Prescription Dose Analysis of Quetiapine in the Elderly and Insomnia

Objective: The purpose of this study is to investigate the appropriate dose of quetiapine in clinical psychiatric diseases by examining the drug prescription dose in the elderly and insomnia group through an analysis of the tendency of quetiapine dose prescribed by psychiatric diagnosis.Methods: Among the patients who had been taking outpatient treatment to the mental health department for about 7 years and 8 months from May 1, 2010 to December 31, 2017, 2,794 patients who were continuously taking quetiapine immediate-release form drugs were retrospectively tested. In addition, all subjects were classified into a total of four groups according to their maintenance dose, four mental diseases that most commonly prescribe quetiapine were selected and grouped, and further analyzed whether there was a difference in prescription capacity by age and comorbidities for the insomnia group.Results: Prescription dose of quetiapine was found to be less than 50 mg in depressive disorders and insomnia, which is a relatively low dose prescribed compared to schizophrenia and bipolar disorder. In the case of insomnia, quetiapine prescribed in the elderly patient group was 30.03±9.14 mg, which was relatively high compared to the non-elderly group. And in the case of insomnia accompanied by depressive disorder, 50.28±11.41 mg was prescribed, more than 60% higher doses than that of primary insomnia.Conclusion: In the case of primary insomnia, quetiapine dose prescribed in the elderly patient group is higher than that in the non-elderly patient group.

Quantitative characteristics of the alpha-rhythm of the electroencephalogram in depressive disorders

The aim of research was to study the quantitative characteristics of the alpha rhythm in patients with depressive disorders. Material and methods. The study sample consisted of patients who were treated at the clinic of the Research Institute of Mental Health (department of affective states) Tomsk NIMC. A total of 84 patients (67 women, 17 men) aged 20 to 60 years with mood disorders in the framework of a depressive episode, recurrent depressive disorder and dysthymia were examined. An electroencephalogram was recorded at rest with closed and open eyes. The values of the absolute spectral power of the alpha rhythm, the parameters of the microstructure of the alpha spindle were analyzed and the reactivity index (the Berger effect) was calculated. Results. With open eyes, the spectral power of the alpha rhythm was statistically significantly higher in patients with depressive disorders in the Fp1 (p=0.041), F4 (p=0.042), F7 (p=0.046) and T4 (p=0.047) leads compared to the control. Also, in patients with depressive disorders, a predominantly low-amplitude alpha rhythm was recorded (53.6% vs. 26.7%, p=0.006). The degree of alpha-rhythm depression in the posterior temporal leads T5 (p=0.012) and T6 (p=0.006) was statistically significantly less pronounced in patients with depressive disorders compared to the control group of healthy individuals. Conclusion. The detected changes indirectly indicate a decrease in the oscillatory activity of brain processes in depressive disorders.

Junior doctor daytime bleep audit

AimsThere had been ongoing concerns with regard to covering daytime duty bleeps across the three sites in the Mental health Department, BCUHB, North Wales.Frequent empty on-call slots meant some doctors being asked to hold the bleep between 9-5 in-order to cover the vacancy.Some felt this added to the existing workload and that it was unfair and unsafe.This issue was raised during a supervision session with the Educational supervisor, North Wales and an initial data collection was suggested.MethodData were collected over 2 week period to look at the Daytime bleep duties between 9 am to 5 pmWe hoped the data would demonstrate certain patterns of the task being asked to perform.ResultThe total number of bleeps were noted to be 249Discharge notification and prescription writing was noted to be the commonest reason for bleep in East and Central while Routine review and Discharge notification was the reason to be bleeped major number of times in the WestNearly 70% and 90% of the bleeps were found to be appropriate by the East and West respectively, while only a mere 15% were reported so in Central.While 30% of these bleeps in the West were considered to be deferred, 70% bleeps were deferrable in the East and almost 95% in Central.The general trend in all 3 centres was as follows:All three centres have high numbers of bleeps for discharge, prescribing tasks and routine patient reviewsMost think planned discharge paperwork could be done in advance and jobs can be deferred if there is a ward/team doctor availableConclusionA simple solution could be some jobs being planned ahead (e.g TTO/Discharge Summaries, Re-write charts) and done by the team/ward doctor. ECG could be arranged to be done by nurses/ECG technicians. Some nurses/HCAs are trained in phlebotomy, however, they have not been utilising the skills. That needed to be reinforced in safety huddles meeting.Apart from these suggestions, we were also wondering about the impact of the service models and how the juniors placed in the community mental health unit could stay involved in their team inpatients

Rockmore, John Myron

John Myron Rockmore (1913–2002) had an outstanding career in which he developed and expanded psychiatric social work practice as an essential component of World War II and post-World War II mental health programs. He was a strong advocate for a strong social work presence in the Connecticut mental health department.

Giant Left Atrial Myxoma Misdiagnosed As Schizophrenia: A Case Report

Background: Primary cardiac tumors are rare. Myxoma is the most common cardiac tumor and presents in the left atrium. Improvements tend to occur with early diagnosis, and with the help of high-resolution imaging technology, such as transesophageal echocardiography (TEE). Patients typically present with tightness of the chest, fatigue and lassitude. There are also cases of misdiagnosis and missed diagnosis. Case presentation: A 59-year-old Chinese woman complained of tightness in her chest, fatigue and lassitude for eight years. She had been misdiagnosed with schizophrenia by the local rural hospital. Computed tomography (CT) confirmed a giant mass in the left atrium, and transthoracic echocardiography (TTE) revealed left atrial enlargement with an occupying lesion. For this patient, we performed tumor resection surgery with a cardiopulmonary bypass. The giant tumor was partially detached during the operation, and the thrombus was removed successfully. After the operation, the mental health department of our hospital thought that the patient's diagnosis of schizophrenia was misdiagnosed. The patient recovered well and appeared rejuvenated after the operation. A two-year follow-up found no adverse events since the operation. Conclusions: When making a diagnosis for a patient who presented with tightness of the chest, we need to administer a cardiac physical examination and echocardiography. The physician diagnosing schizophrenia needs to first rule out any organic diseases. A careful and complete resection of the cardiac myxoma is a vital operation, due to the risk of thromboembolism.

Individual Health Budgets in Mental Health: Results of Its Implementation in the Friuli Venezia Giulia Region, Italy

Background: Individual Health Budget (IHB) is an intervention for recovery in mental health services, providing personalized care for subjects with severe disorders and complex needs. Little is known on its effectiveness and on the criteria for its delivery. Methods: A total of 67 IHB beneficiaries and 61 comparators were recruited among service users of the Mental Health Department of the Trieste Healthcare Agency, Italy. Data included sociodemographic and clinical variables, type of IHB, and Health of the Nation Outcome Scale (HoNOS) scores. Results: A comparison between groups showed significant differences in several socioeconomic and clinical characteristics. Multivariate logistic regression showed that IHB was positively associated to the 20–49 age group, single status, unemployment, low family support, cohabitation with relatives or friends, diagnosis of personality disorder, and a higher number of hospitalizations. The IHB group was at a higher risk of severe problems related to aggressive or agitated behaviors (OR = 1.4), hallucinations and delusions (OR = 1.5), and impairment in everyday life activities (OR = 2.1). Conclusions: IHB was used in patients with severe clinical and social problems. More resources, however, may be aimed at the working and social axes. More research is needed to better assess clinical and social outcomes of IHB and to adjust their intensity in a longitudinal perspective in order to enhance cost-effectiveness.

A Short Report on the English Language Analysis of the Speech of a Nigerian Patient with Schizophrenia During a Medical Interview

Language abnormalities are commonly associated with and diagnostic of a brain disorder like schizophrenia. Attempts have been made in the past to characterize the speech abnormalities in schizophrenia, but no known available research has been conducted in Nigeria where the English language is recognized as the official language. This study was designed to examine the discourse during a medical interview of a Nigerian patient with schizophrenia. A clinical interview between a schizophrenic patient and a doctor was carried out at the Mental Health Department of the University of Benin Teaching Hospital, Benin City, Nigeria. The conversation was tape-recorded, thereafter transcribed and analysed. The findings revealed syntax errors in turn-taking, mistakes in pronunciation, grammatical and phonological errors. The data confirms literature elsewhere and suggests a role for language analysis in the evaluation of persons with schizophrenia.