scholarly journals A study of clozapine and long-term hospitalisation rates

2004 ◽  
Vol 28 (8) ◽  
pp. 285-288 ◽  
Author(s):  
Alan A. Woodall ◽  
David B. Menkes ◽  
Thomas R. Trevelyan ◽  
Colin P. Lanceley
Keyword(s):  
Side Effects ◽  
Older Patients ◽  
Clinical Excellence ◽  
Clinical Implications ◽  
Treatment Resistant ◽  
Nice Guidelines ◽  
Resistant Disease ◽  
Factors Influencing ◽  
The Mean

Aims and MethodThe aim of the study was to investigate the use of clozapine in treatment-resistant schizophrenia and its impact on hospitalisation rates when prescribed in accordance with National Institute for Clinical Excellence (NICE) guidelines. Case records were examined of patients admitted to the psychiatric unit of Glan Clwyd Hospital between 1996 and 2001.ResultsOf 59 patients identified as having treatment-resistant schizophrenia, 83% had been considered for clozapine, 48% were taking clozapine, 20% had refused the drug and 15% had stopped taking it because of side-effects. The mean annual hospitalisation rate for patients receiving clozapine for a minimum of 3 years was 13.5 days, markedly lower than those not receiving this drug (34.0 days, P=0.03). Older patients were less likely to have been offered clozapine (P=0.006).Clinical ImplicationsThis study supports the NICE guidelines recommending clozapine for patients with treatment-resistant disease. Clozapine is offered less often to older patients; factors influencing this require investigation.

scholarly journals Has the referral of older adults with dementia changed since the availability of acetylcholinesterase inhibitors and the NICE guidelines?

2006 ◽  
Vol 30 (4) ◽  
pp. 131-134 ◽  
Author(s):  
Christopher O'Loughlin ◽  
Jon Darley
Keyword(s):  
Mini Mental State Examination ◽  
Mmse Score ◽  
Acetylcholinesterase Inhibitors ◽  
Clinical Excellence ◽  
Clinical Implications ◽  
Nice Guidelines ◽  
Specialist Services ◽  
Old Age Psychiatry ◽  
The Mean ◽  
State Examination

Aims and MethodTo investigate whether patients with dementia are referred to specialist services earlier in the disease since the launch of acetylcholinesterase inhibitors and the publication of the National Institute for Clinical Excellence (NICE) guidelines for the use of these drugs. All referrals to old age psychiatry services in two 6-month periods in 1996 and 2003 were surveyed retrospectively for diagnosis, Mini-Mental State Examination (MMSE) score and use of acetylcholinesterase inhibitors.ResultsThe mean MMSE score at referral increased from 18.8 to 21.5 (P=0.0005) between 1996 and 2003. Acetylcholinesterase inhibitors were prescribed for 35% of all patients and 58% of patients that would be suitable according to NICE guidelines in the 2003 group.Clinical ImplicationsThe earlier referral of patients with dementia to mental health services is encouraging.

scholarly journals Acceptance and Intake of COVID-19 Vaccines among Older Germans

2021 ◽  
Vol 10 (7) ◽  
pp. 1388
Author(s):  
Marta Malesza ◽  
Erich Wittmann
Keyword(s):  
Side Effects ◽  
Long Term Effects ◽  
Negative Side ◽  
Factors Influencing ◽  
Vaccination Acceptance ◽  
Negative Side Effects

The main aim of this study was to investigate the various factors influencing COVID-19 vaccination acceptance and actual intake among older Germans aged over 75 years old (n = 1037). We found that the intention to get vaccinated or intake of the COVID-19 vaccine were positively related to the perceptions of becoming infected, perceptions of the severity of the potential long-term effects, the vaccine’s efficacy, and the benefits of vaccination. Meanwhile, the intention to get the vaccine or vaccine intake were decreased by perceptions of the negative side-effects and the general impediments to vaccination.

scholarly journals Long-Term Effect of Endoscopic Sympathetic Nerve Reconstruction for Side Effects after Endoscopic Sympathectomy

2016 ◽  
Vol 65 (06) ◽  
pp. 484-490 ◽  
Author(s):  
Timo Telaranta ◽  
Tuomo Rantanen
Keyword(s):  
Side Effects ◽  
Sympathetic Nerve ◽  
Nerve Reconstruction ◽  
Endoscopic Thoracic Sympathectomy ◽  
Thoracic Sympathectomy ◽  
Long Term Effect ◽  
Primary Hyperhidrosis ◽  
The Mean

Background Endoscopic thoracic sympathectomy (ETS) is an effective treatment for primary hyperhidrosis. However, compensatory sweating (CS) may occur in many patients. Sympathetic nerve reconstruction (SNR) can be used to counteract severe CS, but the studies on the effects of SNR are few. Patients and Methods Nineteen out of 150 SNR patients were contacted by employing a long-term questionnaire. In this questionnaire, different kinds of sweating were evaluated using a four-graded symptom analysis and the visual analog scale before ETS, after ETS, and after SNR. Results The mean age of the 16 male and 3 female patients at the SNR was 32 years. The mean follow-up was 87 months. According to the long-term questionnaire, the benefit was either excellent (4 patients, 21%), good (3 patients, 15.8%), or reasonable (7 patients, 36.8%) in 14 patients (73.8%), while the benefit was questionable in 1 patient (5.3%). For three patients (15.8%), no benefit was found, and in one patient (5.3%), the situation had deteriorated. Conclusions Improvement in the side effects of ETS after SNR was found in nearly 75% of the patients. This indicates that SNR can be considered as an alternative treatment for patients with severe CS after ETS that is unresponsive to conservative treatment.

Clozapine use – has practice changed?

2020 ◽  
Vol 34 (5) ◽  
pp. 567-573
Author(s):  
Roberta Rowntree ◽  
Sean Murray ◽  
Felicity Fanning ◽  
Dolores Keating ◽  
Atilla Szigeti ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
First Episode Psychosis ◽  
Prescribing Patterns ◽  
First Episode ◽  
Service Utilisation ◽  
Treatment Resistant ◽  
Nice Guidelines ◽  
Episode Psychosis ◽  
The Mean ◽  
The Impact

Background: One-third of individuals with schizophrenia have treatment-resistant illness. Of these, up to 60% will respond to clozapine treatment. Aims: This study retrospectively examined clozapine prescribing patterns against National Institute for Health and Care Excellence (NICE) guidelines as treatment-resistant illness emerged in a first-episode psychosis cohort. Methods: A total of 339 individuals with a first-episode psychosis were included in the study. Clozapine prescribing patterns were compared against the NICE guidelines and the impact of clozapine use on one index of service utilisation (hospitalisation) was assessed. Results: A total of 32 individuals (9.4%) from the cohort were prescribed clozapine. The mean time to clozapine trial was 2.1 years (SD 1.95; range 0.17–6.25). The mean number of adequate trials of antipsychotic prior to starting clozapine was 2.74 (SD 1.13; range 1–5). Following clozapine initiation, mean hospital admissions per year reduced from 2.3 to 0.3 ( p=0.00). Mean hospital days pre- and post-clozapine also reduced (147 vs. 53; p=0.00). In total, 18 patients discontinued clozapine use during follow-up – 5 temporarily and 13 permanently. Conclusions: Patients are being prescribed clozapine earlier than previously demonstrated, though delays are still evident, and many patients discontinue treatment. More work needs to be undertaken to understand and address factors which lead to its discontinuation.

scholarly journals Reflections on melatonin: focus on child mental health

2008 ◽  
Vol 32 (12) ◽  
pp. 444-448 ◽  
Author(s):  
Oluwole Famuyiwa ◽  
Abiodun Adewuya
Keyword(s):  
Side Effects ◽  
Child And Adolescent Psychiatry ◽  
Cochrane Library ◽  
Clinical Implications ◽  
Quality Of Sleep ◽  
Intervention Programme ◽  
Library Resource ◽  
The Cochrane Library

Aims and MethodTo examine the propriety of the use of melatonin in child and adolescent psychiatry based on findings retrieved from multiple electronic databases including the Cochrane Library resource, covering 1950–2007.ResultsThere is evidence for the effectiveness of melatonin in the initiation of sleep in children with a variety of neurodevelopmental disorders but its value in improving quality of sleep is doubtful. Like hormones in general, melatonin has multifarious action sites and hence potential for many side-effects. Posological issues and long-term side-effects are yet to be validly determined.Clinical ImplicationsSleep hygiene should be a major component of the routine intervention programme for insomnia and melatonin judiciously prescribed until the safety of long-term use is known.

scholarly journals The prognosis of depression in late life versus mid-life: implications for the treatment of older adults

2005 ◽  
Vol 17 (4) ◽  
pp. 533-538 ◽  
Author(s):  
Hari Subramaniam ◽  
Alex J. Mitchell
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Nursing Homes ◽  
Late Life ◽  
Clinical Excellence ◽  
Late Life Depression ◽  
Medical Settings ◽  
Nice Guidelines ◽  
Primary Care Settings

Depression in late life is extremely common. Of those aged 65 years or older, 2–5% have syndromal depression, but up to 20% of elderly people have depressive symptoms (Horwath et al., 2002). Both syndromal and subsyndromal depression carry a high risk of long-term complications and both are associated with elevated risks of morbidity and mortality (Penninx et al., 1999). Despite repeated alerts, depression is consistently under-recognized in acute medical settings, in nursing homes and in primary care (Volkers et al., 2004). For reasons that are inadequately understood, late-life depression seems to be under-treated to an even greater extent than depression in mid-life (Mackenzie et al., 1999). This issue is particularly important, given that effective and safe treatments for depression are available (Bartels et al., 2003), even though the evidence regarding maintenance therapies in older people is inconsistent (Geddes et al., 2003; Wilson et al., 2003). Recent evidence suggests that a package of care can improve the care of older depressed patients in primary care settings (Bruce et al., 2004) and in nursing homes (Ciechanowski et al., 2004). This has led to the development of several clinical guidelines specifically for late-life depression (Baldwin et al., 2003; Charney et al., 2003; Lebowitzet al., 1997). Yet, in the recent National Institute of Clinical Excellence (NICE) guidelines for the management of depression in primary and secondary care, no distinction was made between early, middle and late-life depression (Malone and Mitchell, 2005).

scholarly journals Evaluation of the 13-item Hypomania Checklist and a brief 3-item manic features questionnaire in primary care

2017 ◽  
Vol 41 (4) ◽  
pp. 187-191 ◽  
Author(s):  
Sukhmeet Singh ◽  
Paul Scouller ◽  
Daniel J. Smith
Keyword(s):  
Primary Care ◽  
Bipolar Disorder ◽  
Clinical Implications ◽  
Predictive Values ◽  
Mean Delay ◽  
Item Questionnaire ◽  
Primary Care Patients ◽  
The Mean ◽  
Recorded Diagnosis

Aims and methodThe mean delay for bipolar disorder diagnosis is 10 years. Identification of patients with previous hypomania is challenging, sometimes resulting in misdiagnosis. The aims of this study were: (a) to estimate the proportion of primary care patients with depression currently taking antidepressants who have undiagnosed bipolar disorder and (b) to compare a brief 3-item manic features questionnaire with the Hypomania Checklist (HCL-13). The sample comprised patients with a recorded diagnosis of depression, either on long-term antidepressant therapy or with previous multiple courses of antidepressants.ResultsOf 149 participants assessed, 24 (16.1%) satisfied criteria for bipolar disorder. Areas under the curve (AUC) for the 3-item questionnaire and the HCL-13 were similar (0.79 and 0.72, respectively) but positive predictive values (PPV) were low.Clinical implicationsBipolar disorder may be underdiagnosed in primary care. A 3-item questionnaire could be used by general practitioners to screen for bipolar disorder in their patients with depression.

Treatment of Acute Mania

CNS Spectrums ◽  
2003 ◽  
Vol 8 (12) ◽  
pp. 917-928 ◽  
Author(s):  
Paul E. Holtzheimer ◽  
John F. Neumaier
Keyword(s):  
Clinical Practice ◽  
Side Effects ◽  
Drug Administration ◽  
Mood Stabilizers ◽  
Acute Mania ◽  
Treatment Resistant ◽  
Short Term ◽  
The Past ◽  
Term Tolerability

AbstractMood stabilizers have evolved considerably over the past decade. Lithium, divalproex, and olanzapine are currently Food and Drug Administration-approved for the treatment of acute mania. A number of new and traditional medications have also been tested and are commonly used in clinical practice. Several strategies for managing treatment-resistant mania have been suggested, but few have been rigorously tested. Emphases on rapid stabilization and fewer side effects have raised the bar for what is expected from mood stabilizers and the successful treatment of mania involves a delicate balance between swiftness, short-term tolerability, and long-term safety.

scholarly journals A survey of methadone prescribing at an inner-city drug service and a comparison with national data

2003 ◽  
Vol 27 (05) ◽  
pp. 167-170 ◽  
Author(s):  
John Dunn
Keyword(s):  
Inner City ◽  
Methadone Maintenance ◽  
Clinical Implications ◽  
High Dose ◽  
National Data ◽  
Methadone Dose ◽  
National Surveys ◽  
Time In Treatment ◽  
The Mean

Aims and Method Surveys suggest that UK drug services under-prescribe methadone to opiate-dependent patients. This study investigated methadone prescribing for 169 patients on long-term methadone at a specialist drug service. Results The mean methadone dose for patients on maintenance was 65.8 mg, and 67.7% were taking 50 mg or more. Mean doses in relation to methadone formulation varied substantially: mixture 57.4 mg, tablets 81.8 mg and ampoules 113.0 mg. These figures are higher than those reported from national surveys. The proportion of urine screens positive for illicit opiates was inversely related both to methadone dose and length of time in treatment. Clinical Implications This survey shows the levels of methadone prescribing at an inner-city drug service and gives support to the effectiveness of high-dose methadone maintenance.

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