scholarly journals A cross-sectional prevalence survey of psychotropic medication prescribing patterns in prisons in England

2014 ◽  
Vol 2 (33) ◽  
pp. 1-82 ◽  
Author(s):  
Lamiece Hassan ◽  
Martin Frisher ◽  
Jane Senior ◽  
Mary Tully ◽  
Roger Webb ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Prescribing Patterns ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Cross Sectional ◽  
Data Set ◽  
Psychotropic Medicine ◽  
Psychotropic Medicines ◽  
Clinical Records

BackgroundThe prevalence of mental illness is significantly higher among prisoners than among people in the wider community. Psychotropic prescribing in prisons is a complex and controversial area, where prescribers balance individual health needs against security and safety risks. However, there are no current data on prescribing patterns in prisons or how these compare with those in the wider community.AimsThe study aimed to determine the prevalence, appropriateness and acceptability of psychotropic prescribing in prisons. The objectives were to determine rates of prescribing for psychotropic medications, compared with those in the wider community; the appropriateness of psychotropic prescribing in prisons; and the perceived satisfaction and acceptability of prescribing decisions to patients and general practitioners (GPs).MethodEleven prisons, housing 6052 men and 785 women, participated in a cross-sectional survey of psychotropic prescribing. On census days, data were extracted from clinical records for all patients in receipt of hypnotics, anxiolytics, antipsychotics, antimanics, antidepressants and central nervous system stimulants. The Clinical Practice Research Datalink supplied an equivalent data set for a random sample of 30,602 patients prescribed psychotropic medicines in the community. To determine the acceptability of prescribing decisions, patients attending GP consultations at three prisons were surveyed (n = 156). Pre- and post-consultation questionnaires were administered, covering expectations and satisfaction with outcomes, including prescribing decisions. Doctors (n = 6) completed post-consultation questionnaires to explore their perspectives on consultations.ResultsOverall, 17% of men and 48% of women in prison were prescribed at least one psychotropic medicine. After adjusting for age differences, psychotropic prescribing rates were four times higher among men [prevalence ratio (PR) 4.02, 95% confidence interval (CI) 3.75 to 4.30] and six times higher among women (PR 5.95, 95% CI 5.36 to 6.61) than among community patients. There were significant preferences for certain antidepressant and antipsychotic drugs in prison, compared with in the community. In 65.3% of cases, indications for psychotropic drugs were recorded and upheld in theBritish National Formulary. Antipsychotic prescriptions were less likely than other psychotropics to be supported by a valid indication in the patient notes (PR 0.75, 95% CI 0.67 to 0.83). In the acceptability study, patients who identified mental health as their primary problem were more likely than individuals who identified other types of health problems to want to start, stop and/or change their medication (PR 1.46, 95% CI 1.23 to 1.74), and to report dissatisfaction following the consultation (PR 1.76, 95% CI 1.01 to 3.08). Doctors were more likely to issue prescriptions when they thought that the patient wanted a prescription (PR 4.2, 95% CI 2.41 to 7.28), they perceived pressure to prescribe (PR 1.66, 95% CI 1.26 to 2.19), and/or the problem related to mental health (PR 1.67, 95% CI 1.27 to 2.20).ConclusionsPsychotropic medicines were prescribed more frequently in prisons than in the community. Without current and robust data on comparative rates of mental illness, it is not possible to fully assess the appropriateness of psychotropic prescribing. Nonetheless, psychotropic medicines were prescribed for a wider range of clinical indications than currently recommended, with discernible differences in drug choice. Complex health and security concerns exist within prisons. Further research is necessary to determine the effect of psychotropic prescribing on physical health, and to determine the optimum balance between medicines and alternative treatments in prisons.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

scholarly journals Changing use of antidiabetic drugs in the UK: trends in prescribing 2000–2017

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e022768 ◽  
Author(s):  
Samantha Wilkinson ◽  
Ian Douglas ◽  
Heide Stirnadel-Farrant ◽  
Damian Fogarty ◽  
Ana Pokrajac ◽  
...  
Keyword(s):  
Kidney Function ◽  
Clinical Guidelines ◽  
Prescribing Patterns ◽  
Secondary Outcome ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Cross Sectional ◽  
Dipeptidyl Peptidase 4 ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
The Uk

ObjectivesGuidelines for the use of drugs for type 2 diabetes mellitus (T2DM) have changed since 2000, and new classes of drug have been introduced. Our aim was to describe how drug choice at initiation and first stage of intensification have changed over this period, and to what extent prescribing was in accord with clinical guidelines, including adherence to recommendations regarding kidney function.DesignRepeated cross-sectional study.SettingUK electronic primary care health records from the Clinical Practice Research Datalink.ParticipantsAdults initiating treatment with a drug for T2DM between January 2000 and July 2017.Primary and secondary outcome measuresThe primary outcomes were the proportion of each class of T2DM drug prescribed for initiation and first-stage intensification in each year. We also examined drug prescribing by kidney function and country within the UK.ResultsOf 280 241 people initiating treatment with T2DM drugs from 2000 to 2017, 73% (204 238/280 241) initiated metformin, 15% (42 288/280 241) a sulfonylurea, 5% (12 956/280 241) with metformin and sulfonylurea dual therapy and 7% (20 759/280 241) started other options. Clinicians have increasingly prescribed metformin at initiation: by 2017 this was 89% (2475/2778) of drug initiations. Among people with an estimated glomerular filtration rate of ≤30 mL/min/1.73 m2, the most common drug at initiation was a sulfonylurea, 58% (659/1135). In 2000, sulfonylureas were the predominant drug at the first stage of drug intensification (87%, 534/615) but by 2017 this fell to 30% (355/1183) as the use of newer drug classes increased. In 2017, new prescriptions for dipeptidyl peptidase-4 inhibitors (DPP4i) and sodium/glucose cotransporter-2 inhibitors (SGLT2i) accounted for 42% (502/1183) and 22% (256/1183) of intensification drugs, respectively. Uptake of new classes differs by country with DPP4is and SGLT2is prescribed more in Northern Ireland and Wales than England or Scotland.ConclusionsOur findings show markedly changing prescribing patterns for T2DM between 2000 and 2017, largely consistent with clinical guidelines.

Socio Demographic and Clinical Profile of Indoor Female Patients of RINPAS

2017 ◽  
Vol 8 (1) ◽  
pp. 33
Author(s):  
Rajni Suri ◽  
Anshu Suri ◽  
Neelam Kumari ◽  
Amool R. Singh ◽  
Manisha Kiran
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Mentally Ill ◽  
Mental Health Problems ◽  
Demographic Data ◽  
Relevant Information ◽  
Health Problems ◽  
High Rate ◽  
Physical And Mental Health ◽  
Cross Sectional

The role of women is very crucial in our society. She cares for her parents, partner, children and other relatives. She performs all types of duties in family and also in the society without any expectations. Because of playing many roles, women often face many challenges in their life including both physical and mental. Mental health problems affect women and men equally, but some problems are more common among women including both physical and mental health problems. Aim of the study - The present study is aimed to describe and compare the clinical and socio-demographic correlates of female mentally ill patients. Methods and Materials: The study includes 180 female mentally ill patients based on cross sectional design and the sample for the study was drawn purposively. A semi structured socio-demographic data sheet was prepared to collect relevant information as per the need of the study. Result: The present study reveals that the socio-demographic factors contribute a vital role in mental illness. Findings also showed that majority of patients had mental problems in the age range of 20-30 have high rate. Illiterate and primary level of education and daily wage working women as well as low and middle socio-economic status women are more prone to have mental illness. Other factors like marital status, type of family and religion etc also important factors for mental illness. Keywords: Socio demographic profile, female, psychiatric patient

scholarly journals Potential value of the current mental health monitoring of children in state care in England

BJPsych Open ◽  
2018 ◽  
Vol 4 (6) ◽  
pp. 486-491 ◽  
Author(s):  
Christine Cocker ◽  
Helen Minnis ◽  
Helen Sweeting
Keyword(s):  
Mental Health ◽  
Missing Data ◽  
Mental Health Problems ◽  
Population Level ◽  
Cross Sectional ◽  
Data Set ◽  
Looked After Children ◽  
Education Data ◽  
Sample Attrition ◽  
Aggregate Population

BackgroundRoutine screening to identify mental health problems in English looked-after children has been conducted since 2009 using the Strengths and Difficulties Questionnaire (SDQ).AimsTo investigate the degree to which data collection achieves screening aims (identifying scale of problem, having an impact on mental health) and the potential analytic value of the data set.MethodDepartment for Education data (2009–2017) were used to examine: aggregate, population-level trends in SDQ scores in 4/5- to 16/17-year-olds; representativeness of the SDQ sample; attrition in this sample.ResultsMean SDQ scores (around 50% ‘abnormal’ or ‘borderline’) were stable over 9 years. Levels of missing data were high (25–30%), as was attrition (28% retained for 4 years). Cross-sectional SDQ samples were not representative and longitudinal samples were biased.ConclusionsMental health screening appears justified and the data set has research potential, but the English screening programme falls short because of missing data and inadequate referral routes for those with difficulties.Declaration of interestNone.

Dental health of community-living older people attending secondary healthcare: a cross-sectional comparison between those with and without diagnosed mental illness

2009 ◽  
Vol 22 (3) ◽  
pp. 417-425 ◽  
Author(s):  
Nitin Purandare ◽  
Eva Woods ◽  
Sue Butler ◽  
Julie Morris ◽  
Martin Vernon ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Older People ◽  
Dental Treatment ◽  
Dental Health ◽  
Oral Pathology ◽  
Community Living ◽  
Health Examination ◽  
Medical Group ◽  
Cross Sectional

ABSTRACTBackground: Mental illness and cognitive impairment are risk factors for poor dental health.Methods: We conducted a cross-sectional study to compare the dental health of older patients attending out-patient clinics and day hospitals of old age psychiatry services (the psychiatry group, n = 103) with those attending general/geriatric medical services (the medical group; n = 99). Those living in care homes, and those with diagnosed mental illness (in the medical group) were excluded. A registered mental health nurse assessed mental and general health using validated and previously published instruments. A registered dentist made an independent assessment of dental health (examination to assess oral pathology, status of remaining teeth, and dentures) and made an overall judgment about whether the patient needed any dental treatment (a “normative” need).Results: The normative need for dental treatment was significantly higher among the psychiatry group compared to the medical group (85% vs 52%; p<0.001); even after taking account of the effect of age, gender, teeth status, physical comorbidity, cognition, depressive symptoms, and overall mental and social health [adjusted odds ratio, OR (95% confidence interval): 4.32 (2.09, 8.91)]. The presence of any natural remaining teeth [OR: 4.44 (2.10, 9.42)] and Barthel Index [OR: 0.96 (0.93, 0.99)] were the two other independent predictors of the need for treatment.Conclusion: Dental problems are common in community-living older people, especially those with some natural remaining teeth and those with mental illness. There is a need to develop integrated mental health and dental care services for older people with emphasis on prevention of dental problems.

scholarly journals The influence of maternal mental illness on vaccination uptake in children: a UK population-based cohort study

2020 ◽  
Vol 35 (9) ◽  
pp. 879-889
Author(s):  
Cemre Su Osam ◽  
Matthias Pierce ◽  
Holly Hope ◽  
Darren M. Ashcroft ◽  
Kathryn M. Abel
Keyword(s):  
Mental Illness ◽  
Cohort Study ◽  
Substance Misuse ◽  
Childhood Vaccination ◽  
Health Concern ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Vaccination Uptake ◽  
Maternal Alcohol ◽  
Maternal Mental Illness

Abstract Reduced vaccination uptake is a growing and global public health concern. There is limited knowledge about the effect of maternal mental illness (MMI) on rates of childhood vaccination. This retrospective cohort study examined 479,949 mother-baby pairs born between 1993 and 2015 in the Clinical Practice Research Datalink (CPRD GOLD), a UK-based, primary health-care database. The influence of MMI on children’s vaccination status at two and five years of age was investigated using logistic regression adjusting for sex of the child, child ethnicity, delivery year, maternal age, practice level deprivation quintile and region. The vaccinations were: 5-in-1 (DTaP/IPV/Hib) and first dose MMR by the age of two; and all three doses of 5-in-1, first and second dose of MMR vaccines by the age of five. Exposure to MMI was defined using recorded clinical events for: depression, anxiety, psychosis, eating disorder, personality disorder and alcohol and substance misuse disorders. The likelihood that a child completed their recommended vaccinations by the age of two and five was significantly lower among children with MMI compared to children with mothers without mental illness [adjusted odds ratio (aOR) 0.86, 95% CI 0.84–0.88, p < 0.001]. The strongest effect was observed for children exposed to maternal alcohol or substance misuse (at two years aOR 0.50, 95% CI 0.44–0.58, p < 0.001). In the UK, an estimated five thousand more children per year would be vaccinated if children with MMI had the same vaccination rates as children with well mothers. Maternal mental illness is a hitherto largely unrecognised reason that children may be missing vital vaccinations at two and five years of age. This risk is highest for those children living with maternal alcohol or substance misuse.

scholarly journals Empathy, Burnout, and Attitudes towards Mental Illness among Spanish Mental Health Nurses

2022 ◽  
Vol 19 (2) ◽  
pp. 692
Author(s):  
Daniel Román-Sánchez ◽  
Juan Carlos Paramio-Cuevas ◽  
Olga Paloma-Castro ◽  
José Luis Palazón-Fernández ◽  
Isabel Lepiani-Díaz ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Mental Disorders ◽  
Protective Factor ◽  
Maslach Burnout Inventory ◽  
Personal Accomplishment ◽  
Snowball Sampling ◽  
Cross Sectional ◽  
Mental Health Nurses ◽  
Positive Attitudes

Mental health nurses, together with psychiatrists, are the healthcare professionals who display the highest levels of empathy and the best attitudes towards patients with mental disorders. However, burnout is a common problem among these professionals. The aim of our study is to describe the association between empathy, burnout, and attitudes towards patients with mental disorders among mental health nurses in Spain. A descriptive cross-sectional design was used involving a sample of 750 specialist nurses working in mental health facilities in Spain. An intentional, non-probability, non-discriminative, exponential snowball sampling method was used. The Jefferson Scale of Empathy, the Maslach Burnout Inventory, and the Community Attitudes towards Mental Illness Inventory were used to measure the study variables. A positive correlation was observed between empathy and all the study variables, with the exception of the personal accomplishment dimension of burnout and the social restrictiveness and authoritarianism dimensions of attitudes towards mental illness, where a negative relation was observed. Our findings suggest that empathy is associated with an increase in positive attitudes towards patients with mental disorders, decreasing associated stigma, but did not act as a protective factor against burnout in the study sample.

scholarly journals Healthcare resource use and costs for people with type 2 diabetes mellitus with and without severe mental illness in England: longitudinal matched-cohort study using the Clinical Practice Research Datalink

2021 ◽  
pp. 1-8
Author(s):  
Han-I. Wang ◽  
Lu Han ◽  
Rowena Jacobs ◽  
Tim Doran ◽  
Richard I. G. Holt ◽  
...  
Keyword(s):  
Mental Health ◽  
Diabetes Mellitus ◽  
Resource Use ◽  
Healthcare Resource ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Matched Cohort ◽  
Healthcare Resource Use ◽  
Lifetime Costs

Background Approximately 60 000 people in England have coexisting type 2 diabetes mellitus (T2DM) and severe mental illness (SMI). They are more likely to have poorer health outcomes and require more complex care pathways compared with those with T2DM alone. Despite increasing prevalence, little is known about the healthcare resource use and costs for people with both conditions. Aims To assess the impact of SMI on healthcare resource use and service costs for adults with T2DM, and explore the predictors of healthcare costs and lifetime costs for people with both conditions. Method This was a matched-cohort study using data from the Clinical Practice Research Datalink linked to Hospital Episode Statistics for 1620 people with comorbid SMI and T2DM and 4763 people with T2DM alone. Generalised linear models and the Bang and Tsiatis method were used to explore cost predictors and mean lifetime costs respectively. Results There were higher average annual costs for people with T2DM and SMI (£1930 higher) than people with T2DM alone, driven primarily by mental health and non-mental health-related hospital admissions. Key predictors of higher total costs were older age, comorbid hypertension, use of antidepressants, use of first-generation antipsychotics, and increased duration of living with both conditions. Expected lifetime costs were approximately £35 000 per person with both SMI and T2DM. Extrapolating nationally, this would generate total annual costs to the National Health Service of around £250 m per year. Conclusions Our estimates of resource use and costs for people with both T2DM and SMI will aid policymakers and commissioners in service planning and resource allocation.

scholarly journals Prevalence and determinants of tobacco use amongst South African adults with mental illness in the Eastern Cape

2021 ◽  
Vol 27 ◽  
Author(s):  
Linda K. Tindimwebwa ◽  
Anthony I. Ajayi ◽  
Oladele V. Adeniyi
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
General Population ◽  
Tobacco Use ◽  
Depressive Disorders ◽  
Smoking Prevention ◽  
Eastern Cape ◽  
Physical And Mental Health ◽  
Cross Sectional ◽  
Tobacco Products

Background: Given the physical and mental health consequences of tobacco use amongst individuals with mental illness, it was imperative to assess the burden of tobacco use in this population.Aim: This study examined the patterns and factors associated with tobacco use in individuals attending the outpatient unit.Setting: Cecilia Makiwane Hospital Mental Health Department in Eastern Cape province, South Africa.Methods: Lifetime (ever use) use and current use of any tobacco products were examined in a cross-sectional study of 390 individuals between March and June 2020. A logistic regression was fitted to determine the correlates of lifetime and current use of any tobacco products.Results: The rates of ever use and current use of tobacco products were 59.4% and 44.6%, respectively. Of the participants interviewed, lifetime tobacco use was more prevalent amongst individuals with schizophrenia (67.9%) and cannabis-induced disorders (97.3%) and lower in those with major depressive disorders (36.1%) and bipolar and related disorders (43.5%). Men were six times more likely to have ever used or currently use tobacco products in comparison to women. Also, those who had a salaried job or owned a business were over three times more likely to have ever used or currently use tobacco products compared with those receiving government social grants.Conclusions: The prevalence of tobacco use in this study was significantly higher than the general population in the Eastern Cape. Therefore, smoking prevention and cessation interventions targeted at the general population should target this often neglected sub-population in the region.

Learning together about the needs of parents with a mental illness and their children: The implementation of the Mums' and Dads' Practice Research Project

2004 ◽  
Vol 29 (2) ◽  
pp. 35-40 ◽  
Author(s):  
Carmel Alakus
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Mental Health Service ◽  
Health Service ◽  
Parent Education ◽  
Consumer Satisfaction ◽  
Practice Research ◽  
Short Term ◽  
Adult Mental Health ◽  
Difficult Issue

The busy clinical practitioner, while being encouraged to innovate and formally evaluate his or her work, has less time than ever before to do either.The Mums' and Dads' Project represented a modest attempt to implement a short-term parent education project in adult mental health and review it in the style of practice-research. A number of qualitative methods were employed to research the Project conducted in the Mid West Area Mental Health Service exploring consumer satisfaction and parents' perspectives of their children's needs.Consumers attended the sessions readily, demonstrating knowledge of child development and a willingness to confront the difficult issue of informing children about mental illness. They reiterated how much they appreciated meeting other parents with a mental illness.Service delivery to parents with a mental illness and their children deserves dedicated funding if their needs are to be addressed and programs carefully evaluated.

scholarly journals Resilience and associative stigma among mental health professionals in a tertiary psychiatric hospital: a cross-sectional study in Singapore

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e033762 ◽  
Author(s):  
Sherilyn Chang ◽  
Louisa Picco ◽  
Edimansyah Abdin ◽  
Qi Yuan ◽  
Siow Ann Chong ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Family Member ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Health Workers ◽  
Close Friend ◽  
Allied Health Professionals ◽  
Cross Sectional ◽  
Associative Stigma

ObjectivesThe mental health profession exposes healthcare workers to unique stressors such as associative stigma (stigmatisation that is extended from the stigmatised patients to psychiatric professionals and is based on affiliation with an individual with mental illness). Enhancing resilience, or the ability to ‘bounce back’ from adversity, is found to be useful in reducing occupational stress and its negative effects. In view of the high burnout rates reported among mental health professionals, this study aimed to examine resilience in this group of professionals and to explore the association between resilience and associative stigma.DesignObservational study—cross-sectional design.SettingTertiary psychiatry hospital in Singapore.ParticipantsThe study was conducted among 470 mental health professionals (doctors, nurses and allied health professionals) working in the hospital.MeasuresResilience was assessed using the Brief Resilience Scale (BRS) and participants completed questionnaires that examined associative stigma. Participants provided their sociodemographic information, length of service, and information on whether they knew of a close friend or family member who had a mental illness.ResultsMean resilience score for the overall sample was 3.59 (SD=0.64). Older age (β=0.012, 95% CI 0.004 to 0.019, p=0.003) and having known a family member or close friend with a mental illness (β=0.155, 95% CI 0.019 to 0.290, p=0.025) predicted higher BRS score. Associative stigma remained significantly associated with resilience score after controlling for sociodemographic factors whereby higher associative stigma predicted lower resilience scores.ConclusionThe present finding suggests that resilience building programmes among mental health workers should target those of the younger age group, and that addressing the issue of associative stigma is essential.

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