Awareness and documentation of the teratogenic effects of valproate among women of child-bearing potential

Aims and methodWe aimed to evaluate clinical note documentation of valproate prescribing and establish the level of knowledge among women of child-bearing potential regarding valproate-associated adverse effects, including teratogenesis, in a regional Irish mental health service.ResultsOf the 42 women prescribed sodium valproate, 21.4% (n = 9) had some documentation in relation to associated risks and 33.3% (n = 14) described an awareness of these risks from consultation with their treating mental health team. On clinical interview, 9.5% (n = 4) of individuals with clear documentation of the risks of teratogenesis described no such awareness. Augmentation with lithium was associated with greater awareness of the teratogenic risks of valproate (P = 0.011).Clinical implicationsA clear description of the teratogenic risks of valproate and potential management strategies, including advice regarding contraception and supplementation with folic acid, should be clearly documented and provided repeatedly and in context to all women of child-bearing age who are prescribed valproate.Declaration of interestNone.

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A follow-up study of the use of a patient-held record in mental health

Psychiatric Bulletin ◽

10.1192/pb.26.3.91 ◽

2002 ◽

Vol 26 (3) ◽

pp. 91-92 ◽

Cited By ~ 2

Author(s):

A. Stafford ◽

R. Laugharne ◽

K. Gannon

Keyword(s):

Mental Health ◽

Community Mental Health ◽

Pilot Project ◽

Clinical Implications ◽

Community Mental Health Team ◽

Mental Health Team ◽

Health Team ◽

Follow Up Study ◽

The Past

Aims and MethodPatient-held records have been introduced in mental health over the past 2 decades. This follow-up study aimed to evaluate one pilot project 5 years after the records were introduced. All patients initially interviewed 4 years previously were approached and asked about their use and opinion of the record.ResultsOf the 19 people interviewed, 12 were still using the record and had a positive opinion of its usefulness. Of all community mental health team contacts, 72% were recorded in the patient-held notes.Clinical ImplicationsPatient-held records are sustainable in a naturalistic clinical setting over the period of 5 years.

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Liaison-consultation meetings in general practice

Psychiatric Bulletin ◽

10.1192/pb.23.3.161 ◽

1999 ◽

Vol 23 (3) ◽

pp. 161-164 ◽

Cited By ~ 1

Author(s):

Rebecca J. Tipper ◽

Ian M. Pullen

Keyword(s):

Mental Health ◽

General Practice ◽

Community Mental Health ◽

Information Exchange ◽

Clinical Implications ◽

Community Mental Health Team ◽

Mental Health Team ◽

Health Team ◽

Audio Recordings ◽

Shared Information

Aims and methodAudio-recordings were made over a period of six months of liaison–consultation meetings between general practitioners and a community mental health team in the Scottish Borders to show general trends in length of discussion and information exchange.ResultsMeetings were predominantly supportive, with high levels of shared information, but little educational content. Some trends in discussion time are shown.Clinical implicationsAudio-recording could form the basis for reviewing the function of liaison-consultation meetings.

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Review of antipsychotic prescribing at HMP/YOI Low Newton

BJPsych Bulletin ◽

10.1192/bjb.2020.80 ◽

2020 ◽

pp. 1-7

Author(s):

Lois Carey ◽

Stephen Barlow

Keyword(s):

Mental Health ◽

Antipsychotic Medication ◽

Best Practice ◽

Psychotic Disorders ◽

Psychotropic Medications ◽

Clinical Implications ◽

Mental Health Team ◽

Antipsychotic Medications ◽

Off Label ◽

Health Team

Aims and Method The purpose of this review was to establish whether the prescription of antipsychotic medication in HMP Low Newton was safe, rational and consistent with current best practice. A search of the electronic healthcare records was performed on 14 March 2018 to identify all the women in the prison who were prescribed antipsychotic medication, and then data were collected from the records. Results A total of 46 out of 336 prisoners (13.7%) had been prescribed antipsychotic medications; 29 of the 46 patients (84.8%) were also prescribed other psychotropic medications at the same time. Quetiapine was the most frequently prescribed antipsychotic and was also the most likely to be prescribed for off-label indications. Less than one-third of all antipsychotic prescriptions were for psychotic disorders. Clinical implications The rationale for prescribing all antipsychotic medication, especially for off-label indications, should be clearly documented and reviewed regularly within the prison by the mental health team and psychiatrist.

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Mental health day centres

Psychiatric Bulletin ◽

10.1192/pb.25.2.61 ◽

2001 ◽

Vol 25 (2) ◽

pp. 61-66 ◽

Cited By ~ 16

Author(s):

Jocelyn Catty ◽

Tom Burns

Keyword(s):

Mental Health ◽

Social Services ◽

Mental Health Problems ◽

Clinical Implications ◽

Community Mental Health Team ◽

Mental Health Team ◽

Health Team ◽

Team Care ◽

Physical Health Care ◽

Day Hospitals

Aims and MethodMental health day centres have been little researched. We carried out a 1-week census at the four day centres run by a London borough.ResultsThe centres catered for a g roup with long-standing mental health problems, mostly under community mental health team care. A surprising number were suffering from physical ill health. They attended the centres primarily for social reasons or to participate in creative groups such as music and art.Very few were concurrently attending day hospitals.Clinical ImplicationsFurther work is essential to understand the distinction between NHS day hospitals and Social Services day centres in terms of utilisation and client group.This client group's needs, particularly for physical health care, require urgent attention.

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Use of psychotropic medication among psychiatric out-patients with personality disorder

The Psychiatrist ◽

10.1192/pb.bp.108.021758 ◽

2010 ◽

Vol 34 (3) ◽

pp. 83-86 ◽

Cited By ~ 16

Author(s):

Elena Baker-Glenn ◽

Mark Steels ◽

Chris Evans

Keyword(s):

Mental Health ◽

Personality Disorder ◽

Community Mental Health ◽

Psychotropic Medication ◽

Primary Diagnosis ◽

Total Annual Cost ◽

Clinical Implications ◽

Community Mental Health Team ◽

Mental Health Team ◽

Health Team

Aims and methodThis survey was conducted to ascertain the use of psychotropic medication in the treatment of patients with a primary diagnosis of personality disorder within a community mental health team. A sample of 113 patients were identified, their notes were reviewed, and details of current medications and diagnoses recorded.ResultsFour-fifths of patients were prescribed at least one psychotropic medication. The most commonly prescribed medication class was antidepressant, comprising almost half of prescriptions. The total annual cost across 107 patients was £37 000.Clinical implicationsMedication is commonly prescribed to people with personality disorder but more needs to be known about why prescriptions are started and stopped, what the benefits are, and how these are judged by patients and care teams.

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Polypharmacy and high-dose antipsychotic regimes in the community

The Psychiatrist ◽

10.1192/pb.bp.108.020776 ◽

2010 ◽

Vol 34 (2) ◽

pp. 44-46 ◽

Cited By ~ 14

Author(s):

Tongeji E. Tungaraza ◽

Seema Gupta ◽

Jane Jones ◽

Rob Poole ◽

Gary Slegg

Keyword(s):

Mental Health ◽

Community Mental Health ◽

Atypical Antipsychotics ◽

Case Note ◽

Clinical Implications ◽

High Dose ◽

Community Mental Health Team ◽

Mental Health Team ◽

Health Team ◽

Standing Problem

Aims and methodTo determine the pattern of psychotropic prescribing in a group of people with psychosis who were living in the community under community mental health team (CMHT) care. Case-note entries over the previous 12 months were examined.ResultsOnly a third of individuals were on one psychotropic medication. Atypical antipsychotics were prescribed to 80.6%. Polypharmacy was common. A third of people were taking three or more psychotropic drugs and 13.7% were on high-dose regimes, mostly involving two atypical antipsychotics.Clinical implicationsThe use of atypicals has not eliminated polypharmacy or high-dose antipsychotic regimes. Clinicians need to be aware of this long-standing problem.

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Community psychiatry's achievements

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796014000560 ◽

2014 ◽

Vol 23 (4) ◽

pp. 337-344 ◽

Cited By ~ 5

Author(s):

T. Burns

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Care ◽

Community Psychiatry ◽

Psychosocial Interventions ◽

Community Mental Health Team ◽

Pattern Of Care ◽

Mental Health Team ◽

Health Team ◽

Developed World

Mental health care in the second half of the 20th century in much of the developed world has been dominated by the move out from large asylums. Both in response to this move and to make it possible, a pattern of care has evolved which is most commonly referred to as ‘Community Psychiatry’. This narrative review describes this process, from local experimentation into the current era of evidence-based mental health care. It focuses on three main areas of this development: (i) the reprovision of care for those discharged during deinstitutionalisation; (ii) the evolution and evaluation of its characteristic feature the Community Mental Health Team; and (iii) the increasing sophistication of psychosocial interventions developed to support patients. It finishes with an overview of some current challenges.

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To improve the communication between a community mental health team and its service users, their families and carers

BMJ Open Quality ◽

10.1136/bmjoq-2020-000914 ◽

2020 ◽

Vol 9 (4) ◽

pp. e000914

Author(s):

Priyalakshmi Chowdhury ◽

Amir Tari ◽

Ola Hill ◽

Amar Shah

Keyword(s):

Mental Health ◽

Community Mental Health ◽

User Satisfaction ◽

Service User ◽

Service Users ◽

Not Given ◽

Community Mental Health Team ◽

Mental Health Team ◽

Specialist Registrar ◽

Health Team

This article describes the application of quality improvement (QI) to solve a long-standing, ongoing problem where service users or their carers felt they were not given enough information regarding diagnosis and medication during clinic assessments in a community mental health setting. Service users and carers had shared feedback that some of the information documented on clinic letters was not accurate and the service users were not given the opportunity to discuss these letters with the clinician. The aim of this QI project was to improve the communication between the community mental health team (CMHT) and service users and their carers. Wardown CMHT volunteered to take on this project. The stakeholders involved were the team manager and deputy manager, the team consultant, the team specialist registrar, team administrative manager, two carers and one service user. The project had access to QI learning and support through East London NHS Foundation Trust’s QI programme. The team organised weekly meetings to brainstorm ideas, plan tests of change to review progress and to agree on the next course of action. The outcome was an increase in service user satisfaction from 59.9% to 78% over a period of 6 months, and a reduction in complaints to zero.

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