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.

The Role of the Mental Health Counselor in the Psychiatric Liaison Service of the General Hospital

1974 ◽  
Vol 5 (1) ◽  
pp. 1-16 ◽  
Author(s):  
Bernard R. Shochet
Keyword(s):  
Mental Health ◽  
General Hospital ◽  
Case Reports ◽  
Hospital Setting ◽  
Acute Illness ◽  
Supportive Psychotherapy ◽  
Psychosocial Services ◽  
Mental Health Counselor ◽  
Number Of Patients ◽  
Health Counselor

A substantial number of patients admitted to the medical and surgical services of the general hospital experience significant and obvious psychological difficulties associated with their acute illness. This is more likely to be recognized overtly on a medical than on a surgical service; on both, a significant number of patients need psychological services during their acute illness and convalescence. The mental health counselor serves an important function on the medical and surgical units: screening new admissions and identifying those patients in need of psychosocial services, providing supportive psychotherapy to selected patients and consulting with the nursing staff and house staff concerning day to day management. By participating in walking rounds with the medical staff, the counselor is also able to facilitate the request and use of formal psychiatric consultative services. As demonstrated through statistics and case reports, the mental health counselor, trained to operate in the general hospital setting, makes a valuable contribution in the care of medical and surgical patients in the general hospital.

scholarly journals Higher training in liaison psychiatry for older adults: experiences of two specialist training posts

2007 ◽  
Vol 31 (9) ◽  
pp. 354-356
Author(s):  
Maura Young ◽  
Siobhan Morris
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Older People ◽  
General Hospital ◽  
Old Age ◽  
Mental Health Problems ◽  
Hospital Setting ◽  
Health Problems ◽  
Liaison Psychiatry ◽  
The Past

Over the past decade, old age liaison psychiatry services have been developing across the UK. The driving force behind this has been the recognition of the inequity in service provision for people over the age of 65 with mental health problems in a general hospital setting. A postal survey of consultants in old age psychiatry in April 2002 showed that most respondents (71%) considered that the service they provided to older people in general hospitals was poor and needed to be improved (Holmes et al, 2002). Much work has been done to highlight this issue, and liaison psychiatry for older adults is gaining prominence. The national conference on liaison psychiatry for older people, which has been held in Leeds for the past 4 years, attracts large numbers of enthusiastic participants. The Department of Health (2006) document A New Ambition for Old Age specifically mentions the current poor standard of care that older people with mental health problems receive in a general hospital setting. The Royal College of Psychiatrists (2005) has produced guidelines for the development of liaison mental health services for older people.

Physician and behavioral health provider diagnostic agreement in a general hospital setting

2020 ◽  
Vol 55 (4) ◽  
pp. 249-254
Author(s):  
Tyler J Lawrence ◽  
Jennifer S Harsh ◽  
Liz Lyden
Keyword(s):  
Mental Health ◽  
Behavioral Health ◽  
General Hospital ◽  
Depressive Disorders ◽  
Hospital Setting ◽  
Kappa Statistics ◽  
Health Provider ◽  
Health Providers ◽  
Diagnostic Agreement ◽  
Behavioral Health Provider

Objective Behavioral health providers are often employed in inpatient settings. However, it is unclear if there is mental health diagnosis agreement between referring physicians and behavioral health providers. The purpose of this study is to assess for referring physician and behavioral health provider mental health diagnostic agreement in a general hospital setting. Method An analysis of 60 consecutive inpatient referrals to a behavioral health provider in a general hospital setting was conducted. The initial referral diagnosis from referring internal medicine physicians was compared with the diagnosis made by the behavioral health provider. Results Kappa statistics indicated good diagnostic agreement for substance abuse (.79), anxiety disorders (.82), adjustment disorders (.88), relational conflict (.88), and “other” (.74). There was less agreement for depressive disorders (.55). Conclusions Diagnostic agreement was good overall, suggesting that referrals to inpatient behavioral health providers are often appropriate. Results indicated that depression was underdiagnosed by physicians in the study sample. This is problematic given that depression can be successfully treated through the use of medication and psychotherapy.

Knowledge about the Scottish Mental Health Act in a General Hospital Setting

2008 ◽  
Vol 53 (2) ◽  
pp. 15-17 ◽  
Author(s):  
BJ Baig ◽  
J Walker ◽  
ES Crowe ◽  
SM MacHale ◽  
H Aditya ◽  
...  
Keyword(s):  
Mental Health ◽  
General Hospital ◽  
Hospital Setting ◽  
Mental Health Act

scholarly journals Embodied Ethical Decision-Making: A Clinical Case Study of Respect for Culturally Based Meaning Making in Mental Healthcare

2021 ◽  
Author(s):  
Megz Roberts
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Mental Health Treatment ◽  
Ethical Decision ◽  
Ethical Decision Making ◽  
Meaning Making ◽  
Hospital Setting ◽  
Mental Healthcare ◽  
Clinical Case Study ◽  
Culturally Based

AbstractHow does embodied ethical decision-making influence treatment in a clinical setting when cultural differences conflict? Ethical decision-making is usually a disembodied and rationalized procedure based on ethical codes (American Counseling Association, 2014; American Dance Therapy Association, 2015; American Mental Health Counseling Association, 2015) and a collective understanding of right and wrong. However, these codes and collective styles of meaning making were shaped mostly by White theorists and clinicians. These mono-cultural lenses lead to ineffective mental health treatment for persons of color. Hervey’s (2007) EEDM steps encourage therapists to return to their bodies when navigating ethical dilemmas as it is an impetus for bridging cultural differences in healthcare. Hervey’s (2007) nonverbal approach to Welfel’s (2001) ethical decision steps was explored in a unique case that involved the ethical decision-making process of an African-American dance/movement therapy intern, while providing treatment in a westernized hospital setting to a spiritual Mexican–American patient diagnosed with PTSD and generalized anxiety disorder. This patient had formed a relationship with a spirit attached to his body that he could see, feel, and talk to, but refused to share this experience with his White identifying psychiatric nurse due to different cultural beliefs. Information gathered throughout the clinical case study by way of chronological loose and semi-structured journaling, uncovered an ethical dilemma of respect for culturally based meanings in treatment and how we identify pathology in hospital settings. The application of the EEDM steps in this article is focused on race/ethnicity and spiritual associations during mental health treatment at an outpatient hospital setting. Readers are encouraged to explore ways in which this article can influence them to apply EEDM in other forms of cultural considerations (i.e. age) and mental health facilities. The discussion section of this thesis includes a proposed model for progressing towards active multicultural diversity in mental healthcare settings by way of the three M’s from the relational-cultural theory: movement towards mutuality, mutual empathy, and mutual empowerment (Hartling & Miller, 2004).

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