scholarly journals Therapeutic institutions of violence: conceptualising the biographical narratives of mental health service users/survivors accessing long term “treatment” in England

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Stephen J. Macdonald
Keyword(s):  
Mental Health ◽  
Family Members ◽  
Psychiatric Hospitals ◽  
Term Treatment ◽  
Service Users ◽  
Content Type ◽  
Criminal Violence ◽  
Long Term Treatment ◽  
Forms Of Violence

Purpose This paper aims to conceptualise the residential and psychiatric hospital as a space where criminality and social harms can emerge. Because of recent media scandals over the past 10 years concerning privately-owned hospitals, this study examines the lived experiences of service users/survivors, family members and practitioners to examine historic and contemporary encounters of distress and violence in hospital settings. Design/methodology/approach The study consists of 16 biographical accounts exploring issues of dehumanising and harmful practices, such as practices of restraint and rituals of coercive violence. A biographical methodology has been used to analyse the life stories of service users/survivors (n = 9), family members (n = 3) and professional health-care employees (n = 4). Service users/survivors in this study have experienced over 40 years of short-term and long-term periods of hospitalisation. Findings The study discovered that institutional forms of violence had changed after the deinstitutionalisation of care. Practitioners recalled comprehensive experiences of violence within historic mental hospitals, although violence that may be considered criminal appeared to disappear from hospitals after the Mental Health Act (1983). These reports of criminal violence and coercive abuse appeared to be replaced with dehumanising and harmful procedures, such as practices of restraint. Originality/value The data findings offer a unique interpretation, both historical and contemporary, of dehumanising psychiatric rituals experienced by service users/survivors, which are relevant to criminology and MAD studies. The study concludes by challenging oppressive psychiatric “harms” to promote social justice for service users/survivors currently being “treated” within the contemporary psychiatric system. The study intends to conceptualise residential and psychiatric hospitals as a space where criminality and social harms can emerge. The three aims of the study examined risk factors concerning criminality and social harms, oppressive and harmful practices within hospitals and evidence that violence occurs within these institutionalised settings. The study discovered that institutional forms of violence had changed after the deinstitutionalisation of care. These reports of violence include dehumanising attitudes, practices of restraint and coercive abuse.

scholarly journals In VitroEffects of Novel Ruthenium Complexes in Neospora caninum and Toxoplasma gondii Tachyzoites

2013 ◽  
Vol 57 (11) ◽  
pp. 5747-5754 ◽  
Author(s):  
Fabienne Barna ◽  
Karim Debache ◽  
Carsten A. Vock ◽  
Tatiana Küster ◽  
Andrew Hemphill
Keyword(s):  
Electron Microscopy ◽  
Transmission Electron Microscopy ◽  
Toxoplasma Gondii ◽  
Neospora Caninum ◽  
Ruthenium Complexes ◽  
Term Treatment ◽  
Content Type ◽  
Transmission Electron ◽  
Long Term Treatment

ABSTRACTUpon the screening of 16 antiproliferative compounds againstToxoplasma gondiiandNeospora caninum, two hydrolytically stable ruthenium complexes (compounds 16 and 18) exhibited 50% inhibitory concentrations of 18.7 and 41.1 nM (T. gondii) and 6.7 and 11.3 nM (N. caninum). To achieve parasiticidal activity with compound 16, long-term treatment (22 to 27 days at 80 to 160 nM) was required. Transmission electron microscopy demonstrated the rapid impact on and ultrastructural alterations in both parasites. These preliminary findings suggest that the potential of ruthenium-based compounds should thus be further exploited.

Unnecessary Use of Tranquillizers in Elderly Patients

1966 ◽  
Vol 112 (491) ◽  
pp. 989-990 ◽  
Author(s):  
Russell Barton ◽  
Lindsay Hurst
Keyword(s):  
Elderly Patients ◽  
Social Adjustment ◽  
Elderly Women ◽  
Controlled Trial ◽  
Psychiatric Hospitals ◽  
Term Treatment ◽  
Double Blind ◽  
Level Of Functioning ◽  
Long Term Treatment

The evidence that potent tranquillizers are useful in the long-term treatment of elderly patients with dementia in psychiatric hospitals is conflicting.Seager (1955), in a double-blind, controlled trial involving 48 elderly women, 29 of whom suffered from dementia, found a highly significant improvement of social adjustment associated with chlorpromazine therapy. Schulsinger (1961), Exton-Smith (1962) and Post (1963) claimed promazine to be of particular value for agitated elderly patients. Robinson (1959), on the other hand, compared the effects of prolonged administration of chlorpromazine, reserpine, leptazol and a placebo upon 84 senile female patients in a double-blind trial and found no statistically significant improvement associated with the active drugs. Indeed, in the case of chiorpromazine, he found a significant lowering of the level of functioning. Abse and Dahistrom (1960), in a double-blind controlled trial involving 8o patients over 60 years of age with various symptoms (including some with confusion), found that chlorpromazine did not give better results than placebo.

scholarly journals Carers and co-production: enabling expertise through experience?

2015 ◽  
Vol 20 (4) ◽  
pp. 232-241 ◽  
Author(s):  
Eleanor Bradley
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Mental Health Services ◽  
Health Services ◽  
Mental Health Professionals ◽  
Family Members ◽  
Mental Healthcare ◽  
Service Users ◽  
Content Type ◽  
The Impact

Purpose – The purpose of this paper is to provide a brief overview of the literature to date which has focused on co-production within mental healthcare in the UK, including service user and carer involvement and collaboration. Design/methodology/approach – The paper presents key outcomes from studies which have explicitly attempted to introduce co-produced care in addition to specific tools designed to encourage co-production within mental health services. The paper debates the cultural and ideological shift required for staff, service users and family members to undertake co-produced care and outlines challenges ahead with respect to service redesign and new roles in practice. Findings – Informal carers (family and friends) are recognised as a fundamental resource for mental health service provision, as well as a rich source of expertise through experience, yet their views are rarely solicited by mental health professionals or taken into account during decision making. This issue is considered alongside new policy recommendations which advocate the development of co-produced services and care. Research limitations/implications – Despite the launch of a number of initiatives designed to build on peer experience and support, there has been a lack of attention on the differing dynamic which remains evident between healthcare professionals and people using mental health services. Co-production sheds a light on the blurring of roles, trust and shared endeavour (Slay and Stephens, 2013) but, despite an increase in peer recovery workers across England, there has been little research or service development designed to focus explicitly on this particular dynamic. Practical implications – Despite these challenges, coproduction in mental healthcare represents a real opportunity for the skills and experience of family members to be taken into account and could provide a mechanism to achieve the “triangle of care” with input, recognition and respect given to all (service users, carers, professionals) whose lives are touched by mental distress. However, lack of attention in relation to carer perspectives, expertise and potential involvement could undermine the potential for coproduction to act as a vehicle to encourage person-centred care which accounts for social in addition to clinical factors. Social implications – The families of people with severe and enduring mental illness assume a major responsibility for the provision of care and support to their relatives over extended time periods (Rose et al., 2004). Involving carers in discussions about care planning could help to provide a wider picture about the impact of mental health difficulties, beyond symptom reduction. The “co-production of care” reflects a desire to work meaningfully and fully with service users and carers. However, to date, little work has been undertaken in order to coproduce services through the “triangle of care” with carers bringing their own skills, resources and expertise. Originality/value – This paper debates the current involvement of carers across mental healthcare and debates whether co-production could be a vehicle to utilise carer expertise, enhance quality and satisfaction with mental healthcare. The critique of current work highlights the danger of increasing expectations on service providers to undertake work aligned to key initiatives (shared decision-making, person-centred care, co-production), that have common underpinning principles but, in the absence of practical guidance, could be addressed in isolation rather than as an integrated approach within a “triangle of care”.

Shared housing and long-term mental illness

2014 ◽  
Vol 17 (1) ◽  
pp. 41-47
Author(s):  
David Abrahamson
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
Independent Living ◽  
Service Users ◽  
Personal View ◽  
Content Type ◽  
Shared Housing ◽  
Hospital Wards

Purpose – The purpose of this paper is to give an account by a rehabilitation psychiatrist of many years of involvement in shared housing for former long-stay hospital residents and other long-term mental health service users. Design/methodology/approach – The paper offers a personal view based on developments in one locality of East London, blending case study narrative with cited earlier published papers that confirm and/or give greater detail on specific aspects of the experience gained. Findings – Long-term mental health service users, given the opportunity via shared housing to develop more lasting and natural relationships, proved to have social and interactive capacity that was obscured by both the conditions of hospital wards and by isolating accommodation “in the community”. The experience provides lessons for a better understanding of patients’ problems. Practical implications – Shared housing is often seen as simply a poor substitute for independent living; but the experience recounted here suggests that shared living may have particular value for some client groups. Originality/value – The housing developments and the associated research remain unusual and of potential value for planners of long-term services.

Low-Dose Lithium for Long-Term Treatment of Clozapine- Induced Neutropenia: A Case Series

2019 ◽  
Vol 8 (2) ◽  
pp. 155-158 ◽  
Author(s):  
Muhammad R. Baig
Keyword(s):  
Mental Health ◽  
Effective Treatment ◽  
Low Dose ◽  
Lithium Treatment ◽  
Case Series ◽  
Cost Effective ◽  
Term Treatment ◽  
Treatment Resistant ◽  
Long Term Treatment

Background: Treatment-resistant psychosis makes schizophrenia a disabling and costly illness. Clozapine is an effective treatment for treatment-resistant psychosis, though it is underutilized mainly due to prescribing providers’ fear of a serious yet uncommon complication, clozapine-induced neutropenia. Clozapine-induced neutropenia predisposes patients to potentially life-threatening infections leading prescribers to stop use when blood counts start to drop even well above the recommended cut-off point. Colonystimulating factors are effective options for reducing risk and duration of neutropeniarelated events though they add a significant cost burden to the patient and healthcare system. There is a great need for feasible and cost-effective pharmacotherapies in the mental health care setting for the management of clozapine-induced neutropenia. Objective: We evaluated adjunctive use of lithium when prescribed at a low-dose to stabilize dropping blood count in patients receiving clozapine for treatment-resistant psychosis. Methods & Results: A case series analysis of three patients who were followed in a mental health outpatient clinic for the management of schizophrenia. Blood counts of all the patients were stabilized by low-dose lithium treatment and continued to receive long term treatment of clozapine. Conclusion: Results suggest low-dose lithium as a feasible and cost-effective pharmacotherapeutic option enabling the continuation of clozapine, an effective treatment for treatment-resistant psychosis.

Effect of low glycaemic index diets on satiety

2014 ◽  
Vol 116 (8) ◽  
pp. 1233-1246
Author(s):  
Sonia Maria de Medeiros Batista ◽  
Emilia Addison Machado Moreira ◽  
Giovanna Medeiros Rataichesck Fiates ◽  
Maria Alice Altemburg de Assis ◽  
Evanilda Teixeira
Keyword(s):  
Weight Loss ◽  
Blood Glucose ◽  
Blood Glucose Control ◽  
Glycaemic Index ◽  
Term Treatment ◽  
Hypocaloric Diet ◽  
Postprandial Blood Glucose ◽  
Content Type ◽  
Long Term Treatment

Purpose – The purpose of the paper is to determine the effects of a hypocaloric diet with a low-glycaemic index (GI) on weight loss and postprandial blood glucose and assess both the satiety and palatability of the diet. Design/methodology/approach – A clinical trial was conducted with ten women (mean age: 38.8±11.3 years; body mass index: 27.2±3.5 kg/m2) submitted to a hypocaloric diet, assessments were performed at baseline and after seven days of treatment. Findings – Significant reductions were found in body weight (1.1±0.7 kg; p=0.001), triccipital skinfold (2.87±3.24 mm; p=0.021) and waist circumference (3.6±4.8 cm; p=0.041). Mean fasting and postprandial blood glucose values were 88.7±6.1 mg/dL and 91.6±9.6 mg/dL, respectively. Responses regarding satiety and palatability of the low-GI diet were predominantly “extremely satisfied” and “I liked it very much,” respectively, for all meals and throughout all seven days of the study. Originality/value – The present study demonstrated the benefits of a low-GI diet with regard to weight loss, blood glucose control and satiety. The diet proved to be palatable, which could favor compliance with long-term treatment.

Patient and public involvement in integrated psychosocial care

2019 ◽  
Vol 28 (2) ◽  
pp. 135-143
Author(s):  
Io Vassiliadou ◽  
Esther Tolani ◽  
Lindsay Ip ◽  
Abigail Smith ◽  
Iliatha Papachristou Nadal
Keyword(s):  
Mental Health ◽  
Public Involvement ◽  
Healthcare Professionals ◽  
Psychosocial Care ◽  
Patient And Public Involvement ◽  
Service Users ◽  
Long Term Conditions ◽  
Improvement Project ◽  
Content Type

Purpose Recent models of care incorporate service user involvement within the development and sustainability of a quality improvement project. The purpose of this paper is to demonstrate the significance of working with patients and members of the public for the integration of psychosocial care into long-term condition (LTC) management. Design/methodology/approach Research shows that mental health difficulties are more prevalent in people with LTC. The three Dimensions for Long-term Conditions (3DLC) is a patient-centred multidisciplinary service which integrates psychological and social care into the usual physical care. Thematic analysis was conducted on the discussions of the two patient and public involvement workshops that were facilitated by the service. The workshops included healthcare professionals, patients with LTC and their carers. Findings Several themes and subthemes emerged which highlighted the importance of discussing and treating mental health in a physical health setting, the challenges that both the patients and healthcare professionals encounter and the ways in which an integrated care service may address these barriers. The findings show that there was an emphasis on patient-centeredness, accessibility of services and the need for better communication. Practical implications People with LTC can be empowered to better self-manage their condition, whilst having access to all types of care, physical, social and psychological. By involving service users in the implementation process of the 3DLC service, the components of an effective integrated service are delineated. Originality/value The service users have identified barriers and facilitators of integrating a biopsychosocial model in care pathways. This has helped the 3DLC team to further develop the model to ensure improvements in condition-specific outcomes, quality of life and healthcare utilisation.

Long-term intrathecal baclofen therapy for severe spasticity of cerebral origin

2003 ◽  
Vol 98 (2) ◽  
pp. 291-295 ◽  
Author(s):  
A. Leland Albright ◽  
Richard Gilmartin ◽  
Dale Swift ◽  
Linda E. Krach ◽  
Cindy B. Ivanhoe ◽  
...  
Keyword(s):  
Adverse Events ◽  
Lower Extremities ◽  
Intrathecal Baclofen ◽  
Term Treatment ◽  
Content Type ◽  
Severe Spasticity ◽  
Long Term Treatment ◽  
Upper And Lower Extremities ◽  
Fine Print

Object. The goal of this study was to ascertain the long-term effectiveness and safety of intrathecal baclofen (ITB) in the treatment of spasticity of cerebral origin in children and young adults. Methods. A prospective, multicenter study was conducted in 68 patients who had been enrolled in the initial evaluation of ITB therapy and were willing to participate in long-term surveillance. Seventy-three percent of the patients were younger than 16 years of age at the time of study entry. The patients were examined at least every 3 months and were observed for an average of 70 months. At each follow-up visit, spasticity in the upper and lower extremities was evaluated by applying Ashworth scores. All adverse events and complications were recorded on standardized data forms. Spasticity in both upper and lower extremities decreased significantly (p < 0.005) and remained decreased up to 10 years. The dosage of ITB increased from a mean of 157 (µg/day 3 months after pump insertion to 300 (µg/day at 2 years postimplantation, and remained relatively stable thereafter. There were no significant differences in ITB dosage in children of different ages. Adverse events potentially related to ITB therapy occurred in 50% of patients within 2 months after pump insertion and in 50% of patients thereafter; hypotonia and lethargy were the two most common adverse events. The most common complications of surgery were catheter-related problems (31%), seromas (24%), and cerebrospinal fluid leaks (15%). Conclusions. Intrathecal baclofen provides effective long-term treatment of spasticity of cerebral origin and its effects do not appear to diminish with time. This therapy is frequently associated with adverse side effects that usually can be alleviated by adjustments in dosage.

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