Physical health monitoring of patients prescribed depot antipsychotic medication in north west Edinburgh community mental health team

AimsTo monitor the quality of physical health monitoring of patients prescribed depot antipsychotic medication in the North West Edinburgh Community Mental Health Team (CMHT). We also evaluated the completeness of prescriptions and Mental Health Act (Scotland) (Act) 2003 paperwork where relevant.BackgroundAntipsychotic medications are medicines for treating conditions such as Schizophrenia, but some may be associated with an increased risk of Metabolic Syndrome. Moreover, evidence indicates that patients with major mental disorder have a reduced life expectancy in comparison to those without such diagnoses. These two factors illustrate the importance of the physical health of this patient cohort being monitored on a regular basis. This project will evaluate how a local CMHT is performing, with the possibility of enacting service improvements if required.MethodThe records of the 60 patients prescribed depot antipsychotic medication administered by this CMHT were reviewed. A check-list was created consisting of 14 categories analysing the quality of physical health monitoring, as well as compliance with prescription standards and, where relevant, Mental Health Act (Scotland) (Act) 2003 paperwork. We compared patient records against our checklist for the calendar year of 2019. The Scottish Intercollegiate Guidelines Network (SIGN) 131 (Management of Schizophrenia) section 5.2 was used as the gold standard for physical health monitoring against which the data we collected was compared.ResultWe identified a wide range of flaws with the current system and implementation of monitoring, and difficulty in locating the required information. There was no consistent monitoring of physical observations on electronic record, nor an accepted alternative way in which this was documented. Furthermore, blood tests were not consistently obtained either by the service or GP practices in a reproducible manner. This led to discussions within the CMHT regarding creation of a new pathway for the monitoring of this patient cohort using a Quality Improvement model, with the ultimate goal to establish a regular physical health clinic.ConclusionThere is significant evidence that patients with major mental disorder do not access healthcare as consistently as those without, leading to a disparity in life expectancy. In light of the fact that antipsychotic medications can be associated with Metabolic Syndrome, we have an even greater responsibility to tackle this marked health inequality by appropriately monitoring our patients. This was not done well in this particular CMHT, but this project will lead to improvements in the service and ultimately patient care.

Nonpharmacological Interventions for Anxiety and Dementia in Nursing Homes: A Systematic Review

Anxiety is a major mental disorder in later life that impacts on activities of daily living and quality of life for adults living with dementia in nursing homes. The aim of this article was to systematically review nonpharmacological interventions for older adults living in nursing homes who experience comorbid anxiety and dementia. Method A systematic literature search was conducted across key databases (Cinahl, ASSIA, Cochrane reviews and trials, psycARTICLES, psycINFO, and PubMed) to identify studies measuring anxiety as an outcome for an intervention for older adults living with dementia in nursing homes, up to December 31, 2017. Results The search yielded a total of 1,925 articles with 45 articles accessed for full article review. A total of 13 articles were included in this review following quality appraisal based on Cochrane methodology with six different anxiety measures used. The studies included were moderate to high-quality randomized control trials although heterogeneity precluded a combined meta-analysis. Clinical implications The most common interventions used to address anxiety in this population were music therapy and activity-based interventions although there was limited evidence for the efficacy of either intervention. Little is known about effective nonpharmacological treatment for anxiety for people living with dementia in nursing homes. Further research using consistent measurement tools and time points is required to identify effective interventions to improve the quality of life for people living with both dementia and anxiety in nursing homes.

Study of the Santal-Psychiatric Patients and their Belief Towards Mental Illness

This study aims at finding the presence of psychiatric illness of the santals, an ethnic minorities of the northern part of Bangladesh and their belief towards mental illness. Among the 77 patients, 39 (50.64%) were male and 38 (49.35%) were female. The majority of the respondents were in between the age of 16-35 years. Most (80%) believed that possession by Bonga/Kali caused the illness. In the present study, 45 (59.74%) had major mental disorder, 18 (23.37%) had minor mental disorders and 13 (16.88%) had psychotic disorder due to general medical condition (viz. Epilepsy). Observations suggest that change of awareness and perception regarding mental disorder, should be a high priority, as right mental health is one of the key component of total delivery of health care.TAJ 2011; 24(2): 76-81

Discrimination and Calibration Properties of the Level of Service Inventory–Ontario Revision in a Correctional Mental Health Sample

We examined the predictive properties of the Level of Service Inventory–Ontario Revision (LSI-OR) in a sample of 604 provincially incarcerated men with mental illness from a correctional mental health facility followed up nearly 2 years after release. Recidivism base rates and LSI-OR scores were relatively consistent across major mental disorder categories, but higher among individuals with personality disorder, substance use disorder, or dual diagnosis. LSI-OR scores predicted general and violent recidivism in the overall sample and among specific diagnostic groups. Calibration analyses were conducted to model 1-year recidivism estimates for the overall sample and among individual diagnostic groups associated with individual LSI-OR scores. Good correspondence was observed among the different diagnostic groups, with some difference in recidivism trajectories given the differences in base rate. The results support the predictive properties of the LSI-OR with correctional mental health samples and inform the recidivism estimates associated with LSI-OR scores in this population.

Comorbidity assessment

This final chapter in Part II captures the distinctions between autism and other mental disorders (and intellectual disability). Issues and challenges in comorbidity assessment are discussed including development and course of social interaction. Under recognition of autism by psychiatrists and the conditions they tend to diagnose in such cases (depression, BPD, anxiety) are considered. Possible harmful effects of misdiagnosis in clinical contexts and in advice (employers, benefits system, courts, etc.) are discussed. How to differentiate symptoms that might seem to be part of two conditions (e.g. OCD versus RRBs) is discussed as is the possible confusion between autism and other similar clinical presentations. Specific comorbidities covered include ADHD, Intellectual Disability, suicidality, anxiety, depression, and masking issues and any major mental disorder in adulthood. Issues of law are also covered.

Clinical correlates of first episode schizophrenia-a comparative study

Background: Schizophrenia is a major mental disorder which has to be assessed early and managed actively even though long term functional outcome remains relatively poor. The aim of the study is to analyze negative symptoms, suicidal risk and substance use in first episode schizophrenics in comparison with multi-episode schizophrenics.Methods: 30 patients with drug naive first episode schizophrenia and 30 patients with multi episode schizophrenia, who attended the outpatient department of Psychiatry, Government Stanley Medical College, Chennai, Tamilnadu, India were studied to compare predisposing factors and spectrum of symptoms for Schizophrenia for a period of one year (January 2010-December 2010). Psychiatric questionnaire by Michael C. Hilton, DAST by Harvey A. Skinner, AUDIT by WHO, Suicide risk scale by National Health and Medical Research Council, PANSS by SR Kay were used to assess patients.Results: Unemployment and family history of suicide attempts were observed more in drug naive first episode schizophrenics. 90% of these patients had completed their primary education while 47% of multi-episode schizophrenics were illiterates. Positive symptoms (delusions, hallucinatory behaviour and suspiciousness) and negative symptoms (blunted affect, emotional withdrawal and social withdrawal) were observed more in first episode schizophrenics while PANSS, DAST, AUDIT scores did not find any differences between both the groups.Conclusions: In our study, the first episode schizophrenia patients were more educated, more unemployed and had more family history of suicide, elevated sub score of positive symptoms as measured by PANSS. Relative assessment of violence and serious behavior problems that are related to positive symptoms must be done and managed with anti psychotics.

Predicting early transition from sub-syndromal presentations to major mental disorders

BackgroundTransition from at-risk state to full syndromal mental disorders is underexplored for unipolar and bipolar disorders compared with psychosis.AimsProspective, trans-diagnostic study of rates and predictors of early transition from sub-threshold to full syndromal mental disorder.MethodOne-year outcome of 243 consenting youth aged 15–25 years with a sub-syndromal presentation of a potentially severe mental disorder. Survival analysis and odds ratio (OR) for predictors of transition identified from baseline clinical and demographic ratings.ResultsAbout 17% (n=36) experienced transition to a major mental disorder. Independent of syndromal diagnosis, transition was significantly more likely in individuals who were NEET (not in education, employment or training), in females and in those with more negative psychological symptoms (e.g. social withdrawal).ConclusionsNEET status and negative symptoms are modifiable predictors of illness trajectory across diagnostic categories and are not specific to transition to psychosis.

Attitudes towards psychiatry among undergraduate medical students

Mental health is the most neglected and stigmatized branch of medical science in Bangladesh. Attitudes towards psychiatry are an important determination for selection of the subject as career by the undergraduate medical students. The objective of this study was to determine the attitudes of undergraduate medical students towards psychiatry and related factors. It was across sectional study conducted from May 2013 to September 2013 among 1st and 5th year medical students of Rajshahi Medical College, Rajshashi and Shaheed Shahrawardi Medical College, Dhaka. Results showed that only 2.6% of 5th year medical students wanted to be specialized in psychiatry and none of 1st year medical students wanted to be specialized in psychiatry. All of them (100% and 98.7%) agreed with the statement that psychiatric research has made good strides in advancing care of major mental disorder and majority students of both groups were (96% and 86.6% respectively) with the statement that psychiatry was a rapidly expanding frontier of medicine. Around two-third of the students (79.3% and 82.7% respectively) perceived psychiatric treatment as being helpful. Fifty nine (76.6%) of 5th year students and forty one (55.7%) of 1st year students did not agree that psychiatrists frequently abuse their legal power to hospitalize patients against their will. Positive opinions on attitudes of undergraduate medical students towards psychiatry became strengthen further following exposure to psychiatry lectures and clerkship in psychiatry ward.Bang J Psychiatry Dec 2014; 28(2): 45-49