Health screening audit – south Barnet PCMH pilot (original) (raw)
Related papers
Psychiatric disorders and psychiatric consultation in a general hospital: a case- control study
Revista Brasileira de Psiquiatria, 2003
Introduction: Psychiatric consultation (PC) has been considered an efficient tool to develop research, to track and to give assistance benefiting patients, health professionals and the institution. However, it has not been much used in Brazil. Although 30 to 50% of general hospital (GH) inpatients may present a psychiatric disorder, only 1 to 12% of them are referred to assessment. The aims of this study were: to assess mental disorders in a GH; to identify which of these patients are sent to psychiatric care; to verify alleged reasons for referral to psychiatric consultation, and to examine the relationship between PC and psychiatric learning (during medical school and residence). Methods: A case-control patient study was conducted (47 cases and 94 controls) to analyze in detail the following variables: socio-demographic; clinical; degree of information (about the disease and diagnostic/therapeutic procedures), and relationship between patient and health team. Psychiatric diagnoses were made according to the ICD-10 criteria. The Self Report Questionnaire (SRQ), the CAGE and Brief Psychiatric Rating Scale (BPRS) were used as well as a specifically designed questionnaire to collect clinical and demographic data. Results: Behavioral alterations, either of elation or of depression, were the main for requesting a PC ; 95.8% of the cases and 27.7% of the controls had a mental disorder. Organic mental disorders and alcohol-related disorders were the most frequent diagnoses in group I (cases), while anxiety, depressive and alcohol-related disorders were predominant in group II (controls). Control group patients were better informed and more able to establish an appropriate relationship with the health team than case patients. The logistic regression showed CAGEpositive patients having 12.85 times greater risk of being referred to PC, followed by unemployed patients (2.44 times more PC referrals). Discussion: The SRQ and CAGE were quite useful in the screening of possible patients and might be important for medical students to learn and use as generalists. Further research is needed to verify if and how the newlyestablished service will improve the diagnostic and treatment skills of our students.
Concordance in psychopharmacological treatment before and after first mental health consultation
Archives of Psychiatric Nursing, 2022
To analyse concordance between treatment prescribed before and after the first mental health consultation. We understand concordance in two different senses: first, as a similar amount of equivalent doses and drug type; second, as a similar treatment for each patient. Method: This is an analytical, descriptive, retrospective study on psychopharmacological treatment before and after first mental health consultation of 1236 patients. Drugs were classified into four groups and the equivalent dose respect to reference medication was considered in each group in order to make a comparison between primary and mental health. Results: Moderate concordance was found in prescribed treatments before and after first mental health consultation (except antidepressants). The average number of benzodiazepines decreased, as did average doses prescribed at mental health consultation respect to previously prescribed treatment; average doses of antidepressants, however, increased. From the patient's perspective, dose increase was more frequent than decrease. Nevertheless, a high percentage of polymedicated patients were found, although this percentage decreased after the first mental health consultation. Conclusion: There exists a moderate concordance between the pharmacological treatment prescribed before and after the first mental health consultation. However, the use of benzodiazepines diminished significantly after the first consultation, mainly due to a decrease in the percentage of polymedicated patients.
Consultation-liaison psychiatry: Psychopharmacology Dos & Dont���s
2012
Consultation-Liaison (C-L) Psychiatry. C-L psychiatrists are specialists in the care of psychiatric disorders in the medically ill. This specialized field is also now referred to as Psychosomatic Medicine, which became an official psychiatric subspecialty in the U.S. in 2003. 1 The major professional organizations of C-L psychiatrists in the U.S. and Europe are respectively the Academy of Psychosomatic Medicine, and the newly reorganized European Association for Psychosomatic Medicine.2 C-L psychiatrists have special expertise in the diagnosis and treatment of psychiatric illness in complex medically ill patients.3 They treat four types of patients: comorbid psychiatric-medical illnesses complicating each other's management; psychiatric disorders directly resulting from a primary medical condition or its treatment, such as delirium, dementia or other secondary mental disorders; complex illness behaviour such as somatoform and functional disorders; and acute psychopathology admitted to medicalsurgical units, such as attempted suicides. C-L psychiatrists work as consultants in general medical hospitals, in medical-psychiatric inpatient units, and integrated with primary care or medical specialities to provide collaborative care. The nature of the field of C-L psychiatry and the broad scope of C-L psychiatrists' expertise is very well reflected in this special issue of the Journal of Mental Health & Human Behaviour. The issue begins with papers that review conceptual issues, models and principles of C-L practice, as well practice guidelines and the various roles C-L psychiatrists play. The next section covers the key clinical topics of delirium, depression in the medically ill, psychoendocrinology, psychooncology in the medically ill. The final section contains a series of case reports. In my experience, some of the clinically most useful publications in the C-L psychiatry literature are interesting case reports, which is wellillustrated in this issue as well.
BMC Psychiatry, 2007
Background: Few data are available on subjects presenting to acute wards for the first time with psychotic symptoms. The aims of this paper are (i) to describe the epidemiological and clinical characteristics of patients at their first psychiatric admission (FPA), including socio-demographic features, risk factors, life habits, modalities of onset, psychiatric diagnoses and treatments before admission; (ii) to assess the aggressive behavior and the clinical management of FPA patients in Italian acute hospital psychiatric wards, called SPDCs (Servizio Psichiatrico Diagnosi e Cura = psychiatric service for diagnosis and management).
Primary care issues in patients with mental illness
American family physician, 2008
Family physicians commonly care for patients with serious mental illness. Patients with psychotic and bipolar disorders have more comorbid medical conditions and higher mortality rates than patients without serious mental illness. Many medications prescribed for serious mental illness have significant metabolic and cardiovascular adverse effects. Patients treated with second-generation antipsychotics should receive preventive counseling and treatment for obesity, hyperglycemia, diabetes, and hyperlipidemia. First- and second-generation antipsychotics have been associated with QT prolongation. Many common medications can interact with antipsychotics, increasing the risk of cardiac arrhythmias and sudden death. Drug interactions can also lead to increased adverse effects, increased or decreased drug levels, toxicity, or treatment failure. Physicians should carefully consider the risks and benefits of second-generation antipsychotic medications, and patient care should be coordinated b...
Annals of General Psychiatry, 2007
Background The PERSEO study (psychiatric emergency study and epidemiology) is a naturalistic, observational clinical survey in Italian acute hospital psychiatric units, called SPDCs (Servizio Psichiatrico Diagnosi e Cura; in English, the psychiatric service for diagnosis and management). The aims of this paper are: (i) to describe the epidemiological and clinical characteristics of patients, including sociodemographic features, risk factors, life habits and psychiatric diagnoses; and (ii) to assess the clinical management, subjective wellbeing and attitudes toward medications. Methods A total of 62 SPDCs distributed throughout Italy participated in the study and 2521 patients were enrolled over the 5-month study period. Results Almost half of patients (46%) showed an aggressive behaviour at admission to ward, but they engaged more commonly in verbal aggression (38%), than in aggression toward other people (20%). A total of 78% of patients had a psychiatric diagnosis at admission, most frequently schizophrenia (36%), followed by depression (16%) and personality disorders (14%), and no relevant changes in the diagnoses pattern were observed during hospital stay. Benzodiazepines were the most commonly prescribed drugs, regardless of diagnosis, at all time points. Overall, up to 83% of patients were treated with neuroleptic drugs and up to 27% received more than one neuroleptic either during hospital stay or at discharge. Atypical and conventional antipsychotics were equally prescribed for schizophrenia (59 vs 65% during stay and 59 vs 60% at discharge), while atypical drugs were preferred in schizoaffective psychoses (72 vs 49% during stay and 70 vs 46% at discharge) and depression (41 vs 32% during stay and 44 vs 25% at discharge). Atypical neuroleptics were slightly preferred to conventional ones at hospital discharge (52 vs 44%). Polypharmacy was in general widely used. Patient attitudes toward medications were on average positive and self-reported compliance increased during hospital stay. Conclusion Results confirm the widespread use of antipsychotics and the increasing trend in atypical drugs prescription, in both psychiatric in- and outpatients.
Mental Illness and Comorbidities, Aspects of Initial Evaluation
Mental Illness is a public problem in western societies. Recent reports say that the most frequent conditions of psychiatric hospitalization are related to elderly, over 65 years old, diagnosed with dementia, other organic disorders and depression. And we are seeing increasingly in episodes of urgency, consumption of psychoactive drugs, which can foster the emergence of other comorbidities. The aim of this study was to characterize from a socio-demographic, clinical and functional point of view, older people who staged an emergency episode in a psychiatric hospital. This is a cross-sectional, descriptive and correlational study. The sample consisted of 99 elderly people involved in a psychiatric emergency episode in the biennium 2013/2014 and data were collected from the initial evaluation form (IE). Results: People with dementia have more associated diseases than others with other mental Illnesses. Some are at higher risk for potential episodes of falls and loss of functionality and associated factors. Conclusion. More cognitive and functional impairment, evidenced in the functional dependency cycle. The quality of care in later age, requires a multidimensional and interdisciplinary approach. Initial assessment must be complete and holistic in order to give the best care.
Epidemiological Profile of Mental Health Program Patients in a Health Unit
Open Journal of Psychiatry
Aim: To verify the epidemiological profile of patients enrolled in the Mental Health Program at a Family Health Unit, as well as the most prevalent disorders, age and comorbidities. Methods: After analyzing the medical records, the following variables were obtained: diagnosis of mental health status, gender, age group, associated comorbidities and medication in use. Results: There was a prevalence of 61.3% in women and 38.7% in men; patients aged 30 to 39 years were the most affected (22.6%); the most common disorders were epilepsy (36%), depression (14%), anxiety disorder (8.6%) and schizophrenia (8.6%); the most common comorbidities were systemic arterial hypertension (30%) and insomnia (15%) and the most commonly used psychotropic drugs were amitriptyline, carbamazepine and phenobarbital (10.2% each). Conclusion: There was a high prevalence of females, mainly at 30 to 39 years old and the most prevalent diagnoses were epilepsy, depression and anxiety disorder. About medications, antidepressants and anticonvulsants were the most prescribed.