Psychiatric Consequences of Brain Syndromes

This chapter outlines the nature of common and notable brain disorders that have psychiatric consequences for children and young people. All are often managed by paediatric disciplines in European, Australian, and North American countries. Psychiatrists, however, are often the lead discipline in countries where the medical aspects are considered as less important than the mental. In most countries, physical and mental specialists need to work together with enough understanding of each other’s role that there is no gap in the provision of service. Recognizing multiple morbidity is key. This chapter therefore covers the basics of medical diagnosis and treatment as well as what is known about psychological intervention. Epilepsy, cerebral palsy, hydrocephalus, acquired traumatic injury to the head, localized structural lesions, and endocrine disorders are all described in the chapter. In addition, functional neurological disorders are considered, in order to inform joint diagnostic and therapeutic approaches.

Communicating with the Older Adult Cancer Patient

The older adult population continues to increase. Among all known risk factors for developing cancer, the most important is growing old. Thus, caring for older adults with cancer is of increasing importance. This chapter describes important considerations involved in communicating with cancer patients including sensory impairment, cognitive impairment, multiple morbidity, polypharmacy, and psychological distress. It also describes how stereotyping and ageism affect communication with older adults with cancer. Finally, the chapter discusses ways to facilitate communication with older adult cancer patients and their families and provides an example of a training program that was created specifically to enhance communication between healthcare providers and older adult cancer patients and their families.

Pharmacological Interactions in the Elderly

Pharmacological therapy in the elderly is particularly complicated and challenging. Due to coexistence of three main predisposing factors (advanced age, multiple morbidity and polypharmacotherapy), this group of patients is prone to occurrence of drug interactions and adverse effects of incorrect drug combinations. Since many years patient safety during the treatment process has been one of key elements for proper functioning of healthcare systems around the world, thus different preventive measures have been undertaken in order to counteract factors adversely affecting the therapeutic effect. One of the avoidable medical errors is pharmacological interactions. According to estimates, one in six elderly patients may be at risk of a significant drug interaction. Hence the knowledge about mechanisms and causes of drug interactions in the elderly, as well as consequences of their occurrence are crucial for planning the process of pharmacotherapy. For the purpose of pharmacovigilance, a review of available methods and tools gives an insight into possible ways of preventing drug interactions. Additionally, recognizing the actual scale of this phenomenon in geriatric population around the world emphasizes the importance of a joint effort among medical community to improve quality of pharmacotherapy.

Are Children With a Number of Disabilities and Long-Term Illnesses at Increased Risk of Mental Violence, Disciplinary Violence, and Serious Violence?

The focus of this study was on the question of whether or not children with a number of disabilities and long-term illnesses are at increased risk of child maltreatment (mental violence, disciplinary violence, and serious violence). This study was based on the Child Victim Survey of 2013 (FSD2943). The data consist of a nationally representative sample of pupils in Finland in sixth grade (12–13 years of age) and ninth grade (15–16 years of age). The sampling was undertaken as a stratified cluster by province, municipality type, and school size. The total number of respondents was 11,364. According to the logistic regression analyses, the children with at least three disabilities or long-term illnesses had an increased risk of violence compared with children with no disability: The risk of mental violence increased by 2.96 times, the risk of disciplinary violence by 4.30 times, and the risk of serious violence by 3.53 times. The effect of the category of at least three disabilities and illnesses remained statistically significant, although the analysis also accounted for several confounding factors. Thus, a child’s multiple morbidity (in the case of three or more disabilities and illnesses) can be categorized as one of the major risk factors for child maltreatment. The study complements the results of previous studies concerning the effect of children’s disabilities and long-term illnesses and their impact on child maltreatment. The results underline the importance of employees of health and social care having knowledge of multiple morbidity and its importance as a key factor regarding child maltreatment.

A STUDY ON PRESCRIBING PATTERN IN GERIATRIC PATIENTS

Objective: The objective of this study was to study the prescribing pattern in geriatric patients. Methods: A prospective study was carried out for a period of 4 years with one of the objectives to study the prescribing pattern in geriatric patients (≥65 years). The information was collected, from patients admitted to various departments of tertiary care hospital and old-age home at Chitradurga. Sociodemographic, economic, and clinical diagnosis and medication details were collected from medical records in a pre-structured case record form. The medications were classified based on Anatomical Therapeutic Chemical classification system. Results: A total number of 526 geriatric patients were enrolled during the study period. Young older patients (75.29%) and male subjects (55.89%) were predominant. Multiple morbidity conditions were more in the present study. Among the diseases diagnosed, circulatory system (I00-I99) affecting was more 41.83%. Prescriptions found with a sum total of 3228 formulations with 357 active drugs. About 56.27% of patients received ≥6 medications (polymedication) and an average of 6.14 drugs per prescription. Usage of parenterals (53.06%) was more among dosage forms. Prescriptions with alimentary tract, metabolism (A) (26.96%), and general anti-infective (J) (19.08%) class of drugs were common. Among individual drugs, pantoprazole (A02BC02), paracetamol (N02BE01), and ceftriaxone (J01DD04) were found more frequent in prescriptions. Conclusion: The study concludes the need of intellect prescribing practice, to install more rational therapy among geriatric patients.

Cohort Profile: Extended Cohort for E-health, Environment and DNA (EXCEED)

EXCEED is a longitudinal population-based cohort which facilitates investigation of genetic, environmental and lifestyle-related determinants of a broad range of diseases and of multiple morbidity through data collected at baseline and via electronic healthcare record linkage. Recruitment has taken place in Leicester, Leicestershire and Rutland since 2013 and is ongoing, with 10 156 participants aged 30-69 to date. The population of Leicester is diverse and additional recruitment from the local South Asian community is ongoing. Participants have consented to follow-up for up to 25 years through electronic health records (EHR). Data available includes baseline demographics, anthropometry, spirometry, lifestyle factors (smoking and alcohol use) and longitudinal health information from primary care records, with additional linkage to other EHR datasets planned. Patients have consented to be contacted for recall-by-genotype and recall-by-phenotype sub-studies, providing an important resource for precision medicine research. We welcome requests for collaboration and data access by contacting the study management team via [email protected].

The Relationship Between Health and Homelessness in Scotland

BackgroundHomeless people are among the most vulnerable and socially excluded in society, exhibiting higher premature mortality and multiple morbidity. This study links health and homelessness data for the first time at a national level in Scotland. ObjectivesThis study adds to the evidence base on the relationship between homelessness and health needs, including how homeless people exhibit multiple or complex needs. MethodThis study matches those who have experienced homelessness in Scotland since 2002 (n=430,000) with two people of the same age and sex – at random, one control is chosen from the 20% least deprived areas in Scotland and another from the 20% most deprived. This gives 1.3 million people in total. Each cohort is linked to a wide range of health datasets. More detail on the methodology is presented in a separate talk (Challenges of Analysing Case-Control Datasets: A Health andHomelessness Case Study) at this conference. FindingsAt the 2018 ADRN Health and Wellbeing session, we wish to present on our findings that we are publishing shortly before the conference. Large and complex differences were found between the cohorts in health service use and outcomes, particularly for the homeless. Analysis is presented on the different health datasets used, including acute and mental-health admissions, A&E attendances, outpatient appointments, prescriptions and drugs misuse assessments. We also discuss findings for activity related to particular issues including drugs and alcohol. Furthermore, notable differences were also found between once only and repeat homeless individuals. ConclusionsThe range of linked health data used in this study has enabled invaluable evidence to be collected on the scale, severity and complexity of the health needs of homeless populations in Scotland.