Outpatient Psychotropic Drug Interactions in a Public Psychiatry Hospital in Bahrain: An Audit Study

Background: Psychotropic polypharmacy is particularly common which puts psychiatric patients at high risk for developing drug-drug interactions. Objective: We aimed to study potential interactions between psychotropic medications prescribed within the outpatient psychiatry setting. Method: This was an audit study, which targeted a sample of outpatient prescriptions ordered within the outpatient clinics of the main psychiatry hospital in Bahrain over 2017. We studied the degree and correlation between psychotropic drugs. Results: The total number of prescriptions in our sample was 992 (56.1% males, 43.9% females). Psychotropic polypharmacy was detected in 842 prescriptions (84.9%). Potential interactions between psychotropic drugs were observed in 550 prescriptions (56.4%). The degree of interaction was minor in 43 prescriptions (7.8%), significant in 419 prescriptions (76.2%), and serious in 88 prescriptions (16%). Schizoaffective disorder subjects were the most likely to suffer from interactions (64.6%), whereas prescriptions issued for those who had schizophrenia contained the least number of interactions (51.6%). The total number of interactions was strongly associated with polypharmacy (p < .001), and gender (p < .01), but not with age (p > .05) or diagnosis (p > .05). Conclusion: High prevalence of polypharmacy and interactions between psychotropic medications were observed in our sample, particularly of the significant grade.

Criminal and financial penalties for clinicians in the ACT Mental Health Act weigh more heavily on senior doctors

Objective: We sought to assess the attitudes of ACT public psychiatry doctors towards the financial and criminal penalties in the ACT Mental Health Act 2015. Method: Baseline attitude was surveyed with an 11-item 5-point Likert scale. Education was then provided about the offences outlined in the Act and the associated penalties. The same initial survey was then repeated. Primary outcomes were changes in attitude pre- and post- information, and secondarily data was explored for differences related to gender and seniority. Results Forty-nine percent of 89 eligible public mental health system doctors responded. The majority of the survey respondents were female (59%). Provision of information resulted in a significant improvement in understanding of liabilities (2.80 (SD 1.14) versus 3.58 (SD 0.93), t(39) = 4.06, p < 0.001). Gender had no significant impact on scores. Senior staff were less legally secure and less satisfied with the Mental Health Act pre-information being provided. With regards to notification penalties, with education, junior staff became more secure and seniors less so. Conclusions: Information provision improves understanding of the penalties under the Mental Health Act 2015. Having a senior role predicts lower satisfaction with the penalties in the Act.

The Public Psychiatrist as a Leader

One of the many areas in which a community psychiatrist can impact patient care is through providing clinical and administrative leadership. The actions of leaders have consequences, both good and bad. Good leadership in a public mental health organization can be felt even among staff who rarely interact with the executive team. People understand the vision of the organization, and they feel engaged in achieving the organization’s goals and are committed to the organization. Poor leadership impacts morale and leads to high turnover and poor quality of care. This chapter discusses some of the leadership roles available to the public psychiatrist. It incorporates case scenarios that one may confront as a community psychiatrist in a leadership role. This chapter fosters consideration of individual paths to public psychiatry leadership by using several successful community psychiatrist–leaders as examples. The chapter concludes by discussing various ethical issues related to leadership that may arise.

The Public Psychiatrist in History

Just as the patient’s history is important to understanding his or her current situation, an understanding of the social, economic, and political forces that have shaped public psychiatry can offer insight into the public psychiatrist’s contemporary role in the United States. This chapter reviews the many historical factors that shaped the field’s development and that continue to motivate system transformation within public psychiatry today. It explores psychiatry’s shifting understanding of mental illness and treatment, alongside the rise and fall of the asylum movement and the evolution of outpatient psychiatry in the early 20th century and beyond. Then, it describes national legislation that led to the deinstitutionalization movement, the fragmentation of social services in the 1980s and 1990s, and the efforts of patient advocates that resulted in public psychiatry’s adoption of recovery-oriented services under the George W. Bush administration. Last, this chapter provides context to mental health parity laws under the Affordable Care Act.