Heard, known and safe in general practice? An interview study with patients with severe and persistent mental illness

BackgroundAlthough GPs provide care to many patients with severe and persistent mental illness, the role and skillset of the GP in this space are contested. Patients are less satisfied with GP care of mental health than physical health issues.AimTo explore patient expectations and experiences of GP roles in their mental health, and identify opportunities for improving mental health care in general practice.Design & settingPatient participants were recruited from community mental health clinics in Brisbane, Australia.MethodIndividual semi-structured interviews were conducted with a convenience sample of patients. Interviews were audio-recorded and transcribed professionally. The authors conducted an inductive thematic analysis, attending to participant vulnerability and reflexivity.Results16 interviews were conducted by one author (RW), average duration 29 minutes. Three overarching themes were identified: being heard; being known; and being safe. Participants greatly valued ‘good GPs’ who were able to detect early signs of relapse, and with whom they came to feel heard, known and safe over time. Experiences of perfunctory, hurried care and avoidance of mental health issues were also reported. Many participants were uncertain whether GP training in mental health was sufficient to keep them safe. Patients may suspect negative attitudes to mental illness in GPs who actively engage predominantly with their physical health.ConclusionSome GPs play central roles in patients’ mental healthcare. Barriers for others need further exploration, and may include time, confidence and/or expertise. Findings challenge GPs to engage more actively and effectively with these patients in theirgeneral practice consultations.

Strengthening the psychiatric advance directive system in New Zealand: Allowing the mentally ill to help themselves

<p>Psychiatric advance directives (PADs) are an emerging method for adults with serious and persistent mental illness to manage their treatment by documenting treatment preferences in advance of periods of incapacity. However, the application of PADs has largely been neglected by the legal and psychiatric discourse in New Zealand. This paper presents some of the key purposes and unrealised benefits of PADs, and explains why New Zealand’s law and policy surrounding advance directives in the mental health arena is unclear compared to other jurisdictions. Though interviews conducted with New Zealand clinicians and consumer advocates, key practical and legal dilemmas around forming, monitoring, and enforcing PADs were extracted and dissected. Interviews elucidated that, while attitudes were generally positive attitude towards PADs in the mental health system, the lack of a focused PAD strategy stifled its promulgation where it could most benefit service users. This paper proposes that PADs should be promoted, and articulates a normative PAD strategy for New Zealand.</p>

Strengthening the psychiatric advance directive system in New Zealand: Allowing the mentally ill to help themselves

<p>Psychiatric advance directives (PADs) are an emerging method for adults with serious and persistent mental illness to manage their treatment by documenting treatment preferences in advance of periods of incapacity. However, the application of PADs has largely been neglected by the legal and psychiatric discourse in New Zealand. This paper presents some of the key purposes and unrealised benefits of PADs, and explains why New Zealand’s law and policy surrounding advance directives in the mental health arena is unclear compared to other jurisdictions. Though interviews conducted with New Zealand clinicians and consumer advocates, key practical and legal dilemmas around forming, monitoring, and enforcing PADs were extracted and dissected. Interviews elucidated that, while attitudes were generally positive attitude towards PADs in the mental health system, the lack of a focused PAD strategy stifled its promulgation where it could most benefit service users. This paper proposes that PADs should be promoted, and articulates a normative PAD strategy for New Zealand.</p>

Case Report on Paranoid Schizophrenia with Capgras Syndrome

Paranoid is the most common delusion in people living with schizophrenia spectrum disorders which are present in about half of all people seeking treatment for a psychotic disorder. Schizophrenia is a persistent mental illness characterized by a wide range of symptoms, including delusions, hallucinations, disorganized speech or behavior, and cognitive impairment. Capgras syndrome is a form of the delusional belief in which a person has been replaced by an imposter. It can be seen in mental disorders as well as in central nervous system diseases in the form of neurodegenerative and non- neurodegenerative diseases The Capgras Syndrome is not an unusual condition, but an infrequent one which is possibly often unnoticed. A 48- years- old woman was admitted in female psychiatric ward with known case of paranoid schizophrenia with capgras syndrome. In the present case, the treatment approach was mainly somatic therapy i.e. psychopharmacotherapy, Electro convulsive Therapy (ECT) and psychological therapy. Psychiatric nurses have to play an important role to identify the symptoms and they should think critically, take action immediately to provide care to such type of patients.

Palliative Psychiatry for Patients with Severe and Persistent Mental Illness: A Survey on the Attitudes of Psychiatrists in India compared to Psychiatrists in Switzerland

Background Palliative psychiatry is a new approach for the care of patients with severe and persistent mental illness (SPMI). To assess the attitudes of psychiatrists in India towards palliative psychiatry for patients with SPMI and to compare these to the attitudes of psychiatrists in Switzerland. Methods In an online survey, data from 206 psychiatrists in India were collected and compared with data from a previous survey among 457 psychiatrists in Switzerland. Results Psychiatrists in India generally considered it very important to prevent suicide in SPMI patients (97.6%). At the same time, they considered it very important to reduce suffering (98.1%) and to ensure functionality in everyday life (95.6%). They agreed that palliative psychiatry is important for providing optimal care to SPMI patients without life-limiting illness (79.6%) and considered palliative psychiatry as indicated for patients with SPMI (78.2%). By contrast, curing the illness was considered very important by only 39.8 % of respondents. Relative to psychiatrists in Switzerland, psychiatrists in India were significantly more concerned about preventing suicide and less willing to accept a reduction in life expectancy, even at the expense of quality of life in patients with severe and persistent schizophrenia and recurrent major depressive disorder. At the same time, they were significantly more likely to advocate palliative psychiatry. Conclusion Most of the participating psychiatrists in India agreed that palliative psychiatry can be indicated for patients with SPMI. The comparison with psychiatrists in Switzerland highlights the need to take account of cultural differences in future studies of this kind.

Pharmacist-led interventions for people living with severe and persistent mental illness: A systematic review

Objective: People living with severe and persistent mental illness experience poorer physical health, often due to medication and preventable lifestyle factors, and exacerbated by barriers to accessing healthcare services. Pharmacists are well-positioned to improve the physical and mental health of this population. However, little is known about pharmacists’ current practices when providing services to this population nor the impact of pharmacist-led interventions on consumer health outcomes. We undertook a systematic review to identify, describe and assess the effectiveness of pharmacist-led interventions for supporting people living with severe and persistent mental illness and the impact on consumer outcomes. Methods: MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, Scopus, Cochrane Library, International Pharmaceutical Abstracts and ProQuest Dissertations and Theses were searched between January 1990 and April 2020. Full-text studies exploring pharmacist-led interventions in any setting for people living with severe and persistent mental illness were included. A risk of bias assessment was conducted. Results: A total of 37 studies were included. More than half of the pharmacist interventions were multifaceted. The most common components of pharmacist-led interventions included education and/or patient counselling, providing recommendations to healthcare professionals and conducting medication reviews. Multifaceted interventions demonstrated improvements in clinical outcomes, whereas single interventions focused mostly on consumer-reported outcomes. The methodological quality of included studies was moderate-to-high risk of bias and there was considerable heterogeneity in the study design, interventions described, and outcomes reported. Conclusion: There is evidence that pharmacist-led interventions improve consumer-reported and clinical outcomes for people living with severe and persistent mental illness. Pharmacists are capable and have a role in supporting people living with severe and persistent mental illness, either individually or as interprofessional collaborators with other healthcare professionals. Future research should attempt to better understand which particular intervention components have the greatest impact and also evaluate the implementation and long-term sustainability of such interventions.

Compulsory Interventions in Severe and Persistent Mental Illness: A Survey on Attitudes Among Psychiatrists in Switzerland

Background: Some psychiatric patients develop severe and persistent mental illness (SPMI), which, for a variety of reasons, can be therapy-refractory. Sometimes, treatment is not considered helpful by the patients themselves and does not improve their subjective quality of life. Furthermore, many SPMI patients experience compulsory interventions such as seclusion, restraint, or treatment against their will, which can cause harm.Methods: In a cross-sectional survey of 1,311 German-speaking psychiatrists in Switzerland, participants were asked about the care of SPMI patients in general, and about their attitudes with regard to compulsory interventions in particular, using three case vignettes of patients with severe and persistent anorexia nervosa, schizophrenia and depression.Results: Out of 1,311 contacted psychiatrists, 457 (34.9%) returned the completed survey. In general, 91.0% found it important or very important to respect SPMI patients' autonomy in decision making. However, based on three different clinical case vignettes, 36.8% of psychiatrists would act against the wishes of the patient with severe and persistent schizophrenia, 34.1% against the wishes of the patient with severe and persistent depression, and 21.1% against the wishes of the patient with severe and persistent anorexia nervosa, although all patients were stated to have preserved decision-making capacity. With regard to the case vignettes, 41.1% considered compulsory interventions leading to a temporary reduction of quality of life acceptable in the patient with severe and persistent schizophrenia, 39.4% in the patient with severe and persistent depression, and 25.6% in the patient with severe and persistent anorexia nervosa, although it was stated in all three case vignettes that two independent experts ascribed the patients decision-making capacity regarding their illness and further treatment.Conclusions: Many psychiatrists in our sample found themselves in an ethical dilemma between autonomy and the provision of medical care. While most respondents respect the autonomy of SPMI patients, many saw the need to perform compulsory interventions even though it was clearly and prominently stated that two independent psychiatrists had ascribed the patients in the case vignettes decision-making capacity. Further examination of these conflicting views is warranted, perhaps along with the development of guidelines for such situations.