scholarly journals A description of antipsychotic prescribing patterns based on race in the inpatient behavioral health setting

2021 ◽  
Vol 11 ◽  
pp. 204512532110232
Author(s):  
Thomas Maestri ◽  
David Anderson ◽  
Jose Calderon-Abbo ◽  
Taylor Waguespack ◽  
Margarita Echeverri
Keyword(s):  
Mental Health ◽  
Family Support ◽  
Prescribing Patterns ◽  
Screening Tests ◽  
Diagnostic Process ◽  
Inpatient Setting ◽  
Antipsychotic Medications ◽  
Lipid Panel ◽  
Admission Status ◽  
Antipsychotic Prescribing

Background and aims: A growing body of research shows that race contributes to disparities in mental health services utilization and influences the clinical diagnostic process. To our knowledge, no studies on current practice in the Unites States have documented whether these disparities impact the prescription of antipsychotic medications across individual patients based on race. Consequently, this study aims to describe the prescribing patterns of antipsychotic medications in the inpatient setting based on patients’ race, and to explore appropriateness of therapy based on Food and Drug Administration labeling and avoidance of inappropriate polypharmacy. Methods: Single-centered, retrospective, chart review of 398 psychiatric patients in the inpatient setting and who had a psychiatric diagnosis that warranted a prescription for an antipsychotic medication at the time of discharge. Frequencies were computed to describe differences in demographic variables (race, health insurance type, age, and gender), medical conditions (diagnosis, commodities, hospitalization status, antipsychotic medications, etc.), and screening tests (lipid panel, hemoglobin, urine and illicit drug use). Logistic regression, analysis of variance, and hypothesis tests were used to analyze the data. Results: Significant differences were not found in total chlorpromazine equivalent dose equivalencies by race or insurance. However, patients of involuntary admission status, past medication trials, a diagnosis of schizophrenia or bipolar disorder, and who lacked family support had higher total daily doses of antipsychotics upon discharge. Inappropriate therapy was significantly related to differences in increasing age and a diagnosis of insomnia. Conclusion: This single-centered study described patterns of antipsychotic prescribing based on race in an inpatient psychiatry facility. Future studies, using larger and more diverse sample populations, are recommended to elucidate the role that patients’ race, admission status, and family support play in the dose and appropriateness of antipsychotics prescribed for mental health care.

Audit of Antipsychotic Prescribing in a Private Psychiatric Hospital

2004 ◽  
Vol 12 (3) ◽  
pp. 227-233
Author(s):  
Lev Botvinik ◽  
Chee Ng ◽  
Isaac Schweitzer
Keyword(s):  
Psychiatric Hospital ◽  
Psychotic Disorders ◽  
Psychiatric Inpatient ◽  
Prescribing Patterns ◽  
Psychotic Symptoms ◽  
Inpatient Setting ◽  
Antipsychotic Medications ◽  
Published Evidence ◽  
Utility Cost ◽  
And Control

Objectives: There exists a substantial and growing body of evidence suggesting that antipsychotic medications are efficacious in the treatment of many non-psychotic psychiatric disorders. Although indications for the use of antipsychotics (particularly the atypicals) remain relatively narrow in Australia, psychiatrists seem to be using them for an expanding range of disorders in a variety of clinical settings. This has raised issues of costeffectiveness and methods of funding of these medications. The present study aimed to quantify and describe the patterns of prescribing of antipsychotic medications in a large private psychiatric hospital. Another aim was to compare the findings with other published evidence, and consider the implications of antipsychotic use for current clinical practice in Australia. Methods: A retrospective review of the medical records of 100 consecutive patients admitted to a private psychiatric hospital was conducted. The data collected included demographic details, major psychiatric diagnoses, all medications prescribed during the admission and their doses and, in the case of antipsychotics, the target symptoms/conditions for which they were prescribed. Results: Fifty-nine per cent of inpatients received at least one dose of an antipsychotic during their admission. While all patients with psychotic illnesses were treated with antipsychotics, 57% of patients with primary mood disorders and 40% of patients with a primary anxiety disorder also received an antipsychotic. The most common indications for use of antipsychotics included the treatment of psychotic symptoms, augmentation of antidepressants, relief of anxiety symptoms and lessening of agitation, and control of difficult behaviours (including self-harm and aggression) associated with personality disorders. The most frequently used antipsychotic was olanzapine (22%), followed by chlorpromazine (20%), and quetiapine (14%). Eleven per cent of patients received a combination of two antipsychotics. Conclusions: Antipsychotic medications were widely used in a private psychiatric inpatient setting for the treatment of non-psychotic disorders. This finding parallels those from other Australian studies of psychotropic prescribing patterns. The issues of clinical utility, cost-effectiveness and benefits of funding of these medications for such wider indications require further study and evaluation.

African American Women and Depression: Promoting the Need for Culturally Competent Treatment

2018 ◽  
Author(s):  
Bernice Kennedy ◽  
Chalice Jenkins ◽  
Keyword(s):  
Mental Health ◽  
African American ◽  
Depressive Symptoms ◽  
African American Women ◽  
Mental Health Problems ◽  
American Woman ◽  
Stressful Events ◽  
Mental Illnesses ◽  
Diagnostic Process ◽  
American Women

Abstract Depression is gradually increasing in African American women. These women are experiencing role changes and additional life stressors. Depressed African American women may perceive themselves as being devalued by society with fewer support systems to buffer stressful events. Depressive symptoms may develop into clinical depression and a further decrease in the quality of life for the African American woman. The assumption that all women share similar experiences does not allow for differences to emerge regarding the diagnostic process, measuring tools, and successful treatment strategies for various cultures. The authors developed a Multifaceted Model of Depression in African American Women for improving treatment of African American women with depression and future research needs. Cultural background plays a vital role in how the symptoms of mental illnesses are developed, reported, interpreted, and how women are treated. African Americans who subscribed to the Strong Black Women Archetype (SBWA) are naturally strong, resilient, self-contained, and self-sacrificing. This self-reliance prevents them from reaching out for social support. This, in turn, can contribute to depressive symptoms with negative health outcomes. The African American women are more apt to have less access to routine medical care where early diagnosis and interventions can be done, so their mental health problems (e.g., depression, stress, etc.) are often more developed, complicated, and their social supports more depleted when they do access treatment. When African American women do have access to mental health care, they receive poor quality care compared to Whites.

scholarly journals Caregiving Stress Among American Indians With Type 2 Diabetes: The Importance of Awareness of Connectedness and Family Support

2018 ◽  
Vol 24 (4) ◽  
pp. 621-639 ◽  
Author(s):  
Ashleigh Coser ◽  
Kelley J. Sittner ◽  
Melissa L. Walls ◽  
Tina Handeland
Keyword(s):  
Mental Health ◽  
Type 2 Diabetes ◽  
Physical Health ◽  
Family Support ◽  
American Indians ◽  
Diabetes Management ◽  
Cumulative Exposure ◽  
Physical And Mental Health ◽  
Community Connectedness

American Indian (AI) communities experience a disproportionate rate of Type 2 diabetes (T2D) and cumulative exposure to stress. Although this link is well researched among various populations, it has not been examined among AI communities. Path analysis was used to examine a multiple-mediator model to explain how caregiver stress influences self-reported mental and physical health among 100 AI participants with T2D. Caregiver stress was negatively associated with physical and mental health. Physical health was positively associated with family/community connectedness and mental health was positively associated with both family support and connectedness. The relationship between caregiver stress and mental health was partially mediated by family/community connectedness; caregiver stress had no indirect effects on physical health via either hypothesized mediator. Findings demonstrate the importance of integrating individuals’ connection to family and community and its influence on caregiver stress and mental health in intervention programs targeting diabetes management and care among AI communities.

scholarly journals DYSPHAGIA IN NEUROLOGICAL DISORDERS

2020 ◽  
Vol 73 (9) ◽  
pp. 1848-1852
Author(s):  
Amelia Śledzik ◽  
Paweł Szlendak
Keyword(s):  
Neurological Diseases ◽  
Swallowing Disorders ◽  
Screening Tests ◽  
Neurological Deficits ◽  
Diagnostic Process ◽  
Neurogenic Dysphagia ◽  
Standard Procedures ◽  
Volume Viscosity ◽  
Speech Pathologist ◽  
Clinical Conditions

Introduction: Neurogenic dysphagia is a frequent disorder affecting people with neurological diseases. Many experts work together to diagnose and treat dysphagia. The aim: The article focuses on the specificity of neurogenic dysphagia, its symptoms and treatment possibilities. The speech pathologist can be included in the diagnostic process and can evaluate the intake of liquids and foods based on a variety of consistency tests. In clinical conditions, screening tests such as water swallowing test, multiple consistency tests: GUSS (Gugging Swallowing Screen), V-VST (Volume-Viscosity Swallow Test) and EAT-10 questionnaire can be used successfully. If you have limited ability to perform instrumental tests, they can help you to expand your diagnosis. Review and Discussion:Treatment of swallowing disorders is based on a daily modification of the patient’s posture and consistency of the eaten meals. Nursing staff are involved in this adaptation activity, which plays an invaluable role in the diagnosis and treatment of patients in neurological and rehabilitation departments. Conclusions: Despite the knowledge of the problem, difficulty swallowing is still unnoticed. The effects of this neglect are felt both for patients and from the perspective of management within treatment units For people suffering from neurological diseases, swallowing disorders should be diagnosed on a compulsory basis and their assessment should be a permanent part of the standard procedures for assessing patients with neurological deficits.

scholarly journals The use of benzodiazepines and Z-drugs in the Acute Psychiatric Unit at Cavan General Hospital

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S309-S310
Author(s):  
Salah Ateem ◽  
Rachael Cullivan
Keyword(s):  
Mental Health ◽  
General Hospital ◽  
Hospital Setting ◽  
Severity Of Illness ◽  
Prescribing Practices ◽  
Duration Of Treatment ◽  
Dose Frequency ◽  
Admission Status ◽  
Term Administration ◽  
Acute Psychiatric Wards

AimsBenzodiazepines and Z-drugs are used frequently in acute psychiatric wards, however long-term administration can result in undesirable consequences. Guidelines recommend prescription of the lowest effective dose for the shortest period and if possible to prescribe “as required” rather than regularly. The 25-beded inpatient unit at Cavan General Hospital admits adult patients requiring acute care from the counties of Cavan and Monaghan. Admissions are accepted from four community mental health teams, two psychiatry of old age teams and the rehabilitation and mental health of intellectual disability teams. In order to evaluate the potential to improve our practice of prescribing benzodiazepine and Z-drugs, it was decided to evaluate current use.MethodThe NICE guidelines were consulted, and we retrospectively reviewed the use of these agents from mid-January to the end of May 2020. Demographic variables included age, gender, and county. Patients were stratified into three groups, the benzodiazepine group, the Z-drugs group, and the combined benzodiazepine and Z-drugs group. In each group therapeutic variables were recorded including the medication type, dose, frequency, prescriber, and duration of treatment. Other variables included psychiatric diagnoses, length of inpatient admission, status on admission, and recommendations on dischargeResultThere were 101admissions during that period, and 74 of them were prescribed these agents (n = 74; 73.3%). Fifty one (n = 51; 68.9%) received benzodiazepines only, twenty-three (n = 23; 31.1%) were prescribed Z-drugs, and twelve (n = 12; 16.2%) received both benzodiazepines and Z-drugs. Forty two patients (n = 42; 56.8%) were commenced on hypnotics in the APU, 23 patients (n = 23; 31.1%) already received hypnotics from the CMHTs, and the rest were prescribed by both. Thirty two patients (n = 32; 43.2%) were discharged on hypnotics. Patients admitted involuntarily and female patients had longer admissions (mean of 16.62 ± 3.26 days and 16.16 ± 2.89 days respectively). Schizophrenia and BPAD were the commonest diagnoses.ConclusionIt appears that large amounts of these agents are used in the Acute Hospital Setting which is not overly surprising given the severity of illness and clinical indications however improved awareness could still lead to more appropriate and hopefully reduced use. We therefore recommend:A formal audit including appropriate interventions i.e., educate staff and patients, highlight guidelines, and review subsequent practice.Train staff in safer prescribing practices including prn rather than regular use if appropriate.Regularly review discharge prescriptions indicating recommended duration of use.

Dual Guidance Structure for Evaluation of Patients with Unclear Diagnosis in Centers for Rare Diseases (ZSE-DUO): Study Protocol for a Controlled Multi-center Cohort Study

2021 ◽  
Author(s):  
Helge Hebestreit ◽  
Cornalia Zeigler ◽  
Christopher Schippers ◽  
Martina de Zwaan ◽  
Jürgen Deckert ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Disorders ◽  
Rare Disease ◽  
Rare Diseases ◽  
Health Care Professionals ◽  
Standard Care ◽  
Controlled Study ◽  
Diagnostic Process ◽  
Two Phase ◽  
Time To Diagnosis

Abstract Background In individuals suffering from a rare disease the diagnostic process and the confirmation of a final diagnosis often extends over many years. Factors contributing to delayed diagnosis include health care professionals' limited knowledge of rare diseases and frequent (co-)occurrence of mental disorders that may complicate and delay the diagnostic process. The ZSE-DUO study aims to assess the benefits of a combination of a physician focusing on somatic aspects with a mental health expert working side by side as a tandem in the diagnostic process.Study design This multi-center, prospective controlled study has a two-phase cohort design. Methods Two cohorts of 682 patients each are sequentially recruited from 11 university-based German Centers for Rare Diseases (CRD): the standard care cohort (control, somatic expertise only) and the innovative care cohort (experimental, combined somatic and mental health expertise). Individuals aged 12 years and older presenting with symptoms and signs which are not explained by current diagnoses will be included. Data will be collected prior to (T0) and at the first visit (T1) to the CRD’s outpatient clinic and 12 months thereafter (T2). Outcomes Primary outcome is the percentage of patients with one or more confirmed diagnoses covering the symptomatic spectrum presented. Sample size is calculated to detect a 10 percent increase from 30% in standard care to 40% in the innovative dual expert cohort. Secondary outcomes are a) time to diagnosis/diagnoses explaining the symptomatology; b) proportion of patients successfully referred from CRD to standard care; c) costs of diagnosis including incremental cost effectiveness ratios; d) predictive value of screening instruments administered at T0 to identify patients with mental disorders ; e) patients’ quality of life and evaluation of care; and f) physicians’ satisfaction with the innovative care approach. Conclusions This is the first multi-center study to investigate the effects of a mental health specialist working in tandem with a somatic expert physician in CRDs. If this innovative approach proves successful, it will be made available on a larger scale nationally and promoted internationally. In the best case, ZSE-DUO can significantly shorten the time to diagnosis for a suspected rare disease.

scholarly journals Teaching physicians the GPGP method promotes deprescribing in both inpatient and outpatient settings

2019 ◽  
Vol 10 ◽  
pp. 204209861989591
Author(s):  
Aaron Jason Bilek ◽  
Yuval Levy ◽  
Haneen Kab ◽  
Pavel Andreev ◽  
Doron Garfinkel
Keyword(s):  
Family Practice ◽  
Inappropriate Medication ◽  
Intervention Group ◽  
Prescribing Patterns ◽  
Control Group ◽  
Inpatient Setting ◽  
Geriatric Population ◽  
Drug Classes ◽  
Inpatient Settings ◽  
Important Means

Background In complex older patients, inappropriate medication use and polypharmacy (IMUP) are commonplace and increasing exponentially. Reducing IMUP is a challenge in multiple clinical contexts, including acute admission and family practice, due to several key barriers. In the global effort against this epidemic, educational programs geared toward changing physicians’ prescribing patterns represent an important means of promoting deprescribing. Methods This is a nonrandomized, controlled interventional study investigating polypharmacy outcomes and prescribing patterns in patients whose physicians were trained in the Good Palliative-Geriatric Practice (GPGP) method, an algorithm for the reduction of polypharmacy, with patients whose physicians were not. Training involved a one-time, full-day workshop led by a senior geriatrician. Two separate settings were examined. In the inpatient setting, one internal medicine ward was trained and compared with another ward which was not trained. In the family practice setting, 28 physicians were trained and compared with practices of 15 physicians not trained. Patients were above the age of 70, representative of the general geriatric population, and not terminally ill. Results In the inpatient arm, the intervention group ( n = 100) experienced a decrease in medications prescribed from admission to discharge of 18.5%, compared with a decrease of 1.9% in the control group ( n = 100, difference between groups p < 0.0001). In the outpatient arm, the intervention group ( n = 100) experienced a decrease in medication number of 6.1% compared with 0.07% in the control group ( n = 100, difference between groups p = 0.001) over a 6-month period. Preferential decreases in specific drug classes were observed in both groups, including benzodiazepines, psychotropics, and antihypertensives. Conclusions A one-time educational intervention based on GPGP can change prescribing patterns in both outpatient and inpatient settings leading to a moderate reduction in polypharmacy. Future work should focus on longitudinal interventions, and longer-term clinical outcomes such as morbidity, mortality, and quality of life.

scholarly journals Family support as a protective factor for attitudes toward social distancing and in preserving positive mental health during the COVID-19 pandemic

2020 ◽  
pp. 135910532097169
Author(s):  
Shifeng Li ◽  
Qingying Xu
Keyword(s):  
Mental Health ◽  
Family Support ◽  
Protective Factor ◽  
Strong Support ◽  
Demographic Variables ◽  
Positive Mental Health ◽  
Perceived Support ◽  
Chinese People ◽  
Social Distancing

We examined the role of family support in influencing attitudes about social distancing and positive mental health during the COVID-19 pandemic among 1547 Chinese people. The results showed that after the effects of demographic variables were controlled, perceived support from family members made unique contributions to their attitudes about social distancing and positive mental health both directly and indirectly (via buffering loneliness). These results suggest that strong support from family plays an important role in improving individuals’ attitudes about social distancing and maintaining positive mental health during the epidemic.

scholarly journals Factors associated with use of psychiatric intensive care and seclusion in adult inpatient mental health services

2016 ◽  
Vol 27 (1) ◽  
pp. 51-61 ◽  
Author(s):  
A. E. Cullen ◽  
L. Bowers ◽  
M. Khondoker ◽  
S. Pettit ◽  
E. Achilla ◽  
...  
Keyword(s):  
Mental Health ◽  
Intensive Care ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Psychiatric Inpatient ◽  
Specific Patient ◽  
Female Sex ◽  
Admission Status ◽  
Adult Inpatient ◽  
Psychiatric Inpatient Services

Aims.Within acute psychiatric inpatient services, patients exhibiting severely disturbed behaviour can be transferred to a psychiatric intensive care unit (PICU) and/or secluded in order to manage the risks posed to the patient and others. However, whether specific patient groups are more likely to be subjected to these coercive measures is unclear. Using robust methodological and statistical techniques, we aimed to determine the demographic, clinical and behavioural predictors of both PICU and seclusion.Methods.Data were extracted from an anonymised database comprising the electronic medical records of patients within a large South London mental health trust. Two cohorts were derived, (1) a PICU cohort comprising all patients transferred from general adult acute wards to a non-forensic PICU ward between April 2008 and April 2013 (N = 986) and a randomly selected group of patients admitted to general adult wards within this period who were not transferred to PICU (N = 994), and (2) a seclusion cohort comprising all seclusion episodes occurring in non-forensic PICU wards within the study period (N = 990) and a randomly selected group of patients treated in these wards who were not secluded (N = 1032). Demographic and clinical factors (age, sex, ethnicity, diagnosis, admission status and time since admission) and behavioural precursors (potentially relevant behaviours occurring in the 3 days preceding PICU transfer/seclusion or random sample date) were extracted from electronic medical records. Mixed effects, multivariable logistic regression analyses were performed with all variables included as predictors.Results.PICU cases were significantly more likely to be younger in age, have a diagnosis of bipolar disorder and to be held on a formal section compared with patients who were not transferred to PICU; female sex and longer time since admission were associated with lower odds of transfer. With regard to behavioural precursors, the strongest predictors of PICU transfer were incidents of physical aggression towards others or objects and absconding or attempts to abscond. Secluded patients were also more likely to be younger and legally detained relative to non-secluded patients; however, female sex increased the odds of seclusion. Likelihood of seclusion also decreased with time since admission. Seclusion was significantly associated with a range of behavioural precursors with the strongest associations observed for incidents involving restraint or shouting.Conclusions.Whilst recent behaviour is an important determinant, patient age, sex, admission status and time since admission also contribute to risk of PICU transfer and seclusion. Alternative, less coercive strategies must meet the needs of patients with these characteristics.

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