Preliminary investigation into the identification and management of catatonia in patients admitted to adult inpatient units

AimsThe prevalence of catatonia is considered to be approximately 10% in psychiatric inpatients. Clinical experience suggests a lower documented prevalence. This could cause longer admissions and complications, such as Neuroleptic Malignant Syndrome (NMS). We carried out a service evaluation to investigate the recognition and management of catatonia on inpatient units in Southern Health Foundation Trust (SHFT). We reviewed the local documented prevalence of catatonia, treatment offered and prevalence of complications.MethodWe retrospectively reviewed the electronic records of 95 consecutive admissions to four adult inpatient units in SHFT, starting on 1st August 2020. We reviewed notes for the admission to establish whether catatonia was suspected and identified. We applied the screening questions from the Bush-Francis Catatonia Rating Scale (BFCRS) to the documented mental state examinations (MSE) prior to, and shortly after, admission. We also recorded the prescriptions issued during the first 72 hours of admission, and whether patients developed neuroleptic malignant syndrome (NMS), serotonin syndrome or required admission to a general hospital during admission.ResultCatatonia was documented as a possibility for 2 patients (2.1%). One showed possible posturing and stupor, while there were no documented symptoms for the other. In both cases the possibility was discounted by the clinical team. Twelve patients (12.6%) showed one or more possible or confirmed signs of catatonia. Eleven of these were prescribed regular antipsychotic medication on admission, but only 3 were prescribed regular benzodiazepines. NMS was more likely to be suspected in patients with a BFCRS of 1 or more compared with those with a score of 0, with an odds ratio of 8.1 (95% CI [1.03-64.0], Fisher's exact test = 7.79, p = .076).ConclusionCatatonia is likely under-recognised and under-treated locally among psychiatric inpatients. Although only approaching statistical significance, the higher rate of suspected NMS in patients showing possible catatonia is noteworthy and needs further investigation. Regular benzodiazepines were not frequently prescribed in this group, while antipsychotics, prescribed in all of these patients, can precipitate NMS. Alternatively, this finding could reflect the overlap in clinical presentation between NMS and catatonia. Data collection was limited by the frequent use of “remote clerking”, in the context of the COVID-19 pandemic. Additionally, the quality of mental state examinations was often not sufficient to draw any conclusions on the possible presence or absence of catatonic symptoms. This project has highlighted practice in need of improvement, which will be further prospectively investigated and improved via a Quality Improvement Project.

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Collected and Neglected: Are Oxford Hostels for the Homeless Filling up with Disabled Psychiatric Patients?

The British Journal of Psychiatry ◽

10.1192/bjp.157.2.269 ◽

1990 ◽

Vol 157 (2) ◽

pp. 269-272 ◽

Cited By ~ 4

Author(s):

P. Garety ◽

R. M. Toms

Keyword(s):

Mental State ◽

Rating Scale ◽

Psychiatric Patients ◽

Homeless People ◽

Psychiatric Inpatients ◽

Deviant Behaviour ◽

Severely Handicapped ◽

Psychiatric Rating ◽

Psychiatric Rating Scale

“Objective – To assess the severity of psychiatric symptoms among residents of hostels for homeless people. Design – Survey of residents in two hostels in Oxford, comprising three weeks of background fieldwork, a demographic questionnaire, and rating behaviour over two weeks with a behavioural rating scale (REHAB) and mental state with the brief psychiatric rating scale. Setting – Two hostels for homeless people in Oxford. Subjects – 146 Medium to long term residents, of whom 48 were selected by hostel workers by the following criteria: continuous residence for at least two months, signs of persistent severe mental disability, and difficulty in coping independently in the community. Two subjects died during the study; three (previously long term psychiatric inpatients) declined to be assessed on the psychiatric scale. Main outcome measure – Behavioural disturbance and mental state. Results – Only a third of the total sample had been born in Oxfordshire. Subjects had been accepted into the hostel either by arrangement with the local psychiatric service (22) or straight off the streets (26); 43 had had a previous (non-drug related) psychiatric admission. Subjects were significantly more likely than other residents to have spent longer (> 80 weeks) in a hostel in the past three years (p<0.02). With reference to norms for deviant behaviour, the 46 subjects assessed showed considerable deviant behaviour (average weekly scores: 0(11 subjects), 1 (14), 2–3 (16), and ≥4 (5)) not significantly different from that expected in moderately to severely handicapped psychiatric inpatients (χ2 = 1 · 3, df = 3, p > 0 · 7); 22 had scores equivalent to those in most severely handicapped inpatients. Of the 43 subjects assessed with the psychiatric rating scale, 16 had symptoms of neurosis, 29 of florid psychosis, and 32 of a deficit state. Symptoms of deficit state were positively correlated with ratings of low social activity on the behavioural scale (Spearman's rank correlation coefficient 0 · 30, p = 0 · 03). Conclusions – Hostels are having to care for long term severely affected psychiatric patients discharged into the community. The suitability of the services offered to such subjects should be assessed.”

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Mental State Can Influence the Degree of Postoperative Axial Neck Pain Following Cervical Laminoplasty

Global Spine Journal ◽

10.1177/2192568218793861 ◽

2018 ◽

Vol 9 (3) ◽

pp. 292-297

Author(s):

Yasushi Oshima ◽

Yoshitaka Matsubayashi ◽

Yuki Taniguchi ◽

Kentaro Hayakawa ◽

Masayoshi Fukushima ◽

...

Keyword(s):

Neck Pain ◽

Mental State ◽

Rating Scale ◽

Numerical Rating Scale ◽

Short Form ◽

Statistical Significance ◽

Multivariable Logistic Regression Analysis ◽

Cervical Laminoplasty ◽

Imaging Parameters ◽

Axial Neck Pain

Study design: A retrospective cohort study. Objective: To investigate factors influencing the incidence of moderate to severe postoperative axial neck pain following cervical laminoplasty. Methods: We reviewed 125 patients with cervical myelopathy who underwent double-door laminoplasty. The primary outcomes were the Numerical Rating Scale score (NRS score, 0-10) for neck pain, the Short Form 36 (SF-36) Health Survey score (Physical and Mental Component Summary scores [PCS and MCS, respectively]), and satisfaction. Imaging parameters on plain radiographs and magnetic resonance imaging were also evaluated. Patients with moderate to severe postoperative neck pain (NRS ≥ 5) were compared with those with no or mild neck pain (NRS ≤ 4). Results: One hundred and three patients (82%) with complete data were eligible for inclusion. There were 67 men and 36 women, with a mean age of 65 years (32-89 years). Twenty-five patients (23%) had moderate to severe postoperative axial pain (NRS ≥ 5) and were compared with the other 78 patients (NRS ≤ 4), which revealed several predictive factors, including female sex, the presence of preoperative neck pain, low postoperative PCS, low preoperative and postoperative MCS, and satisfaction with the treatment. Multivariable logistic regression analysis revealed that the postoperative MCS ( P = .002) was a risk factor for postoperative neck pain, although the preoperative MCS did not reach statistical significance ( P = .06). Conclusions: Patients with a low mental state, possibly before surgery, are at a high risk for postoperative axial neck pain. None of the imaging parameters were statistically different.

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Characteristics of patients admitted to an adult PICU as compared to general adult inpatient units: a service evaluation

Journal of Psychiatric Intensive Care ◽

10.20299/jpi.2020.020 ◽

2021 ◽

Author(s):

Kirsty Ward ◽

Suveera Prasad

Keyword(s):

Mental Health ◽

Risk Factors ◽

Substance Misuse ◽

Service Evaluation ◽

Adult Mental Health ◽

Icd 10 ◽

Adult Inpatient ◽

Increasing Demand ◽

Mental Health Unit ◽

Inpatient Units

Background: There is a need to ensure that mental health services adapt to the increasing demand for inpatient beds, particularly within PICUs. This study aims to identify risk factors and assess demographics of patients which may increase the risk of admission or transfer to a PICU.Method: A retrospective analysis of 85 discharges from an adult mental health unit. We collected data on demographics, admission, ICD-10 diagnosis and readmission figures. We compared two cohorts: those who required admission to a PICU and those who did not.Results: 18 (21.2%) patients were admitted to the PICU. They were younger, more likely to be male, single and unemployed. PICU admissions were more likely to have a forensic history (p = 0.009), substance misuse history (p = 0.074), to require seclusion (p<0.0001), police involvement (p = 0.443), physical health input in the form of senior medical or surgical advice (p = 0.026) and assessment at an acute hospital (p = 0.015). Schizophrenia and schizoaffective disorders were less common than substance misuse disorders within the PICU cohort (p = 0.535). They were also more likely to be discharged to another PICU and to be re-admitted.Conclusion: This population demonstrated that F10–19 diagnoses were the most frequent within the PICU cohort which contradicts the previous literature. We identified risk factors for admission to a PICU, demonstrating the demand for inpatient services to adapt to the needs and demographics of patients and allowing early identification of high risk individuals.

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Perceived Loneliness and Severe Sleep Disorders in Adult Women during the Covid-19 Quarantine: A Cross-Sectional Study in Colombia

Journal of Primary Care & Community Health ◽

10.1177/21501327211025170 ◽

2021 ◽

Vol 12 ◽

pp. 215013272110251

Author(s):

Álvaro Monterrosa-Castro ◽

Angélica Monterrosa-Blanco ◽

Andrea González-Sequeda

Keyword(s):

Sleep Disorders ◽

Rating Scale ◽

Statistical Significance ◽

Cross Sectional Study ◽

Bivariate Analysis ◽

Adult Women ◽

Sectional Study ◽

Cross Sectional ◽

Emotional Loneliness ◽

Social Loneliness

Background: Quarantine is a measure to control COVID-19 spread, resulting in an increased perception of loneliness. In turn, sleep disorders (SD) may be more frequently reported in uncertain circumstances. Objectives: To identify the association between loneliness and severe SD, in women quarantined due to the COVID-19 pandemic. Methods: A cross-sectional study carried out in women, between 40 and 79 years and living in Colombia. The women were invited through social network to complete 5 digital instruments: de Jong Gierveld Loneliness Scale, Menopause Rating Scale, Fear of COVID-19 Five-item Version, Coronavirus Anxiety Scale, and Francis Religion Scale. Bivariate analysis and adjusted logistic regression between loneliness and SD were performed. Results: 1133 women participated, half of them under 50 years old. 43.1% had emotional loneliness, 39.9% social loneliness and 43.3% general loneliness. SD were identified in 6 out of 10 women, those with mild SD presented an OR of 1.84, 1.85, and 1.64, for emotional, social and general loneliness, respectively. Loneliness was associated twice with moderate SD, and more than twice with severe SD. Very severe SD reached OR:5.81 for emotional loneliness, OR:4.38 social loneliness and OR:4.02 general loneliness. In the presence of religiosity, fear and anxiety due to COVID-19, statistical significance was retained for associations, except intense SD with general loneliness. Conclusions: SD were significantly associated with loneliness in our study population. It is important to assess sleep quality and perception of loneliness in middle-aged women, especially during periods of quarantine due to a pandemic to avoid health implications.

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A-079 Hand Preference in Men and Women with Parkinson’s Disease: A Preliminary Investigation

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acaa068.079 ◽

2020 ◽

Vol 35 (6) ◽

pp. 871-871

Author(s):

Ryan J ◽

Kreiner D ◽

Gontkovsky S ◽

Paolo A

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Neurological Disorders ◽

Rating Scale ◽

Preliminary Investigation ◽

Hand Preference ◽

Dominant Hand ◽

Healthy Individuals ◽

Left Handed ◽

Increased Risk

Abstract Objective Research has identified common genetic influences on handedness and neurological/mental health phenotypes. It also has been shown there may be increased risk for development of neurological disorders/diseases among individuals naturally left-handed or demonstrating non-right-hand preference. This investigation examined prevalence of right-handed versus non-right-handed individuals with Parkinson’s disease (PD) compared to controls. Method Participants were 264 patients with PD (mean age = 69.83 years) and 256 control volunteers (mean age = 71.42 years). Mean Dementia Rating Scale composites for the groups were 123.68 and 136.00, respectively. Participants self-identified their dominant hand for writing and usage was confirmed during the session. Results Proportions of non-right- and right-handed controls (7.0% and 93.0%) versus individuals with PD (6.8% and 93.2%) did not differ. Changes in proportions of non-right- and right-handedness across age ranges were not significant for controls or patients. There was a trend for a larger proportion of women (55.9%) versus men among controls (44.1%), □ 2 (1) = 3.29, p < .10; whereas, the proportion of men (64.4%) with PD was larger than that of women. (35.6%), □ 2 (1) = 21.31, p < .001. For controls and patients, non-right and right handedness gender proportions were similar. Conclusions This study is the first to assess handedness prevalence rates in PD. Results suggest prevalence of non-right handedness is similar in PD and healthy individuals and does not appear to differ markedly by gender or with advancing age. The occurrence of a trend for a larger proportion of women than men among controls is consistent with census-based statistics.

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Clinical benefits, referral practice and cost implications of an in-hospital pain service: results of a service evaluation in a London teaching hospital

British Journal of Pain ◽

10.1177/2049463716673667 ◽

2016 ◽

Vol 11 (1) ◽

pp. 36-45 ◽

Cited By ~ 5

Author(s):

Maya Sussman ◽

Elizabeth Goodier ◽

Izabella Fabri ◽

Jessica Borrowman ◽

Sarah Thomas ◽

...

Keyword(s):

Regression Analysis ◽

Pain Management ◽

Teaching Hospital ◽

Rating Scale ◽

Service Evaluation ◽

Rank Test ◽

Future Research ◽

Binary Logistic Regression Analysis ◽

Significant Difference ◽

Referral Practice

Background: In-hospital pain services (IPS) are commonplace, but evidence of efficacy is inadequate, and patients’ pain management in any hospital ward remains problematic. This service evaluation aimed to measure the effect of a contemporary IPS, its appropriate use and cost-efficacy. Methods: Records of 249 adults reviewed by the IPS in an inner London Teaching Hospital over an 8-month period were analysed for demographic data, interventions, workload and change in pain intensity measured by numerical rating scale (NRS). Non-parametric tests were used to evaluate differences between initial and final NRS. Spearman’s rank correlation analysis was used to create a correlation matrix to evaluate associations between all identified independent variables with the change in NRS. All strongly correlated variables (ρ > 0.5) were subsequently included in a binary logistic regression analysis to identify predictors of pain resolution greater than 50% NRS and improvement rather than deterioration or no change in NRS. Finally, referral practice and cost of inappropriate referrals were estimated. Referrals were thought to be inappropriate when pain was not optimised by the referring team; they were identified using a set algorithm. Results: Initial median NRS and final median NRS were significantly different when a Wilcoxon signed-rank test was applied to the whole cohort; Z = –5.5 (p = 0.000). Subgroup analysis demonstrated no significant difference in the ‘mild’ pain group; z = –1.1 (p = 0.253). Regression analysis showed that for every unit increase in initial NRS, there was a 62% chance of general and a 33% chance of >50% improvement in final NRS. An estimated annual cost-saving potential of £1546 to £4558 was found in inappropriate referrals and patients experiencing no benefit from the service. Discussion: Results suggest that patients with moderate to severe pain benefit most from IPS input. Also pain management resources are often distributed inefficiently. Future research is required to develop algorithms for easy identification of potential treatment responders.

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The use of an antagonist 5-HT2a/c for depression and motor function in Parkinson' disease

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2009000300007 ◽

2009 ◽

Vol 67 (2b) ◽

pp. 407-412 ◽

Cited By ~ 25

Author(s):

Antonio Luiz dos Santos Werneck ◽

Ana Lucia Rosso ◽

Maurice Borges Vincent

Keyword(s):

Parkinson Disease ◽

Motor Function ◽

Rating Scale ◽

Statistical Significance ◽

Psychotic Symptoms ◽

Initial Moment ◽

The Mean ◽

Group 2 ◽

To Receive ◽

Group 1

OBJECTIVE: To test the ability of a 5HT2a/c (trazodone) antagonist, to improve depression and motor function in Parkinson' disease (PD). METHOD: Twenty PD patients with and without depression were randomly assigned to receive trazodone (group 1) or not (group 2). They were evaluated through UPDRS and Hamilton Depression Rating Scale (HAM-D). RESULTS: For the UPDRS the mean score of group 2 was 33.1 ± 19.7 and 37.1 ± 18.0 at the end. For the group 1, the corresponding scores were 31.4 ± 11.3 and 25.9 ± 13.7. The variations in the Mann-Whitney test were 0.734 at the initial moment and 0.208 at the final moment. The variation in the comparison of the initial moment with the final moment was 0.005 providing statistical significance. For the HAM-D, the mean score went up 4 points in group 2, contrary to a 5.5 points decrease in group 1. CONCLUSION: Data analysis shows that this agent significantly improves depression, but the motor function improved only in the depressed patients. Because of the known anti-dopaminergic property of the 5-HT2c receptors, a possible approach for depression in PD could be the use of 5-HT2c antagonists, similarly to the use of atypical neuroleptics in case of psychotic symptoms.

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PRN Medication for Psychiatric Inpatients

The Canadian Journal of Psychiatry ◽

10.1177/070674378703200308 ◽

1987 ◽

Vol 32 (3) ◽

pp. 199-203 ◽

Cited By ~ 31

Author(s):

John L. Craven ◽

Peter M. Voore ◽

George Voineskos

Keyword(s):

Personality Disorder ◽

Drug Use ◽

Psychotropic Drug ◽

Teaching Hospital ◽

Psychotropic Medication ◽

Psychotropic Drugs ◽

Psychiatric Inpatient ◽

Psychiatric Inpatients ◽

Psychotropic Medications ◽

Inpatient Units

Little is known about the extent of the use of prn psychotropic medication in psychiatric inpatient units. A survey of the prn prescription and administration of psychotropic drugs in a psychiatric teaching hospital revealed that a large number of inpatients were prescribed and administered such drugs on a prn basis. Although 50% of the prescriptions were never administered, only 25% were actively discontinued by physicians. A diagnosis of personality disorder was the factor most frequently associated with the rate of prn prescriptions and of administrations. A large number of prn prescriptions had no instructions for indications, minimum time spacing between doses or maximum daily dosage. It is suggested that hospitals monitor the prn use of psychotropic medications in their inpatient units, and explore the reasons for such use. Psychotropic drug use on a prn basis should preferably be reserved for emergencies, and the instructions of prn prescriptions should be clear and detailed.

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Reducing the use of high dose antipsychotic medication in acute adult inpatient psychiatric units

BJPsych Open ◽

10.1192/bjo.2021.893 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S341-S341

Author(s):

Shay-Anne Pantall ◽

Sarah Warwicker ◽

Lisa Brownell

Keyword(s):

Antipsychotic Medication ◽

Psychiatric Inpatient ◽

Electronic Prescribing ◽

Antipsychotic Treatment ◽

High Dose ◽

Junior Doctors ◽

List Type ◽

Increased Risk ◽

Adult Inpatient ◽

Inpatient Units

AimsTo evaluate the use of antipsychotics, and high dose antipsychotic treatment (HDAT) in psychiatric inpatient unitsBackgroundThe Royal College of Psychiatrists published a consensus statement on high dose antipsychotic medication in October 1993. Such treatment carries an increased risk of adverse effects including towards ventricular tachycardia and sudden death.MethodA retrospective case note review of all male patients on acute adult inpatient units in a psychiatric hospital in South Birmingham on a date in June 2018 (n = 45) including review of electronic patient records and prescriptions. This was compared with the results of an earlier study, with identical methods, undertaken in June 2015.Result•In both 2015 and 2018, only a minority of patients (20% and 11% respectively) were informal.•In both 2015 and 2018, the majority of inpatients had a diagnosis of schizophrenia (54% and 67%)•In both 2015 and 2018, 93% inpatients were prescribed antipsychotic medication.•In 2015, 56% patients were prescribed HDAT. This reduced in 2018 to 16%.•This reduction in use of HDAT was almost entirely due to a reduction in the prescription of PRN antipsychotic medication.•In terms of regularly prescribed antipsychotic medication, in both years, the most commonly prescribed drug was flupentixol, with a range of other second generation oral and long acting medications being prescribed, usually at doses within BNF limits.Between the two years, there was a substantial change in the prescribing of PRN antipsychotics. In 2015, 59% individuals were prescribed at least one PRN antipsychotic (27% were prescribed two). In 2018, this reduced to 40% prescribed at least one, and only 2% being prescribed 2 PRN antipsychotics. In both years, oral quetiapine was a common choice (39% patients in 2015 prescribed oral quetiapine, and 34% in 2018). In 2015, 39% patients were prescribed oral or intramuscular aripiprazole, while this reduced to 7% in 2018.ConclusionThe vast majority of psychiatric inpatients were being prescribed antipsychotic medication. Prescription of high dose antipsychotic medication was common in 2015, and this was largely attributable to high levels of prescribing of PRN antipsychotics. Following an educational programme for junior doctors and ward nurses, and the introduction of electronic prescribing, we achieved a significant change in practice, particularly in the prescribing of PRN antipsychotics, which has reduced our patients’ risk of receiving high dose antipsychotic medication.

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