scholarly journals The impact of COVID-19 restrictions on the presentation of self-injury: experience at a tertiary centre

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S230-S231
Author(s):  
Tobias Adams ◽  
A Arnaout ◽  
S Bickerton ◽  
L Li ◽  
AWN Reid ◽  
...  
Keyword(s):  
Mental Health ◽  
Tendon Injuries ◽  
Prior History ◽  
Soft Tissue Reconstruction ◽  
Inpatient Psychiatry ◽  
Tertiary Referral Centre ◽  
Self Injury ◽  
Number Of Patients ◽  
History Of ◽  
The Impact

AimsThe national lockdowns due to the COVID-19 pandemic, have had a considerable effect on mental health, with reduced access to social interaction through work and leisure activities, and increased barriers to community mental health services.This study aims to evaluate how the presentation of patients with self-injury has changed during the first national U.K. lockdown, at a Plastic Surgery Tertiary Referral Centre in the East of England.MethodRetrospectively recorded data from 23 March 2020 to 31 December 2020, spanning the duration of the first two lockdowns in the UK, were compared to the same period in 2019. The demographics of patients, along with the nature, severity and outcomes of the self-injury were recorded and compared.ResultThe number of patients referred for self-injury reduced by 22.9% during lockdown (2020: N = 42/109, 2019: 67/109)The most common attendance route was via ambulance during lockdown (2020:40.5% 2019: 31.3%) whilst the most common attendance route being via the front door in 2019 (2019: 35.8%, 2020: 26.2%)The number of new presentations with no prior history of self-injury was higher in lockdown 38.1%) compared to 2019 26.9%.The lockdown cohort had a smaller proportion of patients presenting with complications (2020: 9.5% vs 2019: 17.9%), less readmitted (2020: 11.9% vs 2019: 23.9%). Similar re-attendance rate (2020: 40.3% vs 2019: 38.1%) and re-intervention (2020: 13.4% vs 2019: 14.3%).A greater proportion in 2020 met the threshold for inpatient psychiatry input (2020: 52.4% vs 2019: 41.8%).During the lockdown, a higher percentage of flexor tendon injuries involved multiple tendons (60.0% vs 52.2%). A higher percentage of extensor tendon injuries (14.3% vs 7.4%), and a greater proportion of these also involved multiple tendons (66.7% vs 40.0%). More self-injuries were complicated by fractures (7.1% vs 4.5%) and more required soft tissue reconstruction (11.9% vs 3.0%).ConclusionDespite fewer patients presenting with self-injury during the 2020 lockdown, the injuries were more severe. Many of which had multiple structural injuries, and some with life-changing injuries, this is in line with our clinical observations.During lockdown there was a higher proportion of first-time presentations without a history of self-injury and an increased need for inpatient psychiatry input. This may reflect the impact on mental health as a result of restricted social interactions.These findings demonstrate the impact of lockdown on mental-health and may help inform medical services of potential changes in the presentations in future national social restrictions.

History of Sexual Orientation and Mental Health

2020 ◽  
pp. 9-24
Author(s):  
Kristin A. Hancock ◽  
Douglas C. Haldeman
Keyword(s):  
Mental Health ◽  
Psychological Research ◽  
The Political ◽  
Political Movements ◽  
International Policy ◽  
Psychological Science ◽  
Aids Epidemic ◽  
History Of ◽  
And Bisexual ◽  
The Impact

Psychology’s understanding of lesbian, gay, and bisexual (LGB) people has evolved, become more refined, and impacted the lives of LGB people in profound ways. This chapter traces the history of LGB psychology from the nineteenth century to the present and focuses on major events and the intersections of theory, psychological science, politics, and activism in the history of this field. It explores various facets of cultural and psychological history that include the pathologizing of homosexuality, the rise of psychological science and the political movements in the mid-twentieth century, and the major shifts in policy that ensued. The toll of the AIDS epidemic on the field is discussed as is the impact of psychological research on national and international policy and legislation.

scholarly journals 570. “I don’t know”: The Typical Response When Taking Pneumococcal Immunization Histories in Kidney Transplant Candidates

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S349-S351
Author(s):  
Jahanavi M Ramakrishna ◽  
Tambi Jarmi ◽  
Claudia R Libertin
Keyword(s):  
Infectious Disease ◽  
Kidney Transplant ◽  
Pneumococcal Vaccine ◽  
Patient Population ◽  
Pneumococcal Vaccination ◽  
Prior History ◽  
Vaccine Preventable Diseases ◽  
Number Of Patients ◽  
Order Completion ◽  
History Of

Abstract Background Vaccine-preventable diseases account for significant morbidity and mortality in the kidney transplant (KT) patient population. AST Guidelines support review and documentation of pneumococcal vaccines in KT candidate infectious disease (ID) evaluations. The objective of this study is to determine the number of KT candidates screened for prior pneumococcal immunizations and the frequency of vaccines ordered by providers when indicated at Mayo Clinic Florida’s (MCF) Transplant Center. Methods This study was an institution-based retrospective analysis of all KT candidates evaluated at MCF from December 2, 2019 – January 14, 2020. Data collection was obtained by electronic health record review. Outcomes included known history and documentation rates of prior pneumococcal vaccinations (both Prevnar 13 and Pneumovax 23) by infectious disease (ID) providers, as well as pneumococcal vaccine order frequency during ID pre-transplant evaluation when indicated. Data analysis was done using simple descriptive statistics. Results Sixty-one patients underwent KT evaluation during the study period. Among the 61 patients, 20 (32.8%) and 20 (32.8%) had a known prior history of receiving Prevnar 13 and Pneumovax 23 vaccinations, respectively. Vaccine history was unknown for Prevnar 13 and Pneumovax 23 in 39 (63.9%) patients. Vaccine status was not documented by ID providers in 2 (3.3%) patients. When appropriate, ID providers ordered Prevnar 13 and Pneumovax 23 in 38 (92.7%) and 41 (100%) patients, respectively. Orders included both electronic and written documentation to account for patients planning immunization elsewhere. Of the 38 patients advised to receive the Prevnar 13 vaccine, 17 (41.5%) patients were documented completing immunization. Pneumovax 23 order completion rates were not recorded since the study period only lasted six weeks due to closure by COVID-19. Table 1. Pneumococcal Vaccine History Documentation Rates Obtained by Patient Recall or Records Table 2. Pneumococcal Vaccine Order Rates at Pre-Kidney Transplant Consultations Table 3. Prevnar 13 Order Completion Rate by Documentation Conclusion The data reflect a high number of patients who either do not recall or have documentation of prior pneumococcal vaccination available at time of KT ID evaluation. Providers documented history of pneumococcal vaccinations extremely well, ordering immunizations when necessary. This study highlights lack of portability of immunization histories in a given patient population and opportunity for improved care. Disclosures Claudia R. Libertin, MD, Pfizer, Inc. (Grant/Research Support, Research Grant or Support)

scholarly journals The Emergency Assessment and Management of Non-Suicidal Self-Injury in Adolescents

2020 ◽  
Vol 9 (2) ◽  
pp. 92-99
Author(s):  
Sindhu A. Idicula ◽  
Amy Vyas ◽  
Nicole Garber
Keyword(s):  
Mental Health ◽  
Mental Health Professionals ◽  
Outpatient Clinics ◽  
Psychiatric Diagnoses ◽  
Mental Health Providers ◽  
Health Providers ◽  
Levels Of Care ◽  
Self Injury ◽  
History Of ◽  
Inpatient Units

Background and Goals: Non-suicidal self-injury (NSSI) is a common presenting issue mental health providers experience in all levels of care from outpatient clinics to inpatient units. It is common among adolescents seen in emergency settings, either as a presenting problem or as a covert condition that may not be detected unless specifically assessed for. The presence of NSSI increases the risk of suicide. This article aims to help the clinician develop a better understanding of NSSI – what it may entail, the prevalence, and the motivations for why young people engage in it. Methods: We review the reasons adolescents injure themselves, the link between NSSI and psychiatric diagnoses and suicide, the assessment of NSSI, and treatment planning, with emphasis on ways to screen for NSSI and interventions that can be implemented in the Emergency Department. We illustrate the complexity of NSSI with the case of a young patient with a complex psychiatric history and an extensive history of self-injury. Results and Discussion: Despite the seeming intractability of NSSI, a number of evidencebased treatments exist. Treatment primarily involves specialized forms of psychotherapy, but interventions can be implemented in the ED that will reduce the immediate risk of NSSI while more definitive intervention is awaited. Conclusion: Mental health consultations in the ED should always include screening for NSSI. Mental health professionals in the ED can play an important role in the detection and treatment of this condition..

Self-injurious behaviour in forensic mental health care: a study into the prevalence and characteristics of incidents of self-injury

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Vivienne de Vogel ◽  
Nienke Verstegen
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Suicide Attempts ◽  
Psychiatric Patients ◽  
Forensic Mental Health ◽  
Content Type ◽  
Self Injury ◽  
Forensic Psychiatric ◽  
The Impact

Purpose Incidents of self-injury by forensic psychiatric patients often have a deleterious impact on all those involved. Moreover, self-injurious behaviour is an important predictor for violence towards others during treatment. The aim of this study is to analyse methods and severity of incidents of self-injury of patients admitted to forensic psychiatry, as well as the diagnoses of self-injuring patients. Design/methodology/approach All incidents of self-injury during treatment in a forensic psychiatric centre recorded between 2008 and 2019 were analysed and the severity was coded with the modified observed aggression scale+ (MOAS+). Findings In this period, 299 incidents of self-injury were recorded, displayed by 106 patients. Most of these incidents (87.6%) were classified as non-suicidal. Methods most often used were skin cutting with glass, broken plates, a razor or knife and swallowing dangerous objects or liquids. Ten patients died by suicide, almost all by suffocation with a rope or belt. The majority of the incidents was coded as severe or extreme with the MOAS+. Female patients were overrepresented and they caused on average three times more incidents than male patients. Practical implications More attention is warranted for self-injurious behaviour during forensic treatment considering the distressing consequences for both patients themselves, supervisors and witnesses. Adequate screening for risk of self-injurious behaviour could help to prevent this behaviour. Further research is needed in different forensic settings into predictors of self-injurious behaviour, more specifically, if there are distinct predictors for aggression to others versus to the self. Originality/value Incidents of self-injury occur with some regularity in forensic mental health care and are usually classified as severe. The impact of suicide (attempts) and incidents of self-injurious behaviour on all those involved can be enormous. More research is needed into the impact on all those involved, motivations, precipitants and functions of self-injurious behaviour and effective treatment of it.

Barriers to Practitioners' Endorsement of a Recovery Perspective

2021 ◽  
pp. 861-879
Author(s):  
Debra Kram-Fernandez
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Mental Health Treatment ◽  
Behavioral Theory ◽  
Meaningful Life ◽  
Health Treatment ◽  
Surgeon General ◽  
History Of ◽  
Cognitive Behavioral Theory ◽  
The Impact

This chapter is concerned with the impact of practitioner biases on the experience of a meaningful life for individuals who live with serious mental illness (SMI). Professional biases, systemic biases that originate in societal fear and lack of knowledge, and internalized stigma taken on by the consumer affect life decisions. Following a history of treatment initiatives experienced by consumers as abusive, it is important to understand how a system envisioned to protect and treat was often experienced as harmful. In the 1980s a movement emerged to transform the nature of mental health treatment to a client-centered, recovery-oriented model. In 1999, the Surgeon General proclaimed that all agencies serving this population should be recovery oriented. Yet, the shift to this approach to understanding people with SMI has not been complete. While there are many explanations why practitioners may not fully embrace this perspective, this chapter introduces the concept of “schemas” from cognitive behavioral theory as a way of examining professional biases in the field of SMI.

scholarly journals Impact of the M184V/I Mutation on the Efficacy of Abacavir/Lamivudine/Dolutegravir Therapy in HIV Treatment-Experienced Patients

2019 ◽  
Vol 6 (10) ◽  
Author(s):  
Flaminia Olearo ◽  
Huyen Nguyen ◽  
Fabrice Bonnet ◽  
Sabine Yerly ◽  
Gilles Wandeler ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Antiviral Treatment ◽  
Composite Endpoint ◽  
Hiv Treatment ◽  
Hiv Positive ◽  
Prior History ◽  
History Of ◽  
The Impact ◽  
Hiv 1

Abstract Objective The impact of the M184V/I mutation on the virological failure (VF) rate in HIV-positive patients with suppressed viremia switching to an abacavir/lamivudine/dolutegravir regimen has been poorly evaluated. Method This is an observational study from 5 European HIV cohorts among treatment-experienced adults with ≤50 copies/mL of HIV-1 RNA who switched to abacavir/lamivudine/dolutegravir. Primary outcome was the time to first VF (2 consecutive HIV-1 RNA >50 copies/mL or single HIV-1 RNA >50 copies/mL accompanied by change in antiretroviral therapy [ART]). We also analyzed a composite outcome considering the presence of VF and/or virological blips. We report also the results of an inverse probability weighting analysis on a restricted population with a prior history of VF on any ART regimen to calculate statistics standardized to the disparate sampling population. Results We included 1626 patients (median follow-up, 288.5 days; interquartile range, 154–441). Patients with a genotypically documented M184V/I mutation (n = 137) had a lower CD4 nadir and a longer history of antiviral treatment. The incidence of VF was 29.8 cases (11.2–79.4) per 1000 person-years in those with a previously documented M184V/I, and 13.6 cases (8.4–21.8) in patients without documented M184V/I. Propensity score weighting in a restricted population (n = 580) showed that M184V/I was not associated with VF or the composite endpoint (hazard ratio [HR], 1.27; 95% confidence interval [CI], 0.35–4.59 and HR 1.66; 95% CI, 0.81–3.43, respectively). Conclusions In ART-experienced patients switching to an abacavir/lamivudine/dolutegravir treatment, we observed few VFs and found no evidence for an impact of previously-acquired M184V/I mutation on this outcome. Additional analyses are required to demonstrate whether these findings will remain robust during a longer follow-up.

scholarly journals The Impact of COVID-19 on Epilepsy Care: A Survey of the American Epilepsy Society Membership

2020 ◽  
Vol 20 (5) ◽  
pp. 316-324
Author(s):  
Dara V. F. Albert ◽  
Rohit R. Das ◽  
Jayant N. Acharya ◽  
Jong Woo Lee ◽  
John R. Pollard ◽  
...  
Keyword(s):  
Elective Surgery ◽  
Clinical Care ◽  
Single Point ◽  
The United States ◽  
Prior History ◽  
Delivery Of Care ◽  
History Of ◽  
Almost All ◽  
The Impact ◽  
New Onset

The COVID-19 pandemic has impacted the delivery of care to people with epilepsy (PWE) in multiple ways including limitations on in-person contact and restrictions on neurophysiological procedures. To better study the effect of the pandemic on PWE, members of the American Epilepsy Society were surveyed between April 30 and June 14, 2020. There were 366 initial responses (9% response rate) and 337 respondents remained for analysis after screening out noncompleters and those not directly involved with clinical care; the majority were physicians from the United States. About a third (30%) of respondents stated that they had patients with COVID-19 and reported no significant change in seizure frequency. Conversely, one-third of respondents reported new onset seizures in patients with COVID-19 who had no prior history of seizures. The majority of respondents felt that there were at least some barriers for PWE in receiving appropriate clinical care, neurophysiologic procedures, and elective surgery. Medication shortages were noted by approximately 30% of respondents, with no clear pattern in types of medication involved. Telehealth was overwhelmingly found to have value. Among the limitation of the survey was that it was administered at a single point in time in a rapidly changing pandemic. The survey showed that almost all respondents were affected by the pandemic in a variety of ways.

scholarly journals The Spiritism as therapy in the health care in the epilepsy

2016 ◽  
Vol 69 (4) ◽  
pp. 804-810 ◽  
Author(s):  
Rodrigo Luiz Vancini ◽  
Claudio Andre Barbosa de Lira ◽  
Cássia Regina Vancini-Campanharo ◽  
Dulce Aparecida Barbosa ◽  
Ricardo Mario Arida
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Neurological Disorders ◽  
Complementary Treatment ◽  
Positive Coping ◽  
Health Dimension ◽  
Important Health ◽  
History Of ◽  
Patients With Epilepsy ◽  
The Impact

ABSTRACT Objective: to present a brief history of Spiritism, the vision of epilepsy by Spiritism, and the potential of spirituality and religiosity care as complementary and coadjutants treatments in epilepsy. Method: this is a brief review about the impact of faith, spirituality, and religiosity, particularly the Spiritism philosophy as complementary treatment to neurological disorders (particularly focusing on epilepsy) and mental health. We conduct a review of published articles (about religion/spirituality and epilepsy) in the Pubmed and SciELO databases. Conclusion: the exercise of spirituality and religiosity can be a positive coping strategy to support the traditional therapy of patients with epilepsy and other neurological disorders. However, it is necessary to demystify myths and beliefs about the epilepsy and improve knowledge about this important health dimension among professionals, patients, and caregivers to explore their full treatment and supportive potential.

scholarly journals 257 The Effect of the COVID-19 Pandemic on Mental Health Associated Trauma, Admissions and Fractures at a London Major Trauma Centre

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M S Jamal ◽  
D Hay ◽  
K Al-Tawil ◽  
A Petohazi ◽  
V Gulli ◽  
...  
Keyword(s):  
Mental Health ◽  
Psychiatric Diagnosis ◽  
Major Trauma ◽  
Mental Health Problems ◽  
Demographic Data ◽  
Trauma Centre ◽  
Related Factors ◽  
Number Of Patients ◽  
Major Trauma Centre ◽  
The Impact

Abstract Aim Non-injury related factors have been extensively studied in major trauma and shown to have a significant impact on patient outcomes, with mental illness and associated medication use proven to have a negative effect on bone health and fracture healing. We report the epidemiological effect of COVID-19 pandemic on mental health associated Orthopaedic trauma, fractures, and admissions to our centre. Method We collated data retrospectively from the electronic records of Orthopaedic inpatients in an 8-week non-COVID and COVID period analysing demographic data, referral and admission numbers, orthopaedic injuries, surgery performed and patient co-morbidities including psychiatric history. Results here were 824 Orthopaedic referrals and 358 admissions (6/day) in the non-COVID period with 38/358 (10.6%) admissions having a psychiatric diagnosis and 30/358 (8.4%) also having a fracture. This was compared to 473 referrals and 195 admissions (3/day) in the COVID period with 73/195 (37.4%) admissions having a documented psychiatric diagnosis and 47/195 (24.1%) a fracture. 22/38 (57.9%) and 52/73 (71.2%) patients were known to mental health services, respectively. Conclusions Whilst total numbers utilising the Orthopaedic service decreased, the impact of the pandemic and lockdown disproportionately affected those with mental health problems, a group already at higher risk of poorer functional outcomes and non-union. The proportion of patients with both a fracture and a psychiatric diagnosis more than doubled and the number of patients presenting due to a traumatic suicide attempt almost tripled. It is imperative that adequate support is in place for vulnerable mental health patients, particularly as we are currently experiencing the “second wave” of COVID-19.

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