Hamid Rahmanian | St George's, University of London (original) (raw)

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Papers by Hamid Rahmanian

Kent Journal of Psychiatry, 2017

Attention Deficit and Hyperactivity Disorder (ADHD) is a neuropsychiatric syndrome found in child... more Attention Deficit and Hyperactivity Disorder (ADHD) is a neuropsychiatric syndrome found in children with a triad of symptoms related to hyperactivity, impulsivity and inattention. Research since the 1990s has confirmed that a significant number of children with ADHD continue to have symptoms into their adult lives. In adulthood, the hyperactivity decreases, but inattention, disorganisation, and impulsivity might remain, resulting in difficulty in functioning at home and at work (1). Such patients are more prone to other psychiatric symptoms and disorders including substance abuse and associated risky behaviours. Treatment of ADHD includes psycho-education and pharmacotherapy for ADHD and comorbid disorders, coaching, cognitive behaviour therapy and family therapy (2).

The prevalence of ADHD in adults is 2-5%, and 10-20% in those with common mental health disorders. These rates are higher among those attending forensic, addiction and personality disorder units, which highlights the importance of screening for adult ADHD in such high-risk populations (3, 2).

Our Trust is not commissioned for the treatment of adult ADHD. Therefore, such cases are referred to the specialist centre at the Maudsley for assessment & treatment. This happens despite local consultants being able to diagnose & treat adult ADHD. Following assessment at the Maudsley, they are sent back to the General Practitioner (GP) to implement the treatment plan. In a number of cases, we (secondary psychiatric service) are requested to manage the co-morbid disorders. This leads to confusion among clinicians regarding their treatment roles and causes additional stress to the patients and their carers. A single referral to the specialist centre costs the Clinical Commissioning Groups (CCGs) £1250 with a limited scope for re-referral if the treatment plan does not work. The waiting time for the approval of funding from the CCGs and subsequent specialist assessment can take up to 12 months.

Adult ADHD patients in whom the diagnosis has not been made and/or where ineffective treatments are in place for alternative diagnoses, add to higher rates of presentations to A&E departments and mental health services along with health, legal and financial risks & implications. Transition from child to adult psychiatric services also remains a major concern for having no local service level agreements between various care providers because ADHD treatment is not commissioned for the adult population.

NICE clinical guidelines (4) are a great resource for healthcare professionals to develop, with relevant agencies, effective services for the diagnosis and management of adult ADHD. These guidelines make a case for commissioning services for the diagnosis and management of ADHD, specify service requirements, and help determine local service needs while ensuring quality. They also cover the transition of ADHD cases receiving treatment from child mental/health services to the adult mental health services. Department of Health – DoH (5) made similar recommendations earlier after highlighting the multidimensional social, health and legal needs of adult ADHD sufferers and their carers.

Various government initiatives over time, including National Service Framework (6) New Ways of Working (7) and New Horizons (8) for mental health services, have recommended faster, equal & easy/local access and ways to combat discrimination against individuals/groups of patients to prevent future crises of care. More recently, chief executive of the National Health Service (NHS), Simon Stevens, has talked (9) about commissioners finding smart ways of getting more value for money while appreciating the pull for treating patients close to home though more local & community-orientated services. He also argued that medical training and staffing should not drive the wholesale reorganization of district general hospitals across England.

There is no doubt that NHS is facing a financial challenge and needs to come up with considerable improvements in performance & outcomes if it is to continue providing high-quality services without additional funds. Therefore, there is a great drive from DoH, cascaded down to commissioners/CCGs to improve productivity in mental health services while offering support for coping with the future challenge of building a preventive and empowered mental health systems (10).

European Psychiatry, Apr 1, 2017

European Psychiatry, 2015

Post Natal Depression in Iran 10-15 in very 100 women became depressed after having a baby. A lit... more Post Natal Depression in Iran 10-15 in very 100 women became depressed after having a baby. A litreture review was conducted between December 2012-July 2013. PubMed and ISI web of knowlege searches were used to access academic litretures.grey litreture access through the google search. Finding; Most Studies on PND in Iran focus on prevelance and risk factors. Edinbourgh questionaire (farsi version) was a reliable and valid tool to measure PND. Higher rate of PND in IRAN (20 to 40.4 %) Risk factors: unemployment, low education, younger mother, unplanned pregnancy, undesired gender of the baby, history of depression, prim parity, history of still birth and abortion, having 3 or more child, being house wife mothers anxiry during the pregnancy increased the risk of PND. Conclusion Prevention, screening and effective management are possible. There is a need for increased screening and clinician awarness.

Self-amputation, the extreme form of self-mutilation, is uncommon. The vast majority of cases are... more Self-amputation, the extreme form of self-mutilation, is uncommon. The vast majority of cases are associated with psychosis, with a small number being assigned the controversial diagnosis of body identity integrity disorder. In this article, we report two cases of non-psychotic self-amputation and their similarities with a view to highlighting the risk factors and formulating an appropriate management plan.

Journal of personality disorders, 2021

Systems Training for Emotional Predictability and Problem Solving (STEPPS) for borderline persona... more Systems Training for Emotional Predictability and Problem Solving (STEPPS) for borderline personality disorder (BPD) has been adapted for a primary care setting into a 13-week group treatment for emotional intensity difficulties (STEPPS EI). This is the first study to examine the effectiveness and potential outcome and dropout predictors of STEPPS EI in a primary care setting. Severity of BPD, depression, and anxiety symptoms were measured pre- and postintervention for 148 participants. Treatment completers showed improvements in depression, anxiety, and BPD symptoms with medium to large effect sizes. A predictor of symptom improvement was higher baseline severity for each of the symptom measures. Attending a psychoeducational group prior to STEPPS EI was associated with lower odds of dropout. The findings support the use of STEPPS EI in a primary care setting, with the potential to alleviate the burden from other local services.

Iranian journal of psychiatry and behavioral sciences, 2015

Self-amputation, the extreme form of self-mutilation, is uncommon. The vast majority of cases are... more Self-amputation, the extreme form of self-mutilation, is uncommon. The vast majority of cases are associated with psychosis, with a small number being assigned the controversial diagnosis of body identity integrity disorder. In this article, we report two cases of non-psychotic self-amputation and their similarities with a view to highlighting the risk factors and formulating an appropriate management plan.

As a mental health community we are proud to mark World Health Day, 7th April 2017, which this ye... more As a mental health community we are proud to mark World Health Day, 7th April 2017, which this year has a theme of depression and suicide. This is the first time that there has been mental health theme on World Health Day since 2001. We commemorate this day with stories of depression from over 30 countries around the world. We know that depression is one of the most disabling conditions in global health – currently the third most disabling condition globally and predicted to be the leading and most disabling condition throughout the world by 2030. Depression is universal, taking no account of class, religion, or ethnic group. It spares neither the rich, nor the poor. It is the silent illness causing untold misery. It leads to effects on whole families, children's health and wellbeing. In terms of mental health interventions, if there is just one thing we can do, it should be to diagnose and treat depression. Treatment of depression is cost-effective and cheap, with a huge dividend in well-being for the affected and their families. In these stories we see a range of views of depression, but the same themes come up again and again – barriers to treatment, stigma, missed diagnosis and opportunities to pick up depression are universal in low-, middle- and high-income countries. The countries have been selected through our professional and personal connections and don’t represent any agenda. The views expressed belong to the individual authors.

Kent Journal of Psychiatry, 2017

Attention Deficit and Hyperactivity Disorder (ADHD) is a neuropsychiatric syndrome found in child... more Attention Deficit and Hyperactivity Disorder (ADHD) is a neuropsychiatric syndrome found in children with a triad of symptoms related to hyperactivity, impulsivity and inattention. Research since the 1990s has confirmed that a significant number of children with ADHD continue to have symptoms into their adult lives. In adulthood, the hyperactivity decreases, but inattention, disorganisation, and impulsivity might remain, resulting in difficulty in functioning at home and at work (1). Such patients are more prone to other psychiatric symptoms and disorders including substance abuse and associated risky behaviours. Treatment of ADHD includes psycho-education and pharmacotherapy for ADHD and comorbid disorders, coaching, cognitive behaviour therapy and family therapy (2).

The prevalence of ADHD in adults is 2-5%, and 10-20% in those with common mental health disorders. These rates are higher among those attending forensic, addiction and personality disorder units, which highlights the importance of screening for adult ADHD in such high-risk populations (3, 2).

Our Trust is not commissioned for the treatment of adult ADHD. Therefore, such cases are referred to the specialist centre at the Maudsley for assessment & treatment. This happens despite local consultants being able to diagnose & treat adult ADHD. Following assessment at the Maudsley, they are sent back to the General Practitioner (GP) to implement the treatment plan. In a number of cases, we (secondary psychiatric service) are requested to manage the co-morbid disorders. This leads to confusion among clinicians regarding their treatment roles and causes additional stress to the patients and their carers. A single referral to the specialist centre costs the Clinical Commissioning Groups (CCGs) £1250 with a limited scope for re-referral if the treatment plan does not work. The waiting time for the approval of funding from the CCGs and subsequent specialist assessment can take up to 12 months.

Adult ADHD patients in whom the diagnosis has not been made and/or where ineffective treatments are in place for alternative diagnoses, add to higher rates of presentations to A&E departments and mental health services along with health, legal and financial risks & implications. Transition from child to adult psychiatric services also remains a major concern for having no local service level agreements between various care providers because ADHD treatment is not commissioned for the adult population.

NICE clinical guidelines (4) are a great resource for healthcare professionals to develop, with relevant agencies, effective services for the diagnosis and management of adult ADHD. These guidelines make a case for commissioning services for the diagnosis and management of ADHD, specify service requirements, and help determine local service needs while ensuring quality. They also cover the transition of ADHD cases receiving treatment from child mental/health services to the adult mental health services. Department of Health – DoH (5) made similar recommendations earlier after highlighting the multidimensional social, health and legal needs of adult ADHD sufferers and their carers.

Various government initiatives over time, including National Service Framework (6) New Ways of Working (7) and New Horizons (8) for mental health services, have recommended faster, equal & easy/local access and ways to combat discrimination against individuals/groups of patients to prevent future crises of care. More recently, chief executive of the National Health Service (NHS), Simon Stevens, has talked (9) about commissioners finding smart ways of getting more value for money while appreciating the pull for treating patients close to home though more local & community-orientated services. He also argued that medical training and staffing should not drive the wholesale reorganization of district general hospitals across England.

There is no doubt that NHS is facing a financial challenge and needs to come up with considerable improvements in performance & outcomes if it is to continue providing high-quality services without additional funds. Therefore, there is a great drive from DoH, cascaded down to commissioners/CCGs to improve productivity in mental health services while offering support for coping with the future challenge of building a preventive and empowered mental health systems (10).

European Psychiatry, Apr 1, 2017

European Psychiatry, 2015

Post Natal Depression in Iran 10-15 in very 100 women became depressed after having a baby. A lit... more Post Natal Depression in Iran 10-15 in very 100 women became depressed after having a baby. A litreture review was conducted between December 2012-July 2013. PubMed and ISI web of knowlege searches were used to access academic litretures.grey litreture access through the google search. Finding; Most Studies on PND in Iran focus on prevelance and risk factors. Edinbourgh questionaire (farsi version) was a reliable and valid tool to measure PND. Higher rate of PND in IRAN (20 to 40.4 %) Risk factors: unemployment, low education, younger mother, unplanned pregnancy, undesired gender of the baby, history of depression, prim parity, history of still birth and abortion, having 3 or more child, being house wife mothers anxiry during the pregnancy increased the risk of PND. Conclusion Prevention, screening and effective management are possible. There is a need for increased screening and clinician awarness.

Self-amputation, the extreme form of self-mutilation, is uncommon. The vast majority of cases are... more Self-amputation, the extreme form of self-mutilation, is uncommon. The vast majority of cases are associated with psychosis, with a small number being assigned the controversial diagnosis of body identity integrity disorder. In this article, we report two cases of non-psychotic self-amputation and their similarities with a view to highlighting the risk factors and formulating an appropriate management plan.

Journal of personality disorders, 2021

Systems Training for Emotional Predictability and Problem Solving (STEPPS) for borderline persona... more Systems Training for Emotional Predictability and Problem Solving (STEPPS) for borderline personality disorder (BPD) has been adapted for a primary care setting into a 13-week group treatment for emotional intensity difficulties (STEPPS EI). This is the first study to examine the effectiveness and potential outcome and dropout predictors of STEPPS EI in a primary care setting. Severity of BPD, depression, and anxiety symptoms were measured pre- and postintervention for 148 participants. Treatment completers showed improvements in depression, anxiety, and BPD symptoms with medium to large effect sizes. A predictor of symptom improvement was higher baseline severity for each of the symptom measures. Attending a psychoeducational group prior to STEPPS EI was associated with lower odds of dropout. The findings support the use of STEPPS EI in a primary care setting, with the potential to alleviate the burden from other local services.

Iranian journal of psychiatry and behavioral sciences, 2015

Self-amputation, the extreme form of self-mutilation, is uncommon. The vast majority of cases are... more Self-amputation, the extreme form of self-mutilation, is uncommon. The vast majority of cases are associated with psychosis, with a small number being assigned the controversial diagnosis of body identity integrity disorder. In this article, we report two cases of non-psychotic self-amputation and their similarities with a view to highlighting the risk factors and formulating an appropriate management plan.

As a mental health community we are proud to mark World Health Day, 7th April 2017, which this ye... more As a mental health community we are proud to mark World Health Day, 7th April 2017, which this year has a theme of depression and suicide. This is the first time that there has been mental health theme on World Health Day since 2001. We commemorate this day with stories of depression from over 30 countries around the world. We know that depression is one of the most disabling conditions in global health – currently the third most disabling condition globally and predicted to be the leading and most disabling condition throughout the world by 2030. Depression is universal, taking no account of class, religion, or ethnic group. It spares neither the rich, nor the poor. It is the silent illness causing untold misery. It leads to effects on whole families, children's health and wellbeing. In terms of mental health interventions, if there is just one thing we can do, it should be to diagnose and treat depression. Treatment of depression is cost-effective and cheap, with a huge dividend in well-being for the affected and their families. In these stories we see a range of views of depression, but the same themes come up again and again – barriers to treatment, stigma, missed diagnosis and opportunities to pick up depression are universal in low-, middle- and high-income countries. The countries have been selected through our professional and personal connections and don’t represent any agenda. The views expressed belong to the individual authors.