilst focus groups were conducted to explore the subjective experiences of staff working across BSMHFT LP services.ResultBetween 1st March and 30th June 2020, 984 referrals were made to the QEHB LP service, compared to 1020 referrals in 2019, representing a 3.5% reduction. From 2019 to 2020, referrals due to psychotic symptoms and deliberate self-harm rose by 12.8% and 14.1% respectively, whilst referrals for drug and alcohol-related causes reduced by 28.3%. A significant increase (150%) in referrals for medication or management advice was seen. Focus groups indicated that staff perceived an initial reduction in number of referrals, but an increase in the acuity of patient presentations.Staff reported anxiety around contracting and transmitting SARS-Cov-2, exacerbated by uncertainty around patients’ COVID-19 status. In QEHB, sixty-five of the 984 referrals (7%) had a positive SARS-Cov-2 PCR swab, with the remaining 919 referrals being either negative (68%) or unknown (25%). Ninety-six percent of consultations were conducted face-to-face in QEHB. There were conflicting views amongst staff regarding whether more consultations could have been conducted remotely. Furthermore, varying perceptions of support and communication from both the physical and mental health trust were reported.ConclusionQuantitative data indicates that COVID-19 impacted LP healthcare provision in BSMHFT. Whilst referral numbers remained similar between the equivalent period in 2019 and 2020, a change in the nature of referrals to LP at QEHB was seen. This was corroborated by qualitative data which highlighted a perceived change in acuity of referrals. These findings have been disseminated across the Trust and subsequent recommendations are being implemented during the on-going pandemic.

scholarly journals Acute in-patient psychiatry: how patients spend their time on acute psychiatric wards

2007 ◽  
Vol 31 (5) ◽  
pp. 167-170 ◽  
Author(s):  
Jonathan Radcliffe ◽  
Roger Smith
Keyword(s):  
Mental Health ◽  
Social Interaction ◽  
Group Activity ◽  
Clinical Implications ◽  
Opting Out ◽  
Acute Psychiatric Wards ◽  
Health Trust

Aims and MethodWe observed levels of social interaction and activity among in-patients on 16 acute psychiatric wards in 6 hospitals in a large mental health trust. Each ward was observed for 1 week and attendance at organised activities was audited over 3-week periods.ResultsAt any time during the day 84% of in-patients were socially disengaged and mainly inactive. On average only 4% of in-patients' time was spent in an organised group activity, with many in-patients opting out altogether. Provision and take-up of group activity programmes varied widely between wards.Clinical ImplicationsProvision of organised activity needs to be a higher priority in acute services, and there should be national and local standards for what should be provided. Concerted organisational strategies and assertive approaches by staff are needed to engage in-patients in group activity programmes.

scholarly journals The prevalence of constant supportive observations in high, medium and low secure services

2018 ◽  
Vol 42 (2) ◽  
pp. 54-58 ◽  
Author(s):  
Katie Lambert ◽  
Simon Chu ◽  
Chris Duffy ◽  
Victoria Hartley ◽  
Alison Baker ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Clinical Implications ◽  
Forensic Mental Health ◽  
Adverse Incident ◽  
Clinical Records ◽  
Number Of Individuals ◽  
Incident Rates ◽  
Health Trust

Aims and methodWe explored the prevalence and use of constant supportive observations (CSO) in high, medium and low secure in-patient services in a single National Health Service (NHS) mental health trust. From clinical records, we extracted data on the length of time of CSO, the reason for the initiation of CSO and associated adverse incidents for all individuals who were placed on CSO between July 2013 and June 2014.ResultsA small number of individuals accounted for a disproportionately large proportion of CSO hours in each setting. Adverse incident rates were higher on CSO than when not on CSO. There was considerable variation between different settings in terms of CSO use and the reasons for commencing CSO.Clinical implicationsThe study describes the prevalence and nature of CSO in secure forensic mental health services and the associated organisational costs. The marked variation in CSO use between settings suggests that mental health services continue to face challenges in balancing risk management with minimising restrictive interventions.Declaration of interestA.B. and J.L.I. are both directly employed by the NHS trust in which the study was conducted.

scholarly journals Understanding ‘significant impaired decision-making ability’ with regard to treatment for mental disorder: an empirical analysis

2010 ◽  
Vol 34 (6) ◽  
pp. 239-242 ◽  
Author(s):  
Evonne Shek ◽  
Donald Lyons ◽  
Mark Taylor
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Decision Making ◽  
Cognitive Impairment ◽  
Depressive Symptoms ◽  
Cognitive Function ◽  
Mental Disorder ◽  
Psychotic Symptoms ◽  
Clinical Implications ◽  
Definition Of

Aims and MethodTo capture psychiatrists' reasons for ‘significant impaired decision-making ability’ (SIDMA) as there is no definition of SIDMA in the Mental Health (Care and Treatment) (Scotland) Act 2003. One hundred consecutive mental health reports from January to February 2008 were examined using a questionnaire.ResultsMore than half the mental health reports noted lack of insight as the main cause of SIDMA. Other reasons for SIDMA included limited cognitive function and presence of psychotic symptoms.Clinical implicationsFive reasons for SIDMA were identified: lack of insight, cognitive impairment, presence of psychosis, severe depressive symptoms and learning disability. We recommend psychiatrists working in Scotland give full descriptions of SIDMA, indicating how this has an impact on the patient's ability to make decisions.

scholarly journals Valproate as prophylaxis for clozapine-induced seizures: survey of practice

2008 ◽  
Vol 32 (7) ◽  
pp. 262-265 ◽  
Author(s):  
Anna Sparshatt ◽  
Eromona Whiskey ◽  
David Taylor
Keyword(s):  
Mental Health ◽  
At Risk ◽  
Plasma Level ◽  
Clinical Characteristics ◽  
Electronic Records ◽  
Clinical Implications ◽  
Audit Standard ◽  
Therapeutic Plasma Level ◽  
Health Trust

Aims and MethodTo evaluate the prescribing of valproate in clozapine-treated individuals who may be at risk of seizure. We collected point-prevalent clinical characteristics and demographics of all in-patients prescribed clozapine in an acute mental health trust. Data were collected from case notes, electronic records and drug charts, and analysed against a set audit standard.ResultsData were collected for 81 in-patients. Of all deemed to be at risk of seizure (n=37) only 24% were prescribed valproate at a therapeutic plasma level.Clinical ImplicationsThe majority of patients prescribed clozapine at risk of seizures were not adequately protected from this risk. Clear guidelines are required.

scholarly journals Prevalence study of head shop drug usage in mental health services

2013 ◽  
Vol 37 (2) ◽  
pp. 44-48 ◽  
Author(s):  
John Lally ◽  
Emam-El Higaya ◽  
Zafar Nisar ◽  
Emma Bainbridge ◽  
Brian Hallahan
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Mental State ◽  
Psychotic Symptoms ◽  
Clinical Implications ◽  
Psychoactive Drugs ◽  
Drug Usage ◽  
Adult Mental Health ◽  
History Of

Aims and methodTo examine the prevalence of head shop drug usage in individuals attending a range of adult mental health services. We examined the effect of head shop drug usage on the mental state of individuals with a range of mental health disorders. Clinical data were obtained from 608 consecutively reviewed individuals attending adult mental health services in relation to their use of head shop and psychoactive drugs and the putative effects of head shop drugs on their mental state.ResultsThe prevalence of head shop drug use was 13% (n= 78), with a higher prevalence of usage noted in individuals younger than 35 years of age (25%). A large proportion of individuals (n= 41, 54%) reported adverse effects of these agents on their mental state, with psychotic symptoms being the most prevalent.Clinical implicationsHead shop drug usage was associated with a reported deleterious effect on mental state, which was particularly evident for individuals with a history of psychosis.

scholarly journals The adverse consequences of mephedrone use: a case series

2011 ◽  
Vol 35 (6) ◽  
pp. 203-205 ◽  
Author(s):  
Kirsty Mackay ◽  
Mark Taylor ◽  
Neeraj Bajaj
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Health Services ◽  
Adverse Effects ◽  
Case Series ◽  
Psychotic Symptoms ◽  
Clinical Implications ◽  
Recreational Drug ◽  
Low Mood ◽  
History Of

Aims and methodMephedrone is a cathinone with amphetamine-like stimulant effects, and is a commonly used recreational drug. The adverse effects of mephedrone use have not been extensively studied. All individuals who self-presented between January and June 2010 to the emergency departments and acute mental health services in Edinburgh and Falkirk with adverse effects of self-reported mephedrone use were identified.ResultsTwenty cases were identified and analysed. Severe agitation was the most common presenting problem (70%), with 40% of individuals developing psychotic symptoms and a further 20% reporting low mood and suicidality. One person died by suicide.Clinical implicationsMephedrone can produce amphetamine-like adverse psychological intoxication effects, particularly in those with a history of mental illness. Clinicians should consider advising patients on the adverse effects of mephedrone, where relevant.

scholarly journals Exploration of in-patient attitudes towards smoking within a large mental health trust

2008 ◽  
Vol 32 (5) ◽  
pp. 166-169 ◽  
Author(s):  
Jennifer Smith ◽  
Charlotte O'Callaghan
Keyword(s):  
Mental Health ◽  
Smoking Habits ◽  
Clinical Implications ◽  
Patient Attitudes ◽  
Public Places ◽  
Face To Face ◽  
Smoking Policy ◽  
Smoking Policies ◽  
Health Trust

Aims and MethodTo explore the smoking habits of in-patients on psychiatric wards, their beliefs about the effects of smoking on health, and their attitudes towards hospital and government smoking policies. Face-to-face interviews with 135 in-patients were conducted.ResultsA total of 54.1% of participants smoked. Smoking was less prevalent in those aged 65 years and older (P<0.001). Non-smokers were more likely to believe smoking to be harmful to health (P=0.002). Overall, 71.1% of the participants favoured the existing smoking policy, with only 3.0% wanting a complete ban on smoking and 54.1% agreeing with banning smoking in public places.Clinical ImplicationsFurther studies are warranted into the views of in-patients elsewhere and to see whether attitudes change as trusts tighten their smoking policies. Outdoor smoking areas may need to be considered, although in practice this may not be possible in all trusts.

scholarly journals Violence against psychiatrists by patients: survey in a London mental health trust

2007 ◽  
Vol 31 (10) ◽  
pp. 371-374 ◽  
Author(s):  
Saleh Dhumad ◽  
Anusha Wijeratne ◽  
Ian Treasaden
Keyword(s):  
Mental Health ◽  
Response Rate ◽  
Psychiatric Patients ◽  
Psychological Support ◽  
Psychiatric Ward ◽  
Clinical Implications ◽  
Health Trust

Aims and MethodA survey was undertaken to investigate assaults of psychiatrists by patients in a 12-month period. Surveys were sent to 199 psychiatrists representing all sub-specialties and grades in a London mental health trust.ResultsThere were 129 returned responses (response rate 64.8%). In the 12-month study period, 12.4% of all psychiatrists and 32.4% of senior house officers were assaulted. None received or took up offers of formal, as opposed to informal, psychological support. Most assaults occurred on a psychiatric ward. Vulnerability to assaults was not influenced by courses on prevention and management of violence or by the attitudes of psychiatrists to violence by psychiatric patients.Clinical ImplicationsSenior house officers are most vulnerable to assaults. Greater attention may need to be given to psychiatric wards where most assaults occurred. Trusts should ensure that those assaulted are identified and offered support.

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