scholarly journals Real-world effectiveness of admissions to a tertiary treatment-resistant psychosis service: 2-year mirror-image study

BJPsych Open ◽  
2020 ◽  
Vol 6 (5) ◽  
Author(s):  
Cecilia Casetta ◽  
Fiona Gaughran ◽  
Ebenezer Oloyede ◽  
Juliana Onwumere ◽  
Megan Pritchard ◽  
...  
Keyword(s):  
Mental Health ◽  
Hospital Admissions ◽  
Mirror Image ◽  
Treatment Resistant ◽  
Image Study ◽  
Term Care ◽  
Interactive Search ◽  
Admission Data ◽  
Clinical Records

Background Treatment-resistant schizophrenia is a major disabling illness which often proves challenging to manage in a secondary care setting. The National Psychosis Unit (NPU) is a specialised tertiary in-patient facility that provides evidence-based, personalised, multidisciplinary interventions for complex treatment-resistant psychosis, in order to reduce the risk of readmission and long-term care costs. Aims This study aimed to assess the long-term effectiveness of treatment at the NPU by considering naturalistic outcome measures. Method Using a mirror image design, we compared the numbers of psychiatric and general hospital admissions, in-patient days, acuity of placement, number of psychotropic medications and dose of antipsychotic medication prescribed before and following NPU admission. Data were obtained from the Clinical Records Interactive Search system, an anonymised database sourced from the South London and Maudsley NHS Trust electronic records, and by means of anonymous linkage to the Hospital Episode Statistics system. Results Compared with the 2 years before NPU admission, patients had fewer mental health admissions (1.65 ± 1.44 v. 0.87 ± 0.99, z = 5.594, P < 0.0001) and less mental health bed usage (335.31 ± 272.67 v. 199.42 ± 261.96, z = 5.195 P < 0.0001) after NPU admission. Total in-patient days in physical health hospitals and total number of in-patient days were also significantly reduced (16.51 ± 85.77 v. 2.83 ± 17.38, z = 2.046, P = 0.0408; 351.82 ± 269.09 v. 202.25 ± 261.05, z = 5.621, P < 0.0001). The reduction in level of support required after treatment at the NPU was statistically significant (z = −8.099, P < 0.0001). Conclusions This study demonstrates the long-term effectiveness of a tertiary service specialising in treatment-resistant psychosis.

Adherence, Tolerability and Effective Doses of Aripiprazole Once-monthly in the Long-term Treatment of Patients with Severe Schizophrenia

2021 ◽  
Vol 27 ◽  
Author(s):  
Juan Jose Fernández-Miranda ◽  
Silvia Díaz-Fernández ◽  
Francisco López-Muñoz
Keyword(s):  
Adverse Effects ◽  
Hospital Admissions ◽  
Mirror Image ◽  
Clinical Severity ◽  
High Dose ◽  
Average Dose ◽  
Image Study ◽  
Long Term Treatment

Background: The evaluation of long-term effectiveness and tolerability of Aripiprazole Once-monthly (AOM) is yet scarce, and severely ill patients have not been specifically studied. Objective: The aim of the study was to explore the long-term adherence, effectiveness and tolerability of AOM in the treatment of patients with severe (Clinical Global Impression-Severity, CGI-S ≥ 5) schizophrenia, and whether high-dose therapy may benefit patients inadequately controlled on standard doses. Method: Six-year mirror-image study, with 36-month prospective follow-up, was conducted on patients with severe schizophrenia who underwent treatment with AOM (n = 60). Assessment included the CGI-S, the WHO Disability Assessment Schedule (WHO-DAS), the Medication Adherence Report Scale (MARS), laboratory tests, and weight and adverse effects reported. Reasons for treatment discontinuation, hospital admissions and psychiatric medications in the previous three years and during the follow-up were recorded. Results: The average dose was found to be 780 (120) mg/28 days. Tolerability was good, with few side effects or biological parameters alterations reported. There were three discharges due to adverse effects, two due to lack of effectiveness and one treatment abandoning. Weight and prolactin levels were found to be decreased. CGI-S and WHO-DAS decreased (p < 0.001), and MARS increased (p < 0.001). There were less treatment abandoning, hospital admissions (p < 0.0001) and concomitant medication (p<0.01) than during the previous 36 months. Conclusion: Treatment adherence and tolerability of AOM were found to be remarkable, even in those patients on high doses. AOM showed effectiveness in patients with severe schizophrenia, who recorded less hospitalizations and clinical severity and disability, although a considerable percentage of them needed higher doses than labeled.

Psychotic disorders in young adults with perinatally acquired HIV: a UK case series

2020 ◽  
pp. 1-7
Author(s):  
I. Mallik ◽  
T. Pasvol ◽  
G. Frize ◽  
S. Ayres ◽  
A. Barrera ◽  
...  
Keyword(s):  
Mental Health ◽  
Young Adults ◽  
Young People ◽  
Case Series ◽  
Psychotic Episode ◽  
Published Data ◽  
Growing Up ◽  
Term Care ◽  
Perinatally Acquired

Abstract Background Increasing numbers of children with perinatally acquired HIV (PaHIV) are transitioning into adult care. People living with behaviourally acquired HIV are known to be at more risk of psychosis than uninfected peers. Young adults living with PaHIV face numerous risk factors; biological: lifelong exposure to a neurotrophic virus, antiretroviral medication and immune dysfunction during brain development, and environmental; social deprivation, ethnicity-related discrimination, and migration-related issues. To date, there is little published data on the prevalence of psychotic illness in young people growing up with PaHIV. Methods We conducted a retrospective case note review of all individuals with PaHIV aged over 18 years registered for follow up at a dedicated clinic in the UK (n = 184). Results In total, 12/184 (6.5%), median age 23 years (interquartile range 21–26), had experienced at least one psychotic episode. The presentation and course of the psychotic episodes experienced by our cohort varied from short-lived symptoms to long term illness and nine (75%) appear to have developed a severe and enduring mental illness requiring long term care. Conclusion The prevalence of psychosis in our cohort was clearly above the lifetime prevalence of psychosis in UK individuals aged 16–34 years, which has been reported to be 0.5–1.0%. This highlights the importance of clinical vigilance regarding the mental health of young people growing up with PaHIV and the need to integrate direct access to mental health services within the HIV centres providing medical care.

The Practice of Community Psychiatric Nursing and Mental Health Social Work in Salford Some Implications for Community Care

1988 ◽  
Vol 152 (6) ◽  
pp. 783-792 ◽  
Author(s):  
K. Wooff ◽  
D. P. Goldberg ◽  
T. Fryers
Keyword(s):  
Mental Health ◽  
Psychiatric Symptoms ◽  
Psychiatric Patients ◽  
Psychiatric Nurses ◽  
Health Staff ◽  
Mental Health Staff ◽  
Term Care ◽  
Community Psychiatric ◽  
Wide Range

The context and content of work undertaken with individual clients by community psychiatric nurses (CPNs) and mental health social workers (MHSWs) in Salford were found to be significantly different. Although there were some areas of overlap, the ways in which the two professions worked were quite distinct. MHSWs discussed a wide range of topics and were as concerned with clients' interactions with family and community networks as they were with symptoms. Their interviews with schizophrenic clients followed a similar pattern to those with other groups, and they worked closely with psychiatrists and other mental health staff. CPNs, on the other hand, focused mainly on psychiatric symptoms, treatment arrangements, and medications, and spent significantly less time with individual psychotic clients than they did with patients suffering from neuroses. They were as likely to be in contact with general practitioners as they were with psychiatrists, and had fewer contacts with other mental health staff than the MHSWs. There was evidence that the long-term care of chronic psychiatric patients living outside hospital required more co-ordinated long-term multidisciplinary input.

scholarly journals Health problems and violence experiences of nurses working in acute care hospitals, long-term care facilities, and home-based long-term care in Germany: A systematic review

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0260050
Author(s):  
Andrea Schaller ◽  
Teresa Klas ◽  
Madeleine Gernert ◽  
Kathrin Steinbeißer
Keyword(s):  
Mental Health ◽  
Acute Care ◽  
Long Term Care ◽  
Mental Health Problems ◽  
Acute Care Hospitals ◽  
Health Problems ◽  
Term Care ◽  
Home Based ◽  
Care Facilities

Background Working in the nursing sector is accompanied by great physical and mental health burdens. Consequently, it is necessary to develop target-oriented, sustainable profession-specific support and health promotion measures for nurses. Objectives The present review aims to give an overview of existing major health problems and violence experiences of nurses in different settings (acute care hospitals, long-term care facilities, and home-based long-term care) in Germany. Methods A systematic literature search was conducted in PubMed and PubPsych and completed by a manual search upon included studies’ references and health insurance reports. Articles were included if they had been published after 2010 and provided data on health problems or violence experiences of nurses in at least one care setting. Results A total of 29 studies providing data on nurses health problems and/or violence experience were included. Of these, five studies allowed for direct comparison of nurses in the settings. In addition, 14 studies provided data on nursing working in acute care hospitals, ten on nurses working in long-term care facilities, and four studies on home-based long-term care. The studies either conducted a setting-specific approach or provided subgroup data from setting-unspecific studies. The remaining studies did not allow setting-related differentiation of the results. The available results indicate that mental health problems are the highest for nurses in acute care hospitals. Regarding violence experience, nurses working in long-term care facilities appear to be most frequently affected. Conclusion The state of research on setting-specific differences of nurses’ health problems and violence experiences is insufficient. Setting-specific data are necessesary to develop target-group specific and feasible interventions to support the nurses’ health and prevention of violence, as well as dealing with violence experiences of nurses.

Social care

2020 ◽  
pp. 361-370
Author(s):  
Jo Moriarty
Keyword(s):  
Mental Health ◽  
Social Care ◽  
Mental Health Problems ◽  
Health Problems ◽  
Term Care ◽  
Improved Outcomes ◽  
Broad Term ◽  
Key Policy ◽  
And Control

Social care is the broad term for the support provided to people living at home and in care homes. Major changes have taken place to this sector in the past few years and this chapter describes the key policy developments that have impacted upon the kind of support provided to older people with mental health problems and how that support is funded. The policy of personalization is intended to increase choice and control, but as yet it is unclear whether this will lead to improved outcomes in terms of quality of life or independence. Some long-standing issues, such as the high prevalence of people with unidentified mental health problems in long-term care, continue to provide challenges for organizations providing social care support.

scholarly journals Evaluating the Effect of COVID-19 Pandemic Lockdown on Long-Term Care Residents’ Mental Health: A Data-Driven Approach in New Brunswick

2021 ◽  
Vol 22 (1) ◽  
pp. 187-192
Author(s):  
Caitlin McArthur ◽  
Margaret Saari ◽  
George A. Heckman ◽  
Nathalie Wellens ◽  
Julie Weir ◽  
...  
Keyword(s):  
Mental Health ◽  
New Brunswick ◽  
Long Term Care ◽  
Data Driven ◽  
Term Care ◽  
Data Driven Approach

scholarly journals THE EXTREME FACE OF SOCIAL ISOLATION: A COHORT STUDY OF UNBEFRIENDED INDIVIDUALS IN LONG-TERM CARE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S532-S533
Author(s):  
Stephanie Chamberlain ◽  
Wendy Duggleby ◽  
Pamela B Teaster ◽  
Janet Fast ◽  
Carole Estabrooks
Keyword(s):  
Mental Health ◽  
Cohort Study ◽  
Health Outcomes ◽  
Social Isolation ◽  
Long Term Care ◽  
Poor Health ◽  
Term Care ◽  
Data Set ◽  
Family Contact

Abstract Even though social isolation is a significant predictor of poor health and mortality in older adults, very little is known about social isolation in long-term care (LTC) settings. The aim of this study was to describe the prevalence, demographic characteristics, health outcomes, and disease diagnoses of residents without family contact in Alberta LTC homes. Using data collected between April 2008 and March 2018, we conducted a retrospective cohort study using the Resident Assessment Instrument, Minimum Data Set, (RAI-MDS 2.0) data from 34 LTC facilities in Alberta. We identified individuals who had no contact with family or friends. Using descriptive statistics and binary logistic regression, we compared the characteristics, disease diagnoses, and functional status of individuals who had no contact with family and individuals who did have contact with family. We identified a cohort of 25,330 individuals, of whom 945 had no contact with family or friends. Different from residents who had family, the cohort with no contact was younger (81.47 years, SD=11.79), and had a longer length of stay (2.71 years, SD=3.63). For residents who had contact with family, residents with no contact had a greater number of mental health diagnoses, including depression (OR: 1.21, [95% CI: 1.06-1.39]), bipolar disorder (OR: 1.80, [95% CI: 1.22-2.68]), and schizophrenia (OR: 3.9, [95% CI: 2.96-5.14]). Interpretation: Residents without family contact had a number of unique care concerns, including mental health issues and poor health outcomes. These findings have implications for the training of staff and LTC services available to these vulnerable residents.

scholarly journals Maternal Deaths in NSW (2000–2006) from Nonmedical Causes (Suicide and Trauma) in the First Year following Birth

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Charlene Thornton ◽  
Virginia Schmied ◽  
Cindy-Lee Dennis ◽  
Bryanne Barnett ◽  
Hannah Grace Dahlen
Keyword(s):  
Mental Health ◽  
Traffic Accidents ◽  
Hospital Admissions ◽  
Mental Health Issue ◽  
First Year ◽  
Accidental Injury ◽  
Maternal Deaths ◽  
Term Identification ◽  
Health Diagnosis

Introduction. Trauma, including suicide, accidental injury, motor traffic accidents, and homicides, accounts for 73% of all maternal deaths (early and late) in NSW annually. Late maternal deaths are underreported and are not as well documented or acknowledged as early deaths.Methods. Linked population datasets from births, hospital admissions, and death registrations were analysed for the period from 1 July 2000 to 31 December 2007.Results. There were 552 901 births and a total of 129 maternal deaths. Of these deaths, 37 were early deaths (early MMR of 6.7/100 000) and 92 occurred late (late MMR of 16.6/100 000). Sixty-seven percent of deceased women had a mental health diagnosis and/or a mental health issue related to substance abuse noted. A notable peak in deaths appeared to occur from 9 to 12 months following birth with the odds ratio of a woman dying of nonmedical causes within 9–12 months of birth being 3.8 (95% CI 1.55–9.01) when compared to dying within the first 3 months following birth.Conclusion. Perinatal services are often constructed to provide short-term support. Long-term identification and support of women at particular risk of maternal death due to suicide and trauma in the first year following birth may help lower the incidence of late maternal deaths.

Sign in / Sign up

Export Citation Format

Share Document