scholarly journals Comparing psychotropic medication prescribing in personality disorder between general mental health and psychological services: retrospective cohort study

BJPsych Open ◽  
2021 ◽  
Vol 7 (2) ◽  
Author(s):  
Giouliana Kadra-Scalzo ◽  
Jacqueline Garland ◽  
Stephen Miller ◽  
Chin-Kuo Chang ◽  
Marcella Fok ◽  
...  
Keyword(s):  
Personality Disorder ◽  
Psychotropic Medication ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Service Use ◽  
Mental Healthcare ◽  
Psychological Services ◽  
Sensitivity Analyses ◽  
Healthcare Database ◽  
Medication Prescribing

Background Although no drugs are licensed for the treatment of personality disorder, pharmacological treatment in clinical practice remains common. Aims This study aimed to estimate the prevalence of psychotropic drug use and associations with psychological service use among people with personality disorder. Method Using data from a large, anonymised mental healthcare database, we identified all adult patients with a diagnosis of personality disorder and ascertained psychotropic medication use between 1 August 2015 and 1 February 2016. Multivariable logistic regression models were constructed, adjusting for sociodemographic, clinical and service use factors, to examine the association between psychological services use and psychotropic medication prescribing. Results Of 3366 identified patients, 2029 (60.3%) were prescribed some form of psychotropic medication. Patients using psychological services were significantly less likely to be prescribed psychotropic medication (adjusted odds ratio 0.48, 95% CI 0.39–0.59, P<0.001) such as antipsychotics, benzodiazepines and antidepressants. This effect was maintained following several sensitivity analyses. We found no difference in the risk for mood stabiliser (adjusted odds ratio 0.79, 95% CI 0.57–1.10, P = 0.169) and multi-class psychotropic use (adjusted odds ratio 0.80, 95% CI 0.60–1.07, P = 0.133) between patients who did and did not use psychological services. Conclusions Psychotropic medication prescribing is common in patients with personality disorder, but significantly less likely in those who have used psychological services. This does not appear to be explained by differences in demographic, clinical and service use characteristics. There is a need to develop clear prescribing guidelines and conduct research in clinical settings to examine medication effectiveness for this population.

scholarly journals An audit to look at the prescribing of psychotropic medication in the general adult inpatient setting in patients with emotionally unstable personality disorder

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S31-S31
Author(s):  
Declan Hyland ◽  
Charlie Daniels ◽  
Iulian Ionescu ◽  
Christina Houghton ◽  
Katie Goodier ◽  
...  
Keyword(s):  
Personality Disorder ◽  
Psychotropic Medication ◽  
Psychotropic Medications ◽  
Inpatient Setting ◽  
Mood Stabiliser ◽  
Supportive Psychotherapy ◽  
Psychiatric Comorbidities ◽  
Prescribing Practice ◽  
Medication Prescribing ◽  
Emotionally Unstable Personality Disorder

AimsTo assess the frequency of prescription of psychotropic medication in patients with a primary diagnosis of emotionally unstable personality disorder (EUPD) following admission to Clock View Hospital, an inpatient unit in Mersey Care NHS Foundation Trust.MethodA retrospective analysis of the electronic (RiO) record of 50 patients discharged from Clock View Hospital between 1 January 2020 and 1 November 2020 was performed to assess prescribing practice.Twenty-five patients with a diagnosis of EUPD and no associated psychiatric comorbidities were included in the sample, as well as 25 patients with a diagnosis of EUPD and associated psychiatric comorbidities.Result80% of the 25 patients with EUPD and associated psychiatric comorbidities were prescribed psychotropic medication prior to admission to hospital (56% an antidepressant, 24% a mood stabiliser, 60% an antipsychotic and 8% a benzodiazepine). 64% of patients were prescribed two or more psychotropic medications. 28% were initiated on new psychotropic medications following admission. For four of the seven prescriptions commenced on psychotropic medication, prescribing practice was as advised in Mersey Care's EUPD guidelines.Of the 25 patients with EUPD and no associated psychiatric comorbidities, 96% of the patients were prescribed psychotropic medication prior to admission to hospital (56% an antidepressant, 20% a mood stabiliser, 72% an antipsychotic and 12% a benzodiazepine). 68% of patients were prescribed two or more psychotropic medications. Following admission, 28% of patients were initiated on new regular psychotropic medications. For five of the eight prescriptions for new psychotropic medication, prescribing practice was as advised in Mersey Care's EUPD guidelines.78% of the 50 patients were prescribed as required (PRN) psychotropic medication. In 21 patients, PRN medication was prescribed for longer than one week.ConclusionThere is a higher rate of prescribing of antipsychotic prescription in those EUPD patients with no psychiatric comorbidities compared to associated psychiatric comorbidities (72% vs 60%). Surprisingly, there was a lower rate of psychotropic polypharmacy in those with psychiatric comorbidities.Use of PRN psychotropic medication for longer than a week was higher in those patients with psychiatric comorbidities compared to those without psychiatric comorbidities (58% vs 50%). Benzodiazepines were overwhelmingly the most consistently prescribed PRN medication for patients with EUPD.One action to consider would be highlighting the importance of trialling psychologically-minded interventions and supportive psychotherapy prior to initiation of psychotropic medication. There also needs to be consideration to use of the sedative antihistamine promethazine as a first-line PRN medication for acute agitation.

scholarly journals Safety and Outcome of Carotid Dissection Stenting During the Treatment of Tandem Occlusions

Stroke ◽  
2020 ◽  
Vol 51 (12) ◽  
pp. 3713-3718 ◽  
Author(s):  
Gaultier Marnat ◽  
Bertrand Lapergue ◽  
Igor Sibon ◽  
Florent Gariel ◽  
Romain Bourcier ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Endovascular Therapy ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Favorable Outcome ◽  
Sensitivity Analyses ◽  
Carotid Dissection ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Tandem Occlusion

Background and Purpose: The efficacy of endovascular therapy in patients with acute ischemic stroke due to tandem occlusion is comparable to that for isolated intracranial occlusion in the anterior circulation. However, the optimal management of acute cervical internal carotid artery lesions is unknown, especially in the setting of carotid dissection, but emergency carotid artery stenting (CAS) is frequently considered. We investigated the safety and efficacy of emergency CAS for carotid dissection in patients with acute stroke with tandem occlusion in current clinical practice. Methods: We retrospectively analyzed a prospectively maintained database composed of 2 merged multicenter international observational real-world registries (Endovascular Treatment in Ischemic Stroke and Thrombectomy in Tandem Lesion). Data from endovascular therapy performed in the treatment of tandem occlusions related to acute cervical carotid dissection between January 2012 and January 2019 at 24 comprehensive stroke centers were analyzed. Results: The study assessed 136 patients with tandem occlusion due to dissection, including 65 (47.8%) treated with emergency CAS and 71 (52.2%) without. The overall rates of favorable outcome (90-day modified Rankin Scale score, 0–2) and successful reperfusion (modified Thrombolysis in Cerebral Infarction, 2b–3) were 58.0% (n=76 [95% CI, 49.6%–66.5%]) and 77.9% (n=106 [95% CI, 71.0%–85.0%]), respectively. In subgroup analyses, the rate of successful reperfusion (89.2% versus 67.6%; adjusted odds ratio, 2.24 [95% CI, 1.33–3.77]) was higher after CAS, whereas the 90-day favorable outcome (54.3% versus 61.4%; adjusted odds ratio, 0.84 [95% CI, 0.58–1.22]), symptomatic intracerebral hemorrhage (sICH; 10.8% versus 5.6%; adjusted odds ratio, 1.59 [95% CI, 0.79–3.17]), and 90-day mortality (8.0% versus 5.8%; adjusted odds ratio, 1.00 [95% CI, 0.48–2.09]) did not differ. In sensitivity analyses of patients with successful intracranial reperfusion, CAS was not associated with an improved clinical outcome. Conclusions: Emergency stenting of the dissected cervical carotid artery during endovascular therapy for tandem occlusions seems safe, whatever the quality of the intracranial reperfusion.

scholarly journals Association between Nafamostat Mesylate and In-Hospital Mortality in Patients with Coronavirus Disease 2019: A Multicenter Observational Study

2021 ◽  
Vol 11 (1) ◽  
pp. 116
Author(s):  
Ryota Inokuchi ◽  
Toshiki Kuno ◽  
Jun Komiyama ◽  
Kazuaki Uda ◽  
Yoshihisa Miyamoto ◽  
...  
Keyword(s):  
Propensity Score ◽  
Observational Study ◽  
Hospital Mortality ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Smoking Status ◽  
Retrospective Observational Study ◽  
Sensitivity Analyses ◽  
Multiple Imputations ◽  
Nafamostat Mesylate

Nafamostat mesylate may be effective against coronavirus disease 2019 (COVID-19). However, it is not known whether its use is associated with reduced in-hospital mortality in clinical practice. We conducted a retrospective observational study to evaluate the effect of nafamostat mesylate in patients with COVID-19 using the Medical Data Vision Co. Ltd. hospital-based database in Japan. We compared patients with COVID-19 who were (n = 121) and were not (n = 15,738) administered nafamostat mesylate within 2 days of admission between January and December 2020. We conducted a 1:4 propensity score matching with multiple imputations for smoking status and body mass index and combined the 20 imputed propensity score-matched datasets to obtain the adjusted odds ratio for in-hospital mortality. Crude in-hospital mortality was 13.2% (16/121) and 5.0% (790/15,738), respectively. In the propensity score-matched analysis with multiple imputations, the adjusted odds ratio (use vs. no use of nafamostat mesylate) for in-hospital mortality was 1.27 (95% confidence interval: 0.61–2.64; p = 0.52). Sensitivity analyses showed similar results. The results of this retrospective observational study did not support an association between nafamostat mesylate and improved in-hospital outcomes in patients with COVID-19, although further studies with larger sample sizes are warranted to assess the generalizability of our findings.

Borderline Personality Disorder and Mental Healthcare Service Use Among Adolescents

2013 ◽  
Vol 27 (2) ◽  
pp. 252-259 ◽  
Author(s):  
L. Cailhol ◽  
M. Jeannot ◽  
R. Rodgers ◽  
J. D. Guelfi ◽  
F. Perez-Diaz ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Healthcare Service ◽  
Service Use ◽  
Mental Healthcare ◽  
Borderline Personality ◽  
Healthcare Service Use

Borderline personality disorder and mental healthcare service use among adolescents

2011 ◽  
Vol 26 (S2) ◽  
pp. 1012-1012
Author(s):  
L. Cailhol ◽  
M. Jeannot ◽  
R. Rodgers ◽  
J.-D. Guelfi ◽  
F. Perez-Diaz ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Healthcare Service ◽  
Service Use ◽  
Mental Healthcare ◽  
Borderline Personality ◽  
Psychodynamic Therapy ◽  
Research Network ◽  
Treatment Utilization ◽  
Healthcare Service Use

Borderline personality disorder (BPD) is believed to be frequent among adolescents. While several prospective studies have assessed the use of mental health services among adults who suffer from BPD, few studies have provided adolescent data. This paper presents findings from the first assessment point of the European Research Network on Borderline Personality Disorder (EURNET BPD) study. In this study, we described treatment utilization of 85 adolescents with BPD (M = 16.5 years old). In line with adult findings, patients with BPD reported greater mental healthcare service use (outpatient: 98%; inpatient: 79%) compared to controls. Phenothiazine, a sedative neuroleptic, was the most frequently prescribed treatment. 47% of patients received psychotherapy; one-third of these patients received psychodynamic therapy. For all psychopathological variables, patients who received psychotherapy did not differ from those who did not receive psychotherapy; however, psychotherapy was more frequent among females. These data suggest that psychotherapy may be difficult to access for adolescents suffering from BPD, especially males.

scholarly journals Impact of comorbid personality disorder on violence in psychosis

2003 ◽  
Vol 182 (2) ◽  
pp. 129-134 ◽  
Author(s):  
Paul Moran ◽  
Elizabeth Walsh ◽  
Peter Tyrer ◽  
Tom Burns ◽  
Francis Creed ◽  
...  
Keyword(s):  
Personality Disorder ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Community Dwelling ◽  
Physical Assault ◽  
Psychotic Illness ◽  
Violent Behaviour ◽  
Multiple Data ◽  
Increased Risk ◽  
The Impact

BackgroundThe impact of comorbid personality disorder on the occurrence of violence in psychosis has not been fully explored.AimsTo examine the association between comorbid personality disorder and violence in community-dwelling patients with psychosis.MethodA total of 670 patients with established psychotic illness were screened for comorbid personality disorder. Physical assault was measured from multiple data sources over the subsequent 2 years. Logistic regression was used to assess whether the presence of comorbid personality disorder predicted violence in the sample.ResultsA total of 186 patients (28%) were rated as having a comorbid personality disorder. Patients with comorbid personality disorder were significantly more likely to behave violently over the 2-year period of the trial (adjusted odds ratio = 1.71, 95% CI 1.05–2.79).ConclusionsComorbid personality disorder is independently associated with an increased risk of violent behaviour in psychosis.

scholarly journals Policy initiative to improve access to psychological services for people with affective and anxiety disorders: population-level analysis

2011 ◽  
Vol 198 (2) ◽  
pp. 99-108 ◽  
Author(s):  
Meredith G. Harris ◽  
Philip M. Burgess ◽  
Jane E. Pirkis ◽  
Tim N. Slade ◽  
Harvey A. Whiteford
Keyword(s):  
Anxiety Disorder ◽  
Anxiety Disorders ◽  
Service Use ◽  
Social Inequalities ◽  
Mental Healthcare ◽  
Population Level ◽  
Epidemiological Data ◽  
Psychological Services ◽  
Service Users ◽  
Icd 10

BackgroundIn 2006, Australia introduced new publicly funded psychological services for people with affective and anxiety disorders (the Better Access programme). Despite massive uptake, it has been suggested that Better Access is selectively treating socioeconomically advantaged people, including some who do not warrant treatment, and people already receiving equivalent services.AimsTo explore potential disparities in Better Access treatment using epidemiological data from the 2007 National Survey of Mental Health and Wellbeing.MethodLogistic regression analyses examined patterns and correlates of service use in two populations: people who used the new psychological services in the previous 12 months; and people with any ICD–10 12-month affective and anxiety disorder, regardless of service use.ResultsMost (93.2%) Better Access psychological services users had a 12-month ICD–10 mental disorder or another indicator of treatment need. Better Access users without affective or anxiety disorders were not more socioeconomically advantaged, and received less treatment than those with these disorders. Among the population with affective or anxiety disorders, non-service users were less likely to have a severe disorder and more likely to have anxiety disorder, without a comorbid affective disorder, than Better Access users. Better Access users comprised more new allied healthcare recipients than other service users. A substantial minority of non-service users (13.5%) had severe disorders, but most did not perceive a need for treatment.ConclusionsBetter Access does not appear to be overservicing individuals without potential need or contributing to social inequalities in mental healthcare. It appears to be reaching people who have not previously received psychological care. Treatment rates could be improved for some people with anxiety disorders.

scholarly journals Obstetric near misses among women with serious mental illness: data linkage cohort study

2021 ◽  
pp. 1-7
Author(s):  
Abigail Easter ◽  
Jane Sandall ◽  
Louise M. Howard
Keyword(s):  
Mental Illness ◽  
Cohort Study ◽  
Serious Mental Illness ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Mental Healthcare ◽  
Historical Cohort ◽  
Near Misses ◽  
Still Birth ◽  
History Of

Background Investigating obstetric near misses (life-threatening obstetric complications) provides crucial information to prevent maternal mortality and morbidity. Aims To investigate the rate and type of obstetric near misses among women with serious mental illness (SMI). Method We conducted a historical cohort study, using de-identified electronic mental health records linked with maternity data from Hospital Episode Statistics. The English Maternal Morbidity Outcome Indicator was used to identify obstetric near misses at the time of delivery in two cohorts: (1) exposed cohort – all women with a live or still birth in 2007–2016, and a history of secondary mental healthcare before delivery in south-east London (n = 13 570); (2) unexposed cohort – all women with a live or still birth in 2007–2016, resident within south-east London, with no history of mental healthcare before delivery (n = 223 274). Results The rate of obstetric near misses was 884.3/100 000 (95% CI 733.2–1057.4) maternities in the exposed group compared with 575.1/100 000 (95% CI 544.0–607.4) maternities in the unexposed group (adjusted odds ratio 1.6, 95% CI 1.3–2.0, P < 0.001). Highest risks were for acute renal failure (adjusted odds ratio 2.1, 95% CI 1.1–3.8, P = 0.022); cardiac arrest, failure or infarction (adjusted odds ratio 2.3, 95% CI 1.1–4.8, P = 0.028); and obstetric embolism (adjusted odds ratio 3.1, 95% CI 1.6–5.8, P < 0.001). Conclusions Findings emphasise the importance of integrated physical and mental healthcare before and during pregnancy for women with SMI.

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