scholarly journals Elderly offenders at Wathwood Hospital: perspectives and practicalities

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S313-S314
Author(s):  
Sidra Chaudhry ◽  
Gwilym Hayes
Keyword(s):  
Elderly Patients ◽  
Mental Disorder ◽  
Brain Imaging ◽  
Health Care Professionals ◽  
Paranoid Schizophrenia ◽  
Bipolar Affective Disorder ◽  
Average Score ◽  
Electronic Patient Records ◽  
Elderly Offenders ◽  
Secure Unit

AimsThe following project explores where Wathwood Hospital stands in provision of services to its elderly patients.BackgroundThe only dedicated forensic medium secure unit for elderly offenders in England is the St. Andrews medium secure unit in Northampton with only 17 beds. Due to the limited beds, other units must accommodate elderly patients, which raises the question whether these units can provide the appropriate services for this very vulnerable population.MethodInclusion Criteria:Male>55 years of ageAdmitted from 2012 onwards (from when database was maintained)Data were gathered using patient electronic records including index offence, mental disorder, physical health comorbidities and discharge destinations. Patient identifiable data were anonymized to protect their identities.A staff survey was also conducted to find their perspective on managing elderly patients and whether Wathwood Hospital had the appropriate resources for elderly offenders in their area of work.ResultA total of 220 referrals were searched with only 9 patients >55 years. Index offenses, mental disorder diagnoses, physical comorbidities including cognitive assessments in the form of memory tests and brain imaging were also collated for identified patients from electronic patient records.Index offences included violence against person, arson, homicide, robbery, threatening behaviour and dangerous driving and affray. Diagnoses included learning disability, delusional disorder, paranoid schizophrenia, bipolar affective disorder, alcohol dependence, personality disorder and depressive disorder.Patients had multiple comorbidities such as diabetes, COPD, hypertension, coronary artery disease and musculoskeletal problems. Out of the nine admitted patients, only six had an ACE with an average score of 70.83. Five patients had brain imaging, with two normal results and the others showing some degree of atrophy and ischemic changes.Discharge destinations included medium secure units, low secure unit and prison. One patient unfortunately died during admission and four are still inpatients.A staff survey conducted showed their perspective on the challenges in managing elderly patients and whether Wathwood Hospital had the appropriate resources for them to work with elderly offenders in their area of work. All results will be explained through tables and graphs.ConclusionIt's evident that there are challenges in managing elderly patients in units not specifically designed to manage them. This is also due to the lack of geriatric training and resources available to allied health care professionals to carry out their respective work. It's therefore crucial we formulate more inclusive strategies to address these challenges.

scholarly journals Perceived burden of care and reported coping strategies and needs for family caregivers of people with mental disorders in Zimbabwe

2016 ◽  
Vol 5 (1) ◽  
Author(s):  
Bazondlile D. Marimbe ◽  
Frances Cowan ◽  
Lazarus Kajawu ◽  
Florence Muchirahondo ◽  
Crick Lund
Keyword(s):  
Mental Disorders ◽  
Mental Disorder ◽  
Coping Strategies ◽  
Low Income ◽  
Health Care Professionals ◽  
Financial Burden ◽  
Bipolar Affective Disorder ◽  
Family Members ◽  
Low Income Countries ◽  
Care Giving

Background: Mental health service resources are inadequate in low-income countries, and families are frequently expected to provide care for their relative with a mental disorder. However, research on the consequences of care giving has been limited in low-income countries, including Zimbabwe.Objective: The study explored the perceived impact of mental illness, reported coping strategies and reported needs of family members of persons diagnosed with bipolar affective disorder or schizophrenia attending a psychiatric hospital in Harare, Zimbabwe.Methods: A purposive sample of 31 family members participated in in-depth interviews and focus group discussions using standardized study guides. Participants were also screened for Common Mental Disorders (CMD) using the 14-item Shona Symptom questionnaire (SSQ). Qualitative data were analyzed thematically. Statistical Package for Social Sciences (SPSS version 16) was used for quantitative data analysis.Results: Caregivers experienced physical, psychological, emotional, social and financial burden associated with care giving. They used both emotion-focused and problem-focused coping strategies depending on the ill family members’ behaviours. Seeking spiritual assistance emerged as their most common way of coping. Twenty one (68%) of the caregivers were at risk of CMD and were referred to a psychiatrist for further management. Caregivers required support from health care professionals to help them cope better.Conclusion: Caregivers carry a substantial and frequently unrecognized burden of caring for a family member with mental disorder. Better support is needed from health professionals and social services to help them cope better. Further research is required to quantitatively measure caregiver burden and evaluate potential interventions in Zimbabwe.

scholarly journals Non-medical risk factors associated with postponing elective surgery: a prospective observational study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Julia Becker ◽  
Gerald Huschak ◽  
Hannes-Caspar Petzold ◽  
Volker Thieme ◽  
Sebastian Stehr ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Low Socioeconomic Status ◽  
Elective Surgery ◽  
Nursing Home Residents ◽  
Hospital Staff ◽  
Data Management System ◽  
Electronic Patient Records ◽  
Specific Patient ◽  
Emergency Procedures ◽  
Patient Groups

Abstract Background Operation room (OR) planning is a complex process, especially in large hospitals with high rates of unplanned emergency procedures. Postponing elective surgery in order to provide capacity for emergency operations is inevitable at times. Elderly patients, residents of nursing homes, women, patients with low socioeconomic status and ethnic minorities are at risk for undertreatment in other contexts, as suggested by reports in the medical literature. We hypothesized that specific patient groups could be at higher risk for having their elective surgery rescheduled for non-medical reasons. Methods In this single center, prospective observational trial, we analysed 2519 patients undergoing elective surgery from October 2018 to May 2019. A 14-item questionnaire was handed out to illicit patient details. Additional characteristics were collected using electronic patient records. Information on the timely performance of the scheduled surgery was obtained using the OR’s patient data management system. 6.45% of all planned procedures analysed were postponed. Association of specific variables with postponement rates were analysed using the Mann–Whitney U test and Fisher's exact test/χ2-test. Results Significantly higher rates of postponing elective surgery were found in elderly patients. No significant differences in postponing rates were found for the variables gender, nationality (Germany, EU, non-EU), native language, professional medical background and level of education. Significantly lower rescheduling rates were found in patients with ties to hospital staff and in patients with a private health insurer. Conclusions Elderly patients, retirees and nursing home residents seem to be at higher risk for having their elective surgery rescheduled. However, owing to the study design, causality could not be proven. Our findings raise concern about possible undertreatment of these patient groups and provide data on short-term postponement of elective surgery. Trial registration DRKS00015836. Retrospectively registered.

Hyponatremia-induced organic mental disorder may mask paranoid schizophrenia

1987 ◽  
Vol 22 (5) ◽  
pp. 650-652 ◽  
Author(s):  
W.Wolfgang Fleischhacker ◽  
Christian Barnas ◽  
Maximilian Ledochowski
Keyword(s):  
Mental Disorder ◽  
Paranoid Schizophrenia ◽  
Organic Mental Disorder

scholarly journals Comparison of hospitalizations in patients on first generation versus second generation long acting injectable (LAI) antipsychotics

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S283-S283
Author(s):  
Seemab Rasool ◽  
Paster Venan
Keyword(s):  
Drug Abuse ◽  
Observational Study ◽  
First Generation ◽  
Second Generation ◽  
Hospital Admissions ◽  
Paranoid Schizophrenia ◽  
Bipolar Affective Disorder ◽  
Community Treatment ◽  
P Value ◽  
Targeted Interventions

AimsThere is limited data on the comparison of efficacy between first and second antipsychotic LAIs. One good indicator of efficacy is the rates of hospitalization. Some studies have shown that second generation depot antipsychotics, significantly reduce hospitalizations as compared to conventional depots.Our aim was to compare hospitalizations in patients on first and second generation LAI antipsychotics.MethodA retrospective observational study was done by reviewing the records of all the depot clinics in South Essex, United Kingdom. A list of patients enrolled and receiving LAI antipsychotics was obtained from the 6 depot clinics. Data were collected by going through the electronic records of the patients on the depot clinic lists and taking down the demographics, diagnosis and the hospital admissions. Other variables like comorbid drug abuse were also recorded.ResultAmongst a total of 346 patients 223 (64 %) were males and 123 (36%) were females. Average age was 50.3 (range 21 to 88 years) and 290 (83%) patients were single. An overwhelming majority of patients 299 (87 %) were not in employment. Regarding the diagnosis, the majority, 237 patients were diagnosed with Paranoid Schizophrenia, 49 patients were diagnosed with Schizoaffective disorder, 38 patients were diagnosed with Bipolar affective disorder, 20 patients had a diagnosis of Delusional disorder and only 2 patients had a primary diagnosis of Mental and Behavioral disorders due to substance abuse. Of the total 346 only 17 patients were on a Community treatment Order.Risperidone was the most commonly used second generation LAI at 26%,Aripiprazole in 10% and Paliperidone was used in 5% patients. Olanzapine LAI was only used in 2 patients. Amongst first generation LAIs Zuclopenthixol, Fluclopentixol were both used in 24%, and Haloperidol in 10% patients. 21 % of patients were reported to be actively abusing drugs.65 (32.6%) of the total 200 patients on Ist Generation LAIs had hospital admissions55 (39.8%) of the total 138 patients on 2nd Generation LAIs had hospital admissionsThis difference was not statistically significant (Z test)- P value of 0.082427ConclusionThe results in our observational study are equivocal, both LAIs providing equitable decrease in the hospital admissions albeit with a slightly favourable outcome (not statistically significant though) attributable to the first generation LAIs. There was a high incidence of unemployment and drug abuse in our cohort of patients, thus targeted interventions can be established in rehabilitation of such individuals.

scholarly journals Psychoeducation as an element of psychosocial interventions in a complex system of medic-psychological support for a family, where a patient with endogenous mental disorder lives

2020 ◽  
Keyword(s):  
Complex System ◽  
Mental Disorders ◽  
Mental Disorder ◽  
Family Caregivers ◽  
Adaptive Capacity ◽  
Paranoid Schizophrenia ◽  
Psychosocial Interventions ◽  
Psychological Support ◽  
Her Family ◽  
The Family

The biopsychosocial model of therapy for endogenous mental disorders involves a flexible combination of psychopharmacotherapy with psychosocial interventions. Psychoeducation is one of the most important components of psychosocial interventions in a multifaceted system of psychosocial rehabilitation. The primary task of psychoeducation is to provide patients and their family caregivers with realistic knowledge about mental disorder, on the basis of which the patient and his or her family members can get more control over the symptoms of the disease. The aim of our work was from the standpoint of a systematic approach, based on the study of clinical and psychological manifestations and risk factors for the development of pathological functioning in a family, where a patient with endogenous mental disorder lives, to develop, substantiate scientifically and introduce a psychoeducational module as an element of psychosocial interventions in complex system of medical -psychological support. To achieve this goal, according to the principles of bioethics and medical deontology, a comprehensive examination of 243 patients with endogenous mental disorders (168 patients with paranoid schizophrenia, 75 patients with affective disorders) and 243 family caregivers was performed. The work was done in three stages: during the the first stage we examined patients and their family caregivers. During the second stage, an in-depth study of psycho-emotional, individual-psychological, interpersonal-communicative and psychosocial predictors of reducing the adaptive capacity of the family was performed. The third stage included scientific substantiation, development and implementation of an appropriate comprehensive system of medical and psychological support for the families, based on the analysis of data obtained during the previous stages. The proposed system of medical and psychological support has shown its effectiveness in improving the adaptive capacity of the family, where patients with endogenous mental disorders live, and can be recommended for further implementation in appropriate medical institutions.

Frequent problems and their management among mechanically ventilated critically ill elderly patients

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Watchara Tabootwong ◽  
Frank Kiwanuka
Keyword(s):  
Elderly Patients ◽  
Critically Ill ◽  
Health Care Professionals ◽  
Respiratory Infections ◽  
Psychological Problems ◽  
Pharmacological Management ◽  
Content Type ◽  
Mechanically Ventilated ◽  
Age Related ◽  
Management Of Complications

Purpose Multiple pathologies and age-related physiological changes lead to acute respiratory failure. This necessitates mechanical ventilation among elderly patients. Mechanically ventilated critically ill elderly patients may confront various problems, including physical and psychological issues. Therefore, the purpose of this paper is to present the frequent problems encountered by critically ill elderly patients and management of such problems. Design/methodology/approach This paper reviews relevant literatures. Findings Physical problems include pain and respiratory infections. Additionally, psychological problems include anxiety and stress. Such problems should be managed by physicians, nurses and family members. Pharmacological and non-pharmacological approaches can be used to manage these problems. Pharmacological management involves use of medications, while non-pharmacological interventions include use of music therapy, acupuncture and sensory stimulation. Originality/value The paper indicates physical and psychological problems of mechanically ventilated critically ill elderly patients. To ensure effective management of complications encountered by mechanically ventilated elderly patients, health-care professionals ought to be aware of physical and psychological age-related changes.

Achieving shared understanding in chronic care interactions: the role of caregivers

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Sarah Bigi
Keyword(s):  
Health Care ◽  
Elderly Patients ◽  
Health Care Professionals ◽  
Chronic Care ◽  
Second Step ◽  
Original Research ◽  
Clinical Settings ◽  
Shared Understanding ◽  
Content Type

Purpose Within the context of a research program on the most relevant discourse types in chronic care medical encounters, this contribution reports on a qualitative study on the role caregivers play within the process of shared understanding occurring between health-care professionals and elderly patients. The purpose of the paper is to highlight one dimension of such complexity, by bringing to light the challenges connected to the achievement of shared understanding between health-care professionals and elderly patients when caregivers are involved in the conversation. Design/methodology/approach The paper reports on a two-step analysis of a corpus of transcripts of interactions in diabetes and hypertension settings. In the first step, caregivers’ contributions to deliberative sequences have been analyzed. In the second step, the analysis was extended to caregivers’ contributions to the whole encounter. Findings The results show that professionals’ ability to engage caregivers in deliberations during the encounter and, more generally, to assign a role to caregivers as legitimate participants in the consultation may favor the smooth development of the interaction and an effective process of shared understanding among all participants. Originality/value The paper further develops original research about the functions of the argumentative component in dialogues occurring in clinical settings.

Efficacy of Art Therapy in Treating Patients with Paranoid Schizophrenia

2017 ◽  
pp. 308-320
Author(s):  
Deepali Bedi
Keyword(s):  
Art Therapy ◽  
Health Care Professionals ◽  
Paranoid Schizophrenia ◽  
Intervention Strategy ◽  
Supportive Therapy ◽  
Essential Element ◽  
Recovery Process ◽  
Behavioural Therapy ◽  
Mental Illnesses ◽  
Good Communication

Paranoid Schizophrenia chronic mental illnesses according to DSM-IVTR characterized by the presence of delusion of persecution, suspicious, distrusting, guarded, reserved, tensed, and also sometimes hostile or aggressive. Patients also perceive exaggerated warmth and friendship by the professionals as attempt at bribery, manipulation or exploitation. But therapeutic relationship between patient and the professional is integral to the recovery process and the outcome. Good communication on the part of health care professionals is an essential element in developing the strong practitioner-patient relationship necessary in the treatment of schizophrenia. Professionals are usually at a look out for tools to build a working alliance best used in such cases. Usually behavioural therapy, supportive therapy and family therapy are used for such patients. But sometimes with chronic and resistant client will get stuck at the initial rapport itself. At this stage probably art therapy as an advance intervention strategy to work with patient as an advanced intervention strategies and treatment.

Types of Mental Disorders in People with Intellectual Disability

2020 ◽  
pp. 55-60
Author(s):  
Sally-Ann Cooper
Keyword(s):  
Intellectual Disability ◽  
General Population ◽  
Mental Disorders ◽  
Mental Disorder ◽  
Bipolar Affective Disorder ◽  
Hyperactivity Disorder ◽  
Dsm 5 ◽  
Icd 10 ◽  
Physical Disorders ◽  
Challenging Behaviours

Mental disorders are common in people with intellectual disability, with a reported point prevalence of 36% in children and young people (including challenging behaviours), and 40.9% in adults (or 28.3% excluding challenging behaviours). People with intellectual disability experience all types of mental disorders, some more commonly than the general population, e.g. autism, attention-deficit hyperactivity disorder, schizophrenia, bipolar affective disorder, and dementia. Challenging behaviours are also common, and have no clear general population equivalent. Multi-morbidity of mental and physical disorders is typical. Mental disorder assessments are complex due to multi-morbidity and polypharmacy, in addition to impairments in communication, understanding, vision, and hearing, and the need to work with family and paid carers as well as the person with intellectual disability. Mental disorder classificatory systems have been developed for people with intellectual disability, in view of under-reporting when using general population manuals: DC-LD was designed to complement ICD-10, and DM-ID 2 to interpret DSM-5.

scholarly journals Haemothorax and Thoracic Spine Fractures in the Elderly

2012 ◽  
Vol 2012 ◽  
pp. 1-5
Author(s):  
Michael A. Masteller ◽  
Aakash Chauhan ◽  
Harsha Musunuru ◽  
Mark M. Walsh ◽  
Bryan Boyer ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Elderly Patients ◽  
Health Care Professionals ◽  
Osteoporotic Fractures ◽  
The Elderly ◽  
Spinal Fracture ◽  
Thoracic Spinal ◽  
Hemorrhagic Pleural Effusion ◽  
Thoracic Spine Fractures ◽  
Undetermined Etiology

Both osteoporotic fractures and pleural effusions are frequently observed in medicine. However, rarely does one associate a hemorrhagic pleural effusion with a thoracic spinal fracture when the patient has not sustained massive trauma. In this paper, we discuss two cases where seemingly insignificant low-energy trauma precipitated massive haemothoraces in elderly patients with underlying osteoporosis, ultimately resulting in their immediate causes of death. This paper serves to remind health care professionals of the importance of using caution when moving elderly patients as well as to consider thoracic spinal fracture as a potential explanation for a hemorrhagic pleural effusion of undetermined etiology.

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