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High Lithium Levels: Dead, Alive or Doing Well? a Service Evaluation Looking at Outcomes Over Subsequent 2 Years
- Juliet Raphael, William Heatley, Maryam Patel, Supriya Dastidar, Sara Ormerod
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, pp. S141-S142
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- Article
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Aims
Lithium is an effective mood stabiliser in the management of Bipolar affective Disorder. Timing and decision to restart lithium after an episode of toxicity can be challenging. National guidelines offer advice on management of acute toxicity but little information on restarting lithium. Abrupt withdrawal of lithium can provoke relapse. Clinical experience of the authors was that patients who had Lithium stopped following toxicity often relapsed, leading to poor mental health, frequent admissions to acute and psychiatric hospitals and sometimes death. Restarting of lithium in hospital or after discharge was often variable. The aim of the evaluation was to review the outcomes of patients admitted to the University Hospitals Birmingham NHS Foundation Trust (UHB) with a lithium level over 1.2 mmol/L.
MethodsPatients were selected if recorded lithium level was over 1.2mmol/L on admission to UHB. Case note review of electronic patient records was carried out to identify demographic factors of participants alongside medical and psychiatric outcomes over the following 2 years.
Results84 patients were identified as having lithium levels over 1.2mmol/L. 76% Female. Mean age 61 years (range 20-95 years). 77% of patients had been prescribed lithium for more than 6 years. Mean lithium level was 1.68 mmol/L (range 1.2-3.44 mmol/L). Around 2/3 of patients admitted with lithium above therapeutic range were referred to the liaison psychiatry team. 12% of the patients died during that admission. Just over 2/3 (69%) of those discharged from hospital had been restarted on lithium. When lithium was not restarted during the acute admission, only 13% were restarted in the community within the next 2 months. Two year mortality of patients admitted with elevated lithium levels was 31%. 10% of patients were admitted to a psychiatric hospital within 1 year. The mean number of admissions to the acute hospital (UHB ) within one year was 1.6 (range 0-26).
ConclusionAdmission to hospital with high lithium levels appears to be associated with a number of negative outcomes. These data cannot attribute causality. Conditions predisposing to lithium toxicity such as frailty could contribute to negative outcomes. Given these high mortality figures for this group, discussions on restarting lithium following high levels may need to focus more on the priorities for the patient. Further studies looking at the outcomes of restarting and discontinuing lithium and comparing with those who have not experienced elevated levels would be helpful.
Decoloniality in the Psychedelic Research Space
- Juliet Raphael
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- Journal:
- BJPsych Open / Volume 8 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 20 June 2022, pp. S68-S69
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Aims
Since the 1950's, there has been increasing interest in the potential of the psychedelic experience to generate an enhanced state of emotional well-being in those suffering from a range of mental disorders. Following the so-called ‘War on Drugs’, much of this research was curtailed until a new surge of interest resulting in a ‘psychedelic renaissance’. This has come at a time where powerful institutions, including the medical sphere, are being asked to address their oppressive and damaging pasts; these narratives bear particular relevance to psychedelic research given the widespread use of entheogenic plants as medicines and tools for spiritual healing amongst indigenous groups worldwide, and the political history of the War on Drugs. The aim of this study was to explore how those in the psychedelic community have come to understand what it means to ‘decolonise’ this space and to situate these conversations within existing literature.
MethodsSemi-structured interviews were conducted with 10 participants who were recruited using theoretical and snowball sampling. Data collection and analysis were carried out from a critical theoretical standpoint, further borrowing from aspects of constructivist grounded theory methodologies. This involved open coding of existing literature to devise an interview guide, followed by coding of interview transcripts to generate several key themes as they emerged from the primary data.
ResultsAnalysis of the data generated 8 sub-themes, which were then combined to create the 4 main themes;
• The Making of a ‘New’ Medicine
• Scientism and Spirituality
• Appreciation vs Appropriation
• Beyond Decriminalisation
ConclusionThe study demonstrated the participants’ willingness to engage in a discussion which explored some uncomfortable truths regarding psychedelic research. There was a suggestion amongst some participants that the space can never be truly decolonised given the capitalist and neo-colonial manifestations within the current space. Future research should seek to facilitate more critical discussion of the epistemic, material, and geopolitical injustices which exist, and critical indigenous methodologies offer a meaningful way of understanding and undoing the hierarchical power structures currently at play.
Chapter Seven - The importance of habitat heterogeneity at multiple scales for birds in European agricultural landscapes
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- By Juliet Vickery, British Trust for Ornithology and Royal Society for the Protection of Birds, Raphaël Arlettaz, University of Bern and Swiss Ornithological Institute
- Edited by Robert J. Fuller, British Trust for Ornithology, Norfolk
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- Book:
- Birds and Habitat
- Published online:
- 05 December 2012
- Print publication:
- 08 November 2012, pp 177-204
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Summary
Farmland throughout the world is frequently likened to a mosaic or patchwork and this heterogeneity is widely recognised as strongly influencing the abundance and diversity of species that these landscapes support. Globally, modern intensive agriculture has greatly reduced this ‘patchiness’ at a range of spatial and temporal scales. This change has been particularly well documented in temperate Europe (Benton et al., 2003; Báldi et al., 2005; Roschewitz et al., 2005; Wretenberg et al., 2006; Stoate et al., 2009). The fine-grained, diverse habitat mosaic, typical of much ‘traditional agriculture’, has become increasingly uniform under modern agricultural management. This reduction in habitat complexity has been linked, at least in part, to declines in farmland biodiversity, including plants and invertebrates (Smart et al., 2000; Sotherton and Self, 2000; Oliver et al., 2010), mammals (Smith et al., 2005) and birds (Donald et al., 2001a; Benton et al., 2003; Wilson et al., 2005).
In general, the more habitat elements a farmed landscape contains, the wider the range of resources on offer and the higher the diversity and abundance of organisms supported. This may be due, in part, simply to the increased likelihood of a given farmed landscape containing a key habitat type (Heikkinen et al., 2004). However, many species require a diversity of resources to complete their life cycle. At its most basic, birds require two essential resources: a suitable nest site and sufficient food throughout the year. These basic nesting and foraging requirements often vary within and between seasons. Bird-rich farmland should provide safe foraging habitats, offering abundant and accessible food in relatively close proximity to suitable cover for nesting and/or protection from predators or harsh weather. The extent to which farmland birds require a diverse landscape matrix, containing both density, number of chicks per nest and annual productivity compared to semi-natural and cultivated habitat components, is illustrated by many examples in the following sections.