Rashid Zaman - Academia.edu (original) (raw)
Papers by Rashid Zaman
Psychiatria Danubina, 2019
Gender differences in the prevalence, experiences and presentations of mental illnesses are well-... more Gender differences in the prevalence, experiences and presentations of mental illnesses are well-known and are reflected in research findings, clinical practice, society and popular culture. This paper will compare and contrast the role that gender and other factors play in the portrayals of depressive illness in two acclaimed texts, 'The Bell Jar' by Sylvia Plath and, 'Darkness Visible' by William Styron.
Psychiatria Danubina, 2020
Mental health problems are over-represented in doctors and medical students. However, stigma and ... more Mental health problems are over-represented in doctors and medical students. However, stigma and 'a culture of shame' are formidable barriers to mental health services and consequently many doctors and medical students with mental health difficulties continue to suffer in silence despite the availability of effective treatment. Indeed, a recent study on over 2100 female physicians who met the diagnostic criteria for a mental disorder revealed that 50% were reluctant to seek professional help due to fear of exposure to stigma. Left untreated or undertreated, mental health problems in doctors can result in impairment of occupational functioning, compromise patient safety and place considerable strain on the economy (by increasing the amount of sick leave taken). Moreover, the consequences of mental health stigma in the medical profession can be fatal. Dr Daksha Emson, a psychiatrist with bipolar affective disorder, tragically killed herself and her baby daughter during a psych...
Psychiatria Danubina, 2017
The rise of radicalisation, the 'demonization' of Muslims in the media and the immigratio... more The rise of radicalisation, the 'demonization' of Muslims in the media and the immigration crisis in Europe have all contributed and colluded to heightened levels of Islamophobia in the West. The stigmatisation of Muslims can and has resulted in negative outcomes in this group such as elevated levels of psychological distress and an increase in hate crime and terrorist attacks perpetrated against Muslims from members of the far right. There are 1.6 billion Muslims on the planet and Islam is the fastest growing religion in the world. Now, more than ever it seems, is a critical time to learn about what the true message of Islam is and who the blessed prophet Muhammad peace be upon him (PBUH) was from reliable and authentic sources. This paper aims to challenge the stigma attached to Muslims through the following means: 1. It contains information to educate people about Islam, debunk myths and challenge negative stereotypes; 2. It utilizes the power of 'story-telling' t...
Psychiatria Danubina, 2017
To conduct a pilot study on a motion picture based, anti-stigma programme entitled, "The Wou... more To conduct a pilot study on a motion picture based, anti-stigma programme entitled, "The Wounded Healer film" to measure if it is associated with any changes in stigma variables in healthcare students and if it encouraged care seeking in this group. The 2008 Stigma Shout Survey of almost 4000 people using mental health services and carers revealed that healthcare professionals are a common source of stigma reported by people with mental illness. Psychological problems are common in medical students and doctors, however, thelevel of care seeking in this group is low. Fear of exposure to stigmatization is a crucial barrier to accessing and using mental health services. Recent research has revealed that film-based interventions can be used to challenge mental health stigma and encourage care seeking. We conducted a single-arm, pre-post comparison study on students who attended the Wounded Healer film at a University College London Psychiatry Society event (n=11). Before and a...
Psychiatria Danubina, 2017
1 in 4 people experience mental health problems at some point during their lives and Muslims are ... more 1 in 4 people experience mental health problems at some point during their lives and Muslims are no exception. Exacerbating the morbidity and mortality associated with mental health problems in Muslims is Islamophobia. Stigma and shame are major barriers to accessing and using mental health services and many Muslims with mental health problems do not receive the treatment they need. The Federation of Student Islamic Societies (FOSIS) United Kingdom branch organized a mental health conference to challenge the stigma attached to psychological problems in Muslims and to encourage care seeking in this group. We conducted a single arm, pre-post comparison study on Muslims who attended the FOSIS mental health conference in Birmingham Medical School, England. Validated stigma scales measuring knowledge, attitudes and behavior were administered on participants before and immediately after exposure to the programme. Participants were also asked to respond to statements, the items of which we...
Psychiatria Danubina, 2017
There are higher levels of psychological distress in healthcare professionals and students compar... more There are higher levels of psychological distress in healthcare professionals and students compared to the general population. Yet, despite the availability of effective treatment, many in this group continue to suffer in silence. Fear of exposure to stigmatization has been identified to be a major barrier to accessing and using mental health services. King's College London Undergraduate Psychiatry Society (KCL PsychSoc) organized an event entitled, 'What does bipolar disorder even mean? Psychological distress: How can we challenge the stigma?'. Healthcare professionals who themselves recovered from psychological problems and a mental health advocate with first-hand experience of psychological distress were invited to deliver talks followed by an interactive question and answer session. We conducted a single-arm pre-post comparison study. People who attended the KCL Psych Soc event were recruited to participate. Validated stigma scales on knowledge (Mental Health Knowled...
Psychiatria Danubina, 2015
Impulsivity is a complex behavioural feature of many psychiatric disorders, in particular of risk... more Impulsivity is a complex behavioural feature of many psychiatric disorders, in particular of risk-taking behaviour, and is an important determinant of personality. Both ADHD and bipolar disorder express features of impulsivity. The concept of having two or more simultaneous psychiatric conditions is an increasingly recognised concept in the field of psychiatry, and is important clinically for management and prognosis. Consequently, the aim of this case presentation is to report about a young patient with both bipolar II and ADHD, in order to better understand which of the possible clinical phenotypes of these psychiatric conditions exist in comorbidity, mainly focusing on impulsive features because of the relevant challenge that this psychological aspect can represent in the clinical treatment of these patients.
European Psychiatry, 2015
OCD is a condition seen often in Community Mental Health Teams in England. It is treated with med... more OCD is a condition seen often in Community Mental Health Teams in England. It is treated with medication and psychology. We wanted to assess what co-morbidities were present in our OCD patients, with which medications they were being treated, and whether patients had received psychological treatment. On assessment It is clear that a very large number of the OCD patients in our cohort are complex patients who have not responded to first line treatment, such as SSRIs or basic psychology, and who suffer from co-morbidities. Treatment of these patients, while oriented towards the achievement of recovery, is also relatively complex and long term.
BJPsych Open, 2015
SummarySuicidal thinking, self-harm and suicidal acts are common, although determining their prec... more SummarySuicidal thinking, self-harm and suicidal acts are common, although determining their precise prevalence is complex. Epidemiological work has identified a number of associated demographic and clinical factors, though, with the exception of past acts of self-harm, these are non-specific and weak future predictors. There is a critical need shift focus from managing ‘suicidality-by-proxy’ through general mental health treatments, to better understand the neuropsychology and neurophysiology of such behaviour to guide targeted interventions. The model of the cognitive control of emotion (MCCE) offers such a paradigm, with an underlying pan-diagnostic pathophysiology of a hypoactive prefrontal cortex failing to suitably inhibit an overactive threat-responding limbic system. The result is a phenotype – from any number of causative gene-environment interactions – primed to impulsively self-harm. We argue that such neural dysconnectivity is open to potential therapeutic modification f...
European Psychiatry, 2015
Introduction Prognostic staging is one of the most important current psychiatrical challenges. Ob... more Introduction Prognostic staging is one of the most important current psychiatrical challenges. Objectives Bipolar prognostic factors must be identified to assist in staging. Aims To assess prognostic factors, to describe any correlation with the disease outcome and to recommend that psychiatrists assess bipolar patients, determining their stage of disease in order to identify possible high-risk groups of patients. Methods We collected data from the clinical notes of 70 bipolar outpatients seen at the initial psychiatric assessment clinic about socio-demographic and clinical factors. Results The sample comprised 16 bipolar I (22.9%) and 54 bipolar II (77.1%) outpatients; 60.9% reported anxiety, 71.7 % mixed state features and 72.7% rapid cycling. A comparison between 12 prognostic factors found that only the correlations between current illicit drug use/previous illicit drug use, current alcohol use/previous alcohol use, and current illicit drug use/anxiety were statistically significant; the correlation between previous illicit drug use/previous alcohol use, previous alcohol use/family history and mixed state features/anxiety were almost significant. 17 patients were assigned to a care coordinator; we found no statistically significant differences between the patients with or without a care coordinator on the basis of the presence of 12 possible prognostic factors. Conclusions In our sample, some patients were found not to have information available so we suggest that a questionnaire to remind clinicians of potentially useful information would be helpful to aid in prognostication. Specific features of the disease (family history, age at onset, features of depressive episodes and mixed state, rapid cycling) may be highlighted.
Psychiatria Danubina, 2013
Bipolar Affective Disorder is frequently under-diagnosed and misdiagnosed, particularly as unipol... more Bipolar Affective Disorder is frequently under-diagnosed and misdiagnosed, particularly as unipolar depression. This has serious implications on treatment and outcome of the condition. A community mental health team (CMHT) in Bedford, United Kingdom, has therefore reassessed patients to examine whether it is possible to increase the sensitivity of diagnosis of bipolar affective disorder; to identify more cases and to identify them earlier, in order to be able to offer adequate treatment as early as possible. Standards were decided within the team for the diagnosis of bipolar disorder based on the DSM4 criteria for the diagnosis of Bipolar I and Bipolar II illness. Patients were reassessed and patient data from 2006, 2007, 2010 and 2011, as well as from 2013, with respect to psychiatric diagnoses. The results were audited and analysed in every year in question. The proportions of total bipolar, bipolar I affective disorder and bipolar II affective disorder diagnoses, as well as the p...
Psychiatria Danubina, 2013
The effect of reassessing patients with depression and resistant depression in a CMHT caseload us... more The effect of reassessing patients with depression and resistant depression in a CMHT caseload using the DSM IV criteria for bipolar I and bipolar II conditions inevitably leads to the diagnosis of more patients with bipolar disorder. This has an effect on the number of patients within the population of the CMHT who fall within the psychotic clusters of HONOS-PBR. This should effect the resources which will be allocated to deal with the patients in the team.
Psychiatria Danubina, 2013
A new Assessment service (ASPA) which has been developed in Bedford within the Community Psychiat... more A new Assessment service (ASPA) which has been developed in Bedford within the Community Psychiatric Team has been described. Demography of patients referred to the service as well as their diagnoses are explained. Outcomes of treatment in this assessment service are also assessed. The most common diagnoses were mood disorders. These were generally equally divided between patients with unipolar and bipolar disorder. The next most common diagnosis was obsessive compulsive disorder. Within the period, approximately one third of patients were referred back to primary care, one third were still in the assessment process, and one third had been admitted to secondary care community services.
Medicinski arhiv, 2003
The article describes the development of guidelines for the management of first episode psychosis... more The article describes the development of guidelines for the management of first episode psychosis, over the first few years of the illness. Such guidelines advocate the use of low dose medication (be this with typical or atypical anti-psychotics) as well as psychological techniques, and assertive case management. The paper will review the development of these guidelines, describe them, and suggest outcome measures for the treatment of first and early episodes.
Psychiatria Danubina, 2010
Recently there has been pressure on Secondary Psychiatric services to discharge patients back int... more Recently there has been pressure on Secondary Psychiatric services to discharge patients back into Primary care. This project is to show what depression treatments are used by Bedford East Community Mental Health Team (BECMHT) and therefore identify whether some of these patients could be appropriately managed in Primary care. We identified, using an anonymised database, patients being treated with different anti-depressant regimens in BECMHT. We compared these treatments with the steps described in NICE Guidelines, and other evidence based treatment modalities which we found on literature search. Based on this data, we attempted to predict which patients it might be safe to discharge to primary care for ongoing treatment. Many different combinations of medications were found. Many patients had other intercurrent mental health diagnoses. There are many possible evidence based treatments for depression which can be employed once those listed by NICE are exhausted. We review all of th...
Psychiatria Danubina, 2012
While most of the management of mental health in the UK is conducted in primary care, the diagnos... more While most of the management of mental health in the UK is conducted in primary care, the diagnosis by GPs has been shown to deficient in some areas. Bipolar disorder in particular is known to under-diagnosed but there is confusion as to whether this is due to poor recognition or conversion from unipolar depression In April and May 2012 an audit was conducted in secondary psychiatric services in Bedford, UK among 146 representative patients and 112 bipolar patients, examining the course of their illness and diagnosis Bipolar disorder is under-diagnosed in the community and in secondary care. First manic or hypomanic symptoms usually follow first depressive symptoms by several years (μ=7.3, σ=7.9). A diagnosis of bipolar also commonly follows manic or hypomanic symptoms by years (μ=7.6, σ=8.3). Both psychiatrists and GPs under-diagnose bipolar, but this study shows it may be due to two factors: poor recognition by doctors and conversion from major depressive disorder. GPs and psychia...
Psychiatria Danubina, 2011
Post-traumatic stress disorder (PTSD) can develop following exposure to a stressful event of an e... more Post-traumatic stress disorder (PTSD) can develop following exposure to a stressful event of an exceptionally threatening or catastrophic nature. Symptoms experienced by PTSD suffers can include re-experiencing the trauma through intrusive 'flashbacks' and recurrent dreams or nightmares, avoidance of stimuli associated with the stressor, hyperarousal, emotional blunting and an inability to remember aspects of the period of exposure to the stressor. We performed an audit of the treatment of PTSD in patients under the care of the Bedford East Mental Health Team to examine the psychological and pharmacological treatments currently being used and compared these with data collected in 2008. In summary, in the last 2 years there has been an increase in the identification of PTSD patients in Bedford East. These patients are a group with high levels of comorbidities and risk factors, and are challenging to treat. As a result of this, a wide range of agents including antidepressants ...
European Psychiatry, 2014
Background.: While knowledge of the aetiology of psychiatric disorders is complex and has not bee... more Background.: While knowledge of the aetiology of psychiatric disorders is complex and has not been fully elucidated, recently it has been noted that a sizeable proportion of psychiatric patients have coexisting immunological health conditions. Previous work has given weight to the theory that the immune system has important neuromodulatory roles in the brain, and disturbances in this system can lead to psychiatric manifestations. Aims.: Epidemiological evidence is needed to explore the strength of the correlation between immune conditions and psychiatric disorders, and this audit attempts to investigate this potential association using the psychiatric patient database of Bedford East Community Mental Health Team. Methods.: In this audit, the patient information was analysed to obtain prevalence data for an array of autoimmune conditions. This was then compared to the expected prevalence of the same autoimmune conditions. Results: The results showed that patients with each psychiatric condition had a higher than expected prevalence of autoimmune conditions overall. The most striking discrepancy was that the percentage of patients with coexisting hypothyroidism was higher than expected in almost every psychiatric condition recorded. Other patterns in prevalence of autoimmune conditions were also noted. Discussion: A causative link between psychiatric and autoimmune diseases is still questionable, and this issue needs to be researched further in terms of prevalence data and aetiological evidence. Conclusion.: There are significant implications for clinical practice if a greater incidence of autoimmune conditions among psychiatric patients is proven. This includes screening opportunities and risk assessments, as well as potential for new pharmacological therapies based around immune regulation.
European Psychiatry, 2011
IntroductionPost-traumatic stress disorder (PTSD) is a disorder which can develop following expos... more IntroductionPost-traumatic stress disorder (PTSD) is a disorder which can develop following exposure to one or more severely traumatic events. Symptoms experienced by PTSD suffers include re-experiencing the trauma through intrusive ‘flashbacks’ and recurrent dreams or nightmares, distress when exposed to reminders of the trauma, hyperarousal and emotional blunting. These symptoms can cause significant impairment of function and reduction in quality of life for suffers. Both psychotherapies, including cognitive behavioural therapies (CBTs) and eye movement desensitisation and reprocessing (EMDR), and pharmacotherapy are used in the treatment of PTSD.MethodWe audited patients with PTSD in Bedford East performed in November 2008. A re-audit was performed using data from August 2010 patient database. Demographic information, risk factors, co-morbidities, psychological therapy and pharmacotherapy were compared between these audit and re-audit.ResultsThere is increased use of antidepress...
European Psychiatry, 2008
Psychiatria Danubina, 2019
Gender differences in the prevalence, experiences and presentations of mental illnesses are well-... more Gender differences in the prevalence, experiences and presentations of mental illnesses are well-known and are reflected in research findings, clinical practice, society and popular culture. This paper will compare and contrast the role that gender and other factors play in the portrayals of depressive illness in two acclaimed texts, 'The Bell Jar' by Sylvia Plath and, 'Darkness Visible' by William Styron.
Psychiatria Danubina, 2020
Mental health problems are over-represented in doctors and medical students. However, stigma and ... more Mental health problems are over-represented in doctors and medical students. However, stigma and 'a culture of shame' are formidable barriers to mental health services and consequently many doctors and medical students with mental health difficulties continue to suffer in silence despite the availability of effective treatment. Indeed, a recent study on over 2100 female physicians who met the diagnostic criteria for a mental disorder revealed that 50% were reluctant to seek professional help due to fear of exposure to stigma. Left untreated or undertreated, mental health problems in doctors can result in impairment of occupational functioning, compromise patient safety and place considerable strain on the economy (by increasing the amount of sick leave taken). Moreover, the consequences of mental health stigma in the medical profession can be fatal. Dr Daksha Emson, a psychiatrist with bipolar affective disorder, tragically killed herself and her baby daughter during a psych...
Psychiatria Danubina, 2017
The rise of radicalisation, the 'demonization' of Muslims in the media and the immigratio... more The rise of radicalisation, the 'demonization' of Muslims in the media and the immigration crisis in Europe have all contributed and colluded to heightened levels of Islamophobia in the West. The stigmatisation of Muslims can and has resulted in negative outcomes in this group such as elevated levels of psychological distress and an increase in hate crime and terrorist attacks perpetrated against Muslims from members of the far right. There are 1.6 billion Muslims on the planet and Islam is the fastest growing religion in the world. Now, more than ever it seems, is a critical time to learn about what the true message of Islam is and who the blessed prophet Muhammad peace be upon him (PBUH) was from reliable and authentic sources. This paper aims to challenge the stigma attached to Muslims through the following means: 1. It contains information to educate people about Islam, debunk myths and challenge negative stereotypes; 2. It utilizes the power of 'story-telling' t...
Psychiatria Danubina, 2017
To conduct a pilot study on a motion picture based, anti-stigma programme entitled, "The Wou... more To conduct a pilot study on a motion picture based, anti-stigma programme entitled, "The Wounded Healer film" to measure if it is associated with any changes in stigma variables in healthcare students and if it encouraged care seeking in this group. The 2008 Stigma Shout Survey of almost 4000 people using mental health services and carers revealed that healthcare professionals are a common source of stigma reported by people with mental illness. Psychological problems are common in medical students and doctors, however, thelevel of care seeking in this group is low. Fear of exposure to stigmatization is a crucial barrier to accessing and using mental health services. Recent research has revealed that film-based interventions can be used to challenge mental health stigma and encourage care seeking. We conducted a single-arm, pre-post comparison study on students who attended the Wounded Healer film at a University College London Psychiatry Society event (n=11). Before and a...
Psychiatria Danubina, 2017
1 in 4 people experience mental health problems at some point during their lives and Muslims are ... more 1 in 4 people experience mental health problems at some point during their lives and Muslims are no exception. Exacerbating the morbidity and mortality associated with mental health problems in Muslims is Islamophobia. Stigma and shame are major barriers to accessing and using mental health services and many Muslims with mental health problems do not receive the treatment they need. The Federation of Student Islamic Societies (FOSIS) United Kingdom branch organized a mental health conference to challenge the stigma attached to psychological problems in Muslims and to encourage care seeking in this group. We conducted a single arm, pre-post comparison study on Muslims who attended the FOSIS mental health conference in Birmingham Medical School, England. Validated stigma scales measuring knowledge, attitudes and behavior were administered on participants before and immediately after exposure to the programme. Participants were also asked to respond to statements, the items of which we...
Psychiatria Danubina, 2017
There are higher levels of psychological distress in healthcare professionals and students compar... more There are higher levels of psychological distress in healthcare professionals and students compared to the general population. Yet, despite the availability of effective treatment, many in this group continue to suffer in silence. Fear of exposure to stigmatization has been identified to be a major barrier to accessing and using mental health services. King's College London Undergraduate Psychiatry Society (KCL PsychSoc) organized an event entitled, 'What does bipolar disorder even mean? Psychological distress: How can we challenge the stigma?'. Healthcare professionals who themselves recovered from psychological problems and a mental health advocate with first-hand experience of psychological distress were invited to deliver talks followed by an interactive question and answer session. We conducted a single-arm pre-post comparison study. People who attended the KCL Psych Soc event were recruited to participate. Validated stigma scales on knowledge (Mental Health Knowled...
Psychiatria Danubina, 2015
Impulsivity is a complex behavioural feature of many psychiatric disorders, in particular of risk... more Impulsivity is a complex behavioural feature of many psychiatric disorders, in particular of risk-taking behaviour, and is an important determinant of personality. Both ADHD and bipolar disorder express features of impulsivity. The concept of having two or more simultaneous psychiatric conditions is an increasingly recognised concept in the field of psychiatry, and is important clinically for management and prognosis. Consequently, the aim of this case presentation is to report about a young patient with both bipolar II and ADHD, in order to better understand which of the possible clinical phenotypes of these psychiatric conditions exist in comorbidity, mainly focusing on impulsive features because of the relevant challenge that this psychological aspect can represent in the clinical treatment of these patients.
European Psychiatry, 2015
OCD is a condition seen often in Community Mental Health Teams in England. It is treated with med... more OCD is a condition seen often in Community Mental Health Teams in England. It is treated with medication and psychology. We wanted to assess what co-morbidities were present in our OCD patients, with which medications they were being treated, and whether patients had received psychological treatment. On assessment It is clear that a very large number of the OCD patients in our cohort are complex patients who have not responded to first line treatment, such as SSRIs or basic psychology, and who suffer from co-morbidities. Treatment of these patients, while oriented towards the achievement of recovery, is also relatively complex and long term.
BJPsych Open, 2015
SummarySuicidal thinking, self-harm and suicidal acts are common, although determining their prec... more SummarySuicidal thinking, self-harm and suicidal acts are common, although determining their precise prevalence is complex. Epidemiological work has identified a number of associated demographic and clinical factors, though, with the exception of past acts of self-harm, these are non-specific and weak future predictors. There is a critical need shift focus from managing ‘suicidality-by-proxy’ through general mental health treatments, to better understand the neuropsychology and neurophysiology of such behaviour to guide targeted interventions. The model of the cognitive control of emotion (MCCE) offers such a paradigm, with an underlying pan-diagnostic pathophysiology of a hypoactive prefrontal cortex failing to suitably inhibit an overactive threat-responding limbic system. The result is a phenotype – from any number of causative gene-environment interactions – primed to impulsively self-harm. We argue that such neural dysconnectivity is open to potential therapeutic modification f...
European Psychiatry, 2015
Introduction Prognostic staging is one of the most important current psychiatrical challenges. Ob... more Introduction Prognostic staging is one of the most important current psychiatrical challenges. Objectives Bipolar prognostic factors must be identified to assist in staging. Aims To assess prognostic factors, to describe any correlation with the disease outcome and to recommend that psychiatrists assess bipolar patients, determining their stage of disease in order to identify possible high-risk groups of patients. Methods We collected data from the clinical notes of 70 bipolar outpatients seen at the initial psychiatric assessment clinic about socio-demographic and clinical factors. Results The sample comprised 16 bipolar I (22.9%) and 54 bipolar II (77.1%) outpatients; 60.9% reported anxiety, 71.7 % mixed state features and 72.7% rapid cycling. A comparison between 12 prognostic factors found that only the correlations between current illicit drug use/previous illicit drug use, current alcohol use/previous alcohol use, and current illicit drug use/anxiety were statistically significant; the correlation between previous illicit drug use/previous alcohol use, previous alcohol use/family history and mixed state features/anxiety were almost significant. 17 patients were assigned to a care coordinator; we found no statistically significant differences between the patients with or without a care coordinator on the basis of the presence of 12 possible prognostic factors. Conclusions In our sample, some patients were found not to have information available so we suggest that a questionnaire to remind clinicians of potentially useful information would be helpful to aid in prognostication. Specific features of the disease (family history, age at onset, features of depressive episodes and mixed state, rapid cycling) may be highlighted.
Psychiatria Danubina, 2013
Bipolar Affective Disorder is frequently under-diagnosed and misdiagnosed, particularly as unipol... more Bipolar Affective Disorder is frequently under-diagnosed and misdiagnosed, particularly as unipolar depression. This has serious implications on treatment and outcome of the condition. A community mental health team (CMHT) in Bedford, United Kingdom, has therefore reassessed patients to examine whether it is possible to increase the sensitivity of diagnosis of bipolar affective disorder; to identify more cases and to identify them earlier, in order to be able to offer adequate treatment as early as possible. Standards were decided within the team for the diagnosis of bipolar disorder based on the DSM4 criteria for the diagnosis of Bipolar I and Bipolar II illness. Patients were reassessed and patient data from 2006, 2007, 2010 and 2011, as well as from 2013, with respect to psychiatric diagnoses. The results were audited and analysed in every year in question. The proportions of total bipolar, bipolar I affective disorder and bipolar II affective disorder diagnoses, as well as the p...
Psychiatria Danubina, 2013
The effect of reassessing patients with depression and resistant depression in a CMHT caseload us... more The effect of reassessing patients with depression and resistant depression in a CMHT caseload using the DSM IV criteria for bipolar I and bipolar II conditions inevitably leads to the diagnosis of more patients with bipolar disorder. This has an effect on the number of patients within the population of the CMHT who fall within the psychotic clusters of HONOS-PBR. This should effect the resources which will be allocated to deal with the patients in the team.
Psychiatria Danubina, 2013
A new Assessment service (ASPA) which has been developed in Bedford within the Community Psychiat... more A new Assessment service (ASPA) which has been developed in Bedford within the Community Psychiatric Team has been described. Demography of patients referred to the service as well as their diagnoses are explained. Outcomes of treatment in this assessment service are also assessed. The most common diagnoses were mood disorders. These were generally equally divided between patients with unipolar and bipolar disorder. The next most common diagnosis was obsessive compulsive disorder. Within the period, approximately one third of patients were referred back to primary care, one third were still in the assessment process, and one third had been admitted to secondary care community services.
Medicinski arhiv, 2003
The article describes the development of guidelines for the management of first episode psychosis... more The article describes the development of guidelines for the management of first episode psychosis, over the first few years of the illness. Such guidelines advocate the use of low dose medication (be this with typical or atypical anti-psychotics) as well as psychological techniques, and assertive case management. The paper will review the development of these guidelines, describe them, and suggest outcome measures for the treatment of first and early episodes.
Psychiatria Danubina, 2010
Recently there has been pressure on Secondary Psychiatric services to discharge patients back int... more Recently there has been pressure on Secondary Psychiatric services to discharge patients back into Primary care. This project is to show what depression treatments are used by Bedford East Community Mental Health Team (BECMHT) and therefore identify whether some of these patients could be appropriately managed in Primary care. We identified, using an anonymised database, patients being treated with different anti-depressant regimens in BECMHT. We compared these treatments with the steps described in NICE Guidelines, and other evidence based treatment modalities which we found on literature search. Based on this data, we attempted to predict which patients it might be safe to discharge to primary care for ongoing treatment. Many different combinations of medications were found. Many patients had other intercurrent mental health diagnoses. There are many possible evidence based treatments for depression which can be employed once those listed by NICE are exhausted. We review all of th...
Psychiatria Danubina, 2012
While most of the management of mental health in the UK is conducted in primary care, the diagnos... more While most of the management of mental health in the UK is conducted in primary care, the diagnosis by GPs has been shown to deficient in some areas. Bipolar disorder in particular is known to under-diagnosed but there is confusion as to whether this is due to poor recognition or conversion from unipolar depression In April and May 2012 an audit was conducted in secondary psychiatric services in Bedford, UK among 146 representative patients and 112 bipolar patients, examining the course of their illness and diagnosis Bipolar disorder is under-diagnosed in the community and in secondary care. First manic or hypomanic symptoms usually follow first depressive symptoms by several years (μ=7.3, σ=7.9). A diagnosis of bipolar also commonly follows manic or hypomanic symptoms by years (μ=7.6, σ=8.3). Both psychiatrists and GPs under-diagnose bipolar, but this study shows it may be due to two factors: poor recognition by doctors and conversion from major depressive disorder. GPs and psychia...
Psychiatria Danubina, 2011
Post-traumatic stress disorder (PTSD) can develop following exposure to a stressful event of an e... more Post-traumatic stress disorder (PTSD) can develop following exposure to a stressful event of an exceptionally threatening or catastrophic nature. Symptoms experienced by PTSD suffers can include re-experiencing the trauma through intrusive 'flashbacks' and recurrent dreams or nightmares, avoidance of stimuli associated with the stressor, hyperarousal, emotional blunting and an inability to remember aspects of the period of exposure to the stressor. We performed an audit of the treatment of PTSD in patients under the care of the Bedford East Mental Health Team to examine the psychological and pharmacological treatments currently being used and compared these with data collected in 2008. In summary, in the last 2 years there has been an increase in the identification of PTSD patients in Bedford East. These patients are a group with high levels of comorbidities and risk factors, and are challenging to treat. As a result of this, a wide range of agents including antidepressants ...
European Psychiatry, 2014
Background.: While knowledge of the aetiology of psychiatric disorders is complex and has not bee... more Background.: While knowledge of the aetiology of psychiatric disorders is complex and has not been fully elucidated, recently it has been noted that a sizeable proportion of psychiatric patients have coexisting immunological health conditions. Previous work has given weight to the theory that the immune system has important neuromodulatory roles in the brain, and disturbances in this system can lead to psychiatric manifestations. Aims.: Epidemiological evidence is needed to explore the strength of the correlation between immune conditions and psychiatric disorders, and this audit attempts to investigate this potential association using the psychiatric patient database of Bedford East Community Mental Health Team. Methods.: In this audit, the patient information was analysed to obtain prevalence data for an array of autoimmune conditions. This was then compared to the expected prevalence of the same autoimmune conditions. Results: The results showed that patients with each psychiatric condition had a higher than expected prevalence of autoimmune conditions overall. The most striking discrepancy was that the percentage of patients with coexisting hypothyroidism was higher than expected in almost every psychiatric condition recorded. Other patterns in prevalence of autoimmune conditions were also noted. Discussion: A causative link between psychiatric and autoimmune diseases is still questionable, and this issue needs to be researched further in terms of prevalence data and aetiological evidence. Conclusion.: There are significant implications for clinical practice if a greater incidence of autoimmune conditions among psychiatric patients is proven. This includes screening opportunities and risk assessments, as well as potential for new pharmacological therapies based around immune regulation.
European Psychiatry, 2011
IntroductionPost-traumatic stress disorder (PTSD) is a disorder which can develop following expos... more IntroductionPost-traumatic stress disorder (PTSD) is a disorder which can develop following exposure to one or more severely traumatic events. Symptoms experienced by PTSD suffers include re-experiencing the trauma through intrusive ‘flashbacks’ and recurrent dreams or nightmares, distress when exposed to reminders of the trauma, hyperarousal and emotional blunting. These symptoms can cause significant impairment of function and reduction in quality of life for suffers. Both psychotherapies, including cognitive behavioural therapies (CBTs) and eye movement desensitisation and reprocessing (EMDR), and pharmacotherapy are used in the treatment of PTSD.MethodWe audited patients with PTSD in Bedford East performed in November 2008. A re-audit was performed using data from August 2010 patient database. Demographic information, risk factors, co-morbidities, psychological therapy and pharmacotherapy were compared between these audit and re-audit.ResultsThere is increased use of antidepress...
European Psychiatry, 2008