17 results
Evaluating Current Practice of Prescribing as Required Medications for Psychiatric Inpatients
- Naveen Lalli, Olabisitaiye Abu, Safyan Tariq, Vijay Perla, Nilamadhab Kar
-
- Journal:
- BJPsych Open / Volume 10 / Issue S1 / June 2024
- Published online by Cambridge University Press:
- 01 August 2024, pp. S193-S194
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Aims
Pro re nata (PRN) medications are commonly prescribed for psychiatric patients on admission, often at maximum daily dose (MaxD). We intended to evaluate prescribing patterns for PRN medications, their MaxD, and rationale, specifically in the first seven days in the hospital, along with any concerns of associated physical illnesses.
MethodsAll the inpatients on a specific date, admitted to adult and old age wards of a general psychiatric hospital, for at least 7 days, were recruited for this service evaluation. Data regarding the prescribing of promethazine, lorazepam, zopiclone as PRN, patient demographics, and psychiatric and physical diagnoses were collected using inpatient drug cards and electronic patient notes.
ResultsOut of 52 inpatients, 14 were excluded (4 admitted for < 7 days, and 10 had missing data), leading to a sample size of 38 patients. On admission, a considerable proportion of patients were prescribed promethazine (82%), lorazepam (76%), and zopiclone (50%). More than half (63%) of patients on promethazine were started on 100 mg MaxD, of which 13% had reasons for prescription, and 33% had reasons for the MaxD were noted. None of the old-age patients was prescribed 100 mg of promethazine. During first 7 days, patients used on average 15%, 14% and 29% of the total prescribed dose of PRN promethazine, lorazepam and zopiclone; and 35%, 45% and 47% of patients did not use any PRN drugs. Only one patient used 100% of the available PRN lorazepam and zopiclone. Patients with current illicit substance misuse, used PRN slightly more frequently; promethazine (16% v 12%), lorazepam (20% v 14%) and zopiclone (46% v 24%) compared with those with no misuse. With a current risk of aggression or agitation, all female patients were prescribed PRN promethazine or lorazepam, compared with 86% of male patients.
In regards to British National Formulary (BNF) cautions of associated physical illness, one patient with glaucoma, and one epilepsy was prescribed promethazine; three patients with respiratory condition were prescribed PRN lorazepam; and six patients with depression and four with current drug user were prescribed PRN zopiclone.
Considering diagnoses, promethazine, lorazepam and zopiclone were used by varying proportions of the patients: schizophrenia (10%, 3%, 0%), bipolar affective disorder (0%, 14%, 57%), depression (27%, 11%, 38%), personality disorder (15%, 28%, 48%) respectively.
ConclusionPsychiatric inpatients were prescribed MaxD of PRN medications more than what is being administered. Documentation of rationale for prescribing PRN medications and dose is needed.
Pills, Potions and Psychosocial Support in Pregnancy and the Post-Partum: Evaluating Interventions in a Specialist Perinatal Clinic
- Sheridan McWilliam, Neeti Gupta, Nilamadhab Kar
-
- Journal:
- BJPsych Open / Volume 10 / Issue S1 / June 2024
- Published online by Cambridge University Press:
- 01 August 2024, p. S196
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Aims
Psychiatric illnesses are common in the perinatal period and many women are treated with psychotropic medications. Prescribing psychotropic medications often raises concern among patients and clinicians, because of a lack of information and no license to prescribe during pregnancy. This project aimed to evaluate the interventions offered in a perinatal clinic against the Perinatal College Centre for Quality Improvement standards. This included evaluating medications prescribed in the antenatal and postnatal periods; counselling regarding medication risks and benefits, provision of verbal and written information and psychosocial interventions.
MethodsData of 60 patients (30 antenatal and 30 postnatal) attending perinatal outpatient clinics covering two cities in Midlands, England, consecutively from November 1st 2023 were collected from electronic clinical notes and clinic letters. Patients who did not attend their appointment were excluded.
ResultsThe mean age of the sample was 30.3 ± 5.2 (range 19–41). Average gestational age was 6.5 ± 2.1 months (range 2.0–9.5) for antenatal women, and average postnatal duration was 6.5 ± 5.0 months (range 0.1–22.0) at the time of review. All women had psychiatric diagnosis, except one who was discharged back to primary care. The most common diagnoses were mixed anxiety and depression (38.3%), emotionally unstable personality disorder (38.3%), and postnatal depression (20%). The majority (75.0%) were prescribed psychotropic drugs. Antidepressants were prescribed in 66.7% of antenatal and 76.7% postnatal patients; most commonly prescribed overall were sertraline (33.3%) and citalopram (23.3%). Antipsychotics were prescribed in 30.0% of antenatal and 46.7% of postnatal patients. Aripiprazole and quetiapine were most commonly prescribed in the antenatal (both 13.3%) and postnatal (both 20%) periods. A larger proportion (40.0%) of women had as required medications; promethazine (20.0% vs 30.0%), diazepam (6.7% vs 13.3%) and zopiclone (3.3% vs 13.3%) were most frequently prescribed, with figures indicating prescription rates in the ante- versus postnatal period. None of the medications were prescribed above licensed limits nor met criteria for high dose antipsychotic monitoring. Verbal and written information about medications was provided in 78.3% and 35.0% of all cases respectively. Most (65.0%) women were offered psychological therapies, and of these, 69.2% received it.
ConclusionMost women in the perinatal period were prescribed psychotropic drugs, with higher proportions in the postnatal period. The findings suggested areas of improvement, such as offering written information, documenting the discussion of medication counselling, and to increase the psychotherapeutic support. It also suggests developing manualised educational interventions to improve information sharing with patients, and perinatal care.
Patient Outcomes in Crisis Resolution and Home Treatment Service: A Retrospective, Observational Study in Wolverhampton
- Anurag Misra, Usman Raja, Nilamadhab Kar
-
- Journal:
- BJPsych Open / Volume 10 / Issue S1 / June 2024
- Published online by Cambridge University Press:
- 01 August 2024, pp. S197-S198
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Aims
Crisis Resolution Home Treatment Team (CRHT) provides short-term treatment for psychiatric patients in the place of residence, dealing with mental health crises, risks, deterioration, and preventing hospital admissions. This team works round the clock, seven days a week. This study aimed to analyze the clinical outcomes of the service provided by the CRHT in Wolverhampton.
MethodsIn a retrospective, observational, explorative study design, data was collected from the electronic medical records of 100 (54 female and 46 male) consecutive patients who were treated under the general adult (age range 18–65 years) CRHT from 1st December 2022. We collected outcome variables such as symptomatic improvement, change in risk status, days of treatment under CRHT, and discharge destination.
ResultsIn the sample, 76% had one psychiatric diagnosis, and co-morbidities were present in 20%, with 4% of patients having no syndromal diagnoses. The most common primary diagnosis was personality disorder (24%), followed by psychotic disorders (22%), anxiety disorders 21%, and depression (20%). Overall risk status of red changed from 87% at admission to 17%, at discharge; risk to self from 43% to 17% (p < 0.01), risk to others from 11% to 1% (p < 0.01), respectively. The mean length under care of CRHT was highest with anxiety disorder (27.7 ± 18.2 days), followed by personality disorders 23.7 ± 17.9 days. Age and number of days under CRHT were negatively correlated, suggesting younger age was linked to higher number of days (p < 0.05). Most (71%) patients showed an improvement in their mental health, 15% deteriorated and got admitted to the psychiatric hospital, 9% did not engage and 5% were considered not suitable for care under CRHT for various reasons such as having no fixed abode. Most (80%) patients were discharged back to the community following the CRHT period.
ConclusionDespite the limitation of subjective clinical assessments, the results suggested that the CRHT was effective in considerable proportions of patients with symptomatic improvement and a decrease in risk level, with a small proportion being admitted to a psychiatric ward. There is a need for objective evaluation of risk and symptomatic change using validated instruments and assessing patient experiences about the services.
Prolactin Monitoring for Inpatients on Antipsychotic Drugs: A Clinical Audit
- Farida Kotait, Sheena Parmar, Nilamadhab Kar
-
- Journal:
- BJPsych Open / Volume 10 / Issue S1 / June 2024
- Published online by Cambridge University Press:
- 01 August 2024, pp. S243-S244
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Aims
Many antipsychotics are known to adversely affect prolactin levels causing hyperprolactinemia. National Institute for Health and Care Excellence (NICE) guidelines have suggested monitoring of prolactin levels. It specifies that prolactin should be checked 6 months after starting treatment, then every 12 months; and to ask about symptoms of raised prolactin which include low libido, sexual dysfunction, menstrual abnormalities, gynaecomastia, and galactorrhoea. This also mentions that it is not required for aripiprazole, clozapine, quetiapine, or olanzapine (less than 20 mg daily). We intended to audit the monitoring of prolactin in a sample of inpatients who are on antipsychotic drugs and to check whether action was taken in the event of a high prolactin level.
MethodsAll the adult inpatients of a general psychiatric hospital on a specific date (34, 16 (47.1%) female and 18 (52.9%) male patients), who were on antipsychotics were considered for the audit. We checked the antipsychotic drugs, prolactin assessment within one year and level, action taken if there was hyperprolactinemia. The data was collected from electronic patient records and medication charts.
ResultsThe mean age of the sample was 39.1 ± 14.2 years (range 18–63). Most inpatients (91.2%, 31/34) were on antipsychotics and 25.8% (8/31) were on two antipsychotic drugs. Prolactin was measured in 80.6% (25/31) patients in the last year, with 48% (12/25) having hyperprolactinemia; and amongst these action was taken in 5 (41.7%). Hyperprolactinemia was present in 58.3% of female and 38.5% of male patients. Specifically, out of 31 patients, 14 (45.2%) were on antipsychotic drugs that need monitoring, and 9 (74.3%) of them had taken it for at least one year. Out of these 9 patients, prolactin was measured in 8 (88.9%) patients in the last year, it was elevated in 5 (55.6%), action was taken in 3 (60%) and action was not clear in 2 (40%) patients.
ConclusionAlmost half of the patients on antipsychotic drugs had hyperprolactinemia, highlighting the need to monitor prolactin levels. Along with this, symptoms of hyperprolactinemia should be consistently checked in routine clinical evaluations. Clinician and patient education regarding hyperprolactinemia and its symptoms might improve its monitoring.
Awareness of Fitness to Drive Guidance Amongst Doctors in Black Country Healthcare NHS Foundation Trust : A Survey
- Reka Ajay Sundhar, Pallavi Chandra, Alistair Fraser, Nilamadhab Kar
-
- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S131
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Aims
Psychiatric patients have a higher risk of road traffic accidents than others. The Driver and Vehicle Licensing Agency (DVLA) has provided guidance on different psychiatric conditions and medication that would impact driving. The General Medical Council and Royal College of Psychiatrists advice doctors to notify the DVLA when patients unfit to drive fail to inform the DVLA themselves. In this context, it was aimed to study the awareness of doctors regarding DVLA guidance and its use in their clinical practice.
MethodsWe conducted a survey about doctors’ awareness of guidance on Fitness to Drive via an online questionnaire. Likert type scoring ranging from strongly agree to strongly disagree was used to assess the (i) awareness of DVLA guidance for psychiatric patients, (ii) confidence in advising patients, (iii) feeling it is a job requirement to advise patients on driving; and (iv) checking the driving status and if patients have informed DVLA where necessary. This included questions on years of experience in medicine, current grade and subspecialty of Psychiatry.
ResultsThe sample consisted of 78 doctors, from various grades from Foundation Year 1 trainees to Consultants; working in different Subspecialties in Psychiatry. There were 36 trainees, 12 middle grades, 28 consultants and 2 ‘other’ doctors. The average year of experience of the responding doctors was 14.2±11.0 years with a range of 1-38 years.
Majority (62.8%) of doctors responded that they are aware of the DVLA guidance for psychiatric patients; however 47.5% reported having confidence to advise patients on DVLA guidelines. Considerable proportions (79.5%) of doctors felt that as psychiatrists, it was their job to give advice on driving; but only 50% said they check the driving status and whether patients have informed the DVLA when necessary as part of routine practice.
When using the Likert scale, comparing to other subspecialties, General Adult Psychiatrists responded that they check driving status less routinely (p<0.05), however there was no difference in other areas evaluated. Trainees’ responses indicated less awareness (p<0.001), confidence (p<0.001), and checking of driving related issues routinely in clinical practice (p<0.005).
ConclusionThe survey results suggest variation in awareness of Fitness to drive guidance for psychiatric patients and their use in routine clinical practice amongst doctors. While trainees would need more information and training to increase their confidence, there is a need for all psychiatrists to use the guidelines in regular clinical practice.
Risk Factors Related to Driving: A Review of Clinical Practice Evaluating and Addressing Fitness to Drive Among Psychiatric Inpatients
- Alistair Fraser, Pallavi Chandra, Reka Sundhar, Nilamadhab Kar
-
- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S157
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Aims
Mental illness is linked with a higher risk of dangerous driving; e.g. patients with neurotic disorders have 50% more accidents than controls and 10% of drivers involved in accidents have reported feeling suicidal. The Driver and Vehicle Licensing Agency (DVLA) have provided guidance related to fitness to drive for those with mental illness. In this context we intended to study the risk factors associated with psychiatric inpatients related to driving and whether concerns have been documented in clinical reviews.
MethodsCase notes of 100 randomly selected psychiatric inpatients in one calendar month were evaluated including: their driving status; concerns regarding driving based on their clinical status (Diagnosis, Medications, Side effects); any clinical advice given and communication with DVLA in the previous one year, were ascertained from electronic records. Missing values were not included in calculation.
ResultsThe sample consisted of 51 female and 49 male patients (mean age 39.7±13.5 and 39.1±12.7 respectively), with the majority 69% from Caucasian ethnicity; 64% were informal. There was no difference noted in driving status based on ethnicity or legal status on admission.
On admission 33% of patients reported that they were not driving, 12% were driving, 2% refused to answer and in more than half (53%) driving status was not documented. Considering some of the risk factors for driving, persistent alcohol use was noted in 39.8%, drug use in 34.4%, personality disorder 37%, attention deficit hyperactivity disorder or autistic spectrum disorder in 4%, being on medications with side effects that may impair driving 80.8%, having side effects that impair driving 10%, and suicidality 54.5%. Only in a minority of cases were fitness to drive related issues discussed in their last review (3%), in progress notes (1%), or in discharge notes (2%). There was no documentation related to communication with the DVLA for any patients.
ConclusionThe results suggest there is a need to record the driving status of psychiatric inpatients and to discuss driving related concerns when considering mental state, medications and side effects. Information related to driving should be given to patients, and DVLA should be notified as appropriate. This might help in improving safety related to driving by psychiatric patients.
Ethnic Differences in Dose and Levels of Clozapine: Exploring Need for Any Specific Monitoring Needs
- Stephen Jiwanmall, Nilamadhab Kar, Akua Obuobie, Tanay Maiti, Deborah Lester, Kerry Mclaughlin, Thomas Hanson
-
- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S136
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Aims
Clinical research shows that compared to Caucasian patients, Asian patients appear to have a lower clozapine dose requirement for clinical efficacy. Hence, appropriate dose adjustment should be considered in Asian patients receiving maintenance clozapine therapy. Secondly, studies in the UK report that Asian patients with treatment-resistant schizophrenia were less likely to receive clozapine than Caucasian patients. The objectives of this study were to find out the ethnic difference in dose and levels of clozapine in ethnic minority patient (BME (Black and minority ethnic) populations and to explore if there is a need for any specific monitoring.
MethodsDemographic (age, gender, and ethnicity) and clinical variables (diagnosis, clozapine dose, plasma level of clozapine and nor-clozapine, smoking status, side effect profile, and physical comorbidities) were collected from the electronic patient records and analysed.
ResultsThe sample consisted of 66 (56.4%) Caucasians, 22 (18.8%) Asians, 21 (17.9%) African-Caribbean, and 8 (6.8%) mixed ethnicity patients. Their age range was 19-80, with an average of 46.9 ±11.9 years.
Among the ethnic groups, age, clozapine, nor-clozapine level and QTc were comparable, except for the dose of clozapine; Caucasian had the highest dose (414.8±140.0 mg), followed by African-Caribbean (373.8±163.7 mg), Asian (333.8±121.2 mg) and mixed (260.7±110.7 mg) (F3.68, p<0.05). The difference remained significant when all the BME groups were combined as well.
Side effects such as hypersalivation, drowsiness, blurred vision, polyuria, sore throat, headache, vomiting (none), dizziness, difficulty passing urine, urine incontinence, flu-like symptoms, nausea, were comparable among ethnic groups.
There was no difference in smoking among the groups. Considering comorbidities compared to BME, Caucasians had significantly lower rate of hypertension (27.1% vs 9.1%, p<0.01); diabetes (18.6% vs 4.5%, p<0.05), however dyslipidemia (5.1% vs 3.0%) was comparable.
In addition to the above, the dose of clozapine was positively correlated with clozapine and norclozapine levels (p<0.05). Clozapine and norclozapine levels correlated significantly (p<0.001). Age was negatively correlated with norclozapine assay (p<0.05) and positively with the number of cigarettes. It appears as the age increases, the number of cigarettes goes up, and norclozapine levels come down.
ConclusionThere are a few variations of clozapine prescribing in different ethnic groups. Although the Caucasians had higher doses, they had comparable blood levels. A higher proportion of BME patients on clozapine had hypertension and diabetes, emphasizing metabolic risk. Our study findings suggest clozapine monitoring should look into ethnicity related risk factors.
Prescribing of Psychiatric Drugs in Pregnancy: A Review of Current Practice in a Community Mental Healthcare Setting
- Lucy Hickling, Nilamadhab Kar
-
- Journal:
- BJPsych Open / Volume 8 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 20 June 2022, pp. S156-S157
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Aims
Prescribing of psychotropic medications in pregnancy is still considered a ‘grey area’ in clinical practice. National Institute for Health and Care Excellence (NICE) in the UK suggests that the decisions should be person-specific, considering the risks to both the mother and unborn child, and the patient is supported to make an informed decision. It is important to explore the use of psychotropic medications during pregnancy, or lack of it, and its subsequent impact on maternal mental health. It was intended to review the decisions expectant mothers are making regarding taking psychiatric medications during pregnancy, and the associated clinical outcomes. Their mental capacity for taking decisions was also checked.
MethodsA retrospective audit of case notes of patients (n = 16) known to community psychiatric team (CMHT) and specialist perinatal mental health (PNS) services in Wolverhampton, who notified their pregnancy between December 2020 and December 2021. Demographic and clinical data were collected from the electronic records.
ResultsThe sample had a mean age of 28.8 ± 6.3 years (range: 19 to 39 years), and 68.8% of them were Caucasian. A wide range of psychiatric diagnoses were present, most (62.5%) had comorbid diagnoses; and 25% had substance use, most commonly cannabis. Mean duration of gestation at the review following notification of pregnancy was 14.5 ± 7.7 (range: 6 to 29) weeks. It was observed that 25% were not taking psychiatric medications prior to pregnancy, 43.8% stopped taking their medication prior to the psychiatric review, most stopping abruptly, and 31.2% had continued their medication. The medications included aripiprazole, olanzapine, quetiapine, venlafaxine, sertraline and promethazine. Following the review, only 18.8% continued their medications. Of the 13 (81.3%) patients who were not taking medications, 9 (69.2%) had adverse mental health outcomes, with 2 (15.4%) patients requiring inpatient care. However, later 8 (61.5%) started taking medications whilst under the care of PNS. All of them had mental capacity to decide regarding their psychiatric treatment at the review.
ConclusionMost psychiatric patients avoided taking psychotropic medications initially during pregnancy, however, a considerable proportion restarted their medications following review with the perinatal psychiatry team. The majority of patients who did not take medications had negative mental health consequences. It is important to develop an evidence base about the use of psychiatric medications in pregnancy and the associated short and long-term outcomes that may help the quality of information shared with patients.
Remote Clinical Assessments and Management During COVID-19: Views of the Patients and Clinicians About the Future Preferences
- Nilamadhab Kar, Lai-Ting Cheung, Stephen Jiwanmall
-
- Journal:
- BJPsych Open / Volume 8 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 20 June 2022, p. S130
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Aims
During the COVID-19 pandemic most clinical services changed to remote consultation and management to minimise virus transmission by direct contact. As the social distancing and restrictions have eased with greater control of the pandemic, the nature of consultations is going to change. At this juncture we intended to understand the perception and satisfaction of patients and clinicians on remote consultations and management during COVID-19 and to determine their preference about clinical engagement in the future.
MethodsThis was a trust-wide anonymous survey conducted through surveymonkey. It involved both patients and mental healthcare staff (MHS) and explored about the quality and satisfaction in remote consultations, option to patients, and use of remote consultations in future. Clinicians were sent the online link to complete, with a reminder two weeks later. The patients were explained during their appointments about the survey, those who agreed to participate and gave informed consent, their responses to the questions were recorded.
ResultsThe sample consisted of 78 patients and 107 MHS representing adult, old age, children and adolescent and intellectual disability subspecialties. Most (92.4%) participants had participated in remote consultations and understood the reason behind it. Around a third (32.7%) of MHS and 46.2% of patients felt strongly satisfied in remote consultations, and together with satisfaction these were 56.1% v 71.8% respectively (p < 0.05). The quality of the remote consultations were considered somewhat (11.2% v 23.1%) or a lot better (8.4% v 15.4%) by MHS and patients respectively (p < 0.05). Majority (82.7%) felt that an option should be given to patients for the type of consultation, face to face or remote. After the pandemic, the preference for psychiatric consultations were primarily face to face (30.3%), primarily remote (8.6%) and a mixture of the two (61.1%); there were no difference between patients and MHS. However while 71.4% doctors, 70.8% other clinicians (occupational therapists and psychologists) and 75.0% of clinical managers opted for mixture of face to face and remote, 26.9% of nurses opted for that. Background subspecialty, age group, ethnicity, experience of remote consultation with GP or hospital doctors, attendance or admission to general or psychiatric hospitals during pandemic, disabilities, or having COVID-19 did not influence the suggestion for the future consultation type.
ConclusionFollowing the pandemic, both clinicians and patients express a preference for a mixture of face to face and remote consultations; and an option regarding that should be given to the patients.
Changing Patient Profile in a Psychiatric Hospital During COVID Pandemic: A Comparison With Pre-COVID State
- Nilamadhab Kar, Stephen Amarjeet Jiwanmall
-
- Journal:
- BJPsych Open / Volume 8 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 20 June 2022, p. S136
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Aims
COVID-19 pandemic has a massively adverse mental health impact and people with pre-existing psychiatric illnesses are one of the most severely affected groups. We intended to study the changes in the patient profile in a psychiatric hospital during the COVID-19 pandemic, comparing it to the period just before the pandemic.
MethodsConsecutive patients (n = 210) admitted to psychiatric ward under one team during COVID-19 pandemic (February 2020 to January 2022) were compared with patients (n = 234) admitted in the immediate pre-pandemic period (January 2017 to January 2020). Demographic (age, gender, and ethnicity) and clinical variables (diagnosis, admission days, Mental Health Act status, risk to self and others) were collected from the electronic patient records and analysed.
ResultsDuring the pandemic monthly admission rates have gone up by 38.1% over the base rate of 6.32/month. There was no difference in the mean age at admission; or the proportion of patients aged 18–40 years or above in the pre-pandemic and pandemic groups. Similarly the gender composition of patients in the two periods was comparable. Proportion of patients from Asian background increased from 7.7% to 16.8% during pandemic period (p < 0.05). The number of hospital days decreased from 31.97 ± 45.8 days in the pre-pandemic period to 22.44 ± 25.1 days during pandemic (p < 0.05). Along with increased admission rates, it suggested a rapid flow of the admission and discharge during the pandemic. Considering diagnostic composition between pre-COVID-19 and COVID-19 periods, psychotic (27.8% v 26.7%) and mood disorders (18.8% v 23.3%) were the predominant; and substance related disorders (20.5% v 16.7%) were the most common comorbidities. Risk to self was associated with 84.3% admissions during the pandemic compared to 78.6% in the pre-pandemic period; however, risk to others was noted in 13.8% v 22.2% (p < 0.01) respectively. There was no difference in proportions getting admitted under Mental Health Act or being discharged with Community Treatment Order. Interestingly, proportions of patients getting discharged under the care of Home Treatment Team decreased from 31.1% pre-pandemic to 16.5% during pandemic period (p < 0.005).
ConclusionThere is an increase in admission rate and decrease in the number of admission days, suggestive of increased demand of clinical resources during pandemic. This could be reflective of the stressful situation and adverse impact on mental health in the pandemic period. As the impact on mental health is expected to continue, there is a need for greater resources both in community and inpatient psychiatric services.
Experience of tele-psychiatry during COVID-19 amongst doctors working in a mental health trust: A survey
- Pallavi Chandra, Nilamadhab Kar, Abdalla Yahia
-
- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, pp. S13-S14
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Aims
There is paucity of information about perspectives of psychiatrists about telemedicine practice during COVID-19 pandemic. It was intended to explore the experience of doctors using tele-psychiatry for provision of clinical care during the COVID-19 pandemic in a Mental Health Trust covering four cities in West Midlands, UK.
MethodThe study was conducted as an anonymized questionnaire survey. A 10-item questionnaire was designed with items related to the clinical outcomes, challenges and provider satisfaction when using tele-psychiatry. It had mostly yes/no dichotomous responses along with the scope for making additional comments for each question. An online link of the questionnaire was sent via email to doctors of all grades working across the Black Country Healthcare NHS foundation Trust, in the West Midlands. The survey was open between July and October 2020; and monthly reminders were sent.
ResultThe questionnaire was sent out to 159 doctors and 34 responded (response rate of 21.3%). Just over 50% had used both telephone and video consultations, whereas 47.1% responders had used telephone only. More than half (55.8%) reported that the tele-psychiatry affected clinical outcomes; and it was considered positive in around half (52.9%). Most (73.5%) of the responders found that limitations or challenges of using technology impacted on delivery of care remotely. However 64.7% psychiatrists were satisfied with the process overall; and 79.4% reported that they would like to use tele-psychiatry in the future as well.
Survey captured many observations from the psychiatrists. Positive comments from the psychiatrists included expedited delivery of care, reduced non-attendance rates, as well as successful multidisciplinary meetings. Challenges in specific sub-specialties such as Child and Adolescent Psychiatry or Older Adult psychiatry were reported where complete assessments were not achieved successfully. The process was felt to be appropriate in general for stable or follow-up patients in comparison to new or acutely unwell patients. There was some worry expressed about missing out non-verbal cues which assist with mental state examination.
ConclusionInspite of a low response rate, the survey provided some understanding about the experience of doctors practicing tele-psychiatry during pandemic. While technological challenges were acknowledged, tele-psychiatry seemed to have been accepted by a majority of doctors who are also willing to continue it in their future clinical practice. There is a need to explore in a larger sample involving both patients and clinicians about the beneficial effects of tele-psychiatry that can be incorporated in the usual psychiatric practice.
Profile, referral pathways and re-attendance of psychiatric patients attending the emergency department: focus on suicidality & self-harm
- Haridha Pandian, Nilamadhab Kar
-
- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, pp. S339-S340
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Aims
The number of patients presenting to Emergency Departments (EDs) in the UK with acute psychiatric issues is a major concern. This project aimed to explore the outcome of patients assessed by Mental Health Liaison Services (MHLS) in a large district general hospital ED in the UK, with a focus on patients with self-harm or suicidality.
MethodData were extracted from electronic patient records on 100 consecutive attendees to MHLS in July 2020. Data were collected on demographics, index of multiple deprivation (IMD) by postcode, time and reason for attendance, known ICD-10 diagnoses, self-harm history, alcohol/substance misuse at time of presentation, recent psychosocial stressors and outcome of MHLS assessment. Assessments by MHLS in the preceding 12 months and reattendance to the service within 3 months following this assessment were also recorded.
ResultThe sample included 44 male and 56 female patients, with a mean age of 35.3 years. 80.0% of patients were Caucasian. 67.0% lived in areas classed within the top 30% most deprived in the country, whilst 2.0% had no fixed abode. The majority (79.0%) of patients self-presented; outside of normal working hours (70.0%). The most common reasons for attendance were thoughts/intent of self-harm/suicide (50.0%), overdose (29.0%) and self-harm by laceration (7.0%).
The majority (73.0%) of patients had a known psychiatric diagnosis, with the most frequent being depressive disorder (36.0%) and emotionally unstable personality disorder (15.0%). Almost half (48.0%) had a history of self-harm, and 40.0% were under the influence of alcohol/illicit substances upon presentation to ED. The most common psychosocial triggers were conflict with partner (26.0%) and stress due to the COVID-19 pandemic (19.0%).
Following assessment, 24.0% of patients were discharged to their General Practitioner, 18.0% to the community mental health team; and 17.0% to the Crisis & Home Treatment Team. A minority (13.0%) were admitted to a psychiatric hospital (10.0% informally, 3.0% under the Mental Health Act 1983).
Approximately one in five (21.0%) patients re-attended to MHLS within 3 months. Out of 37 patients that had previously been assessed by MHLS in the preceding 12 months; 37.8% were reassessed within 3 months (p < 0.01).
ConclusionIn the studied sample, most (90%) of psychiatric patients attended ED for self-harm or suicide, and a significant proportion had repeat attendance. Socioeconomic deprivation, substance misuse, relationship difficulties and stress due to the COVID-19 pandemic were major issues, alongside diagnosed depression and personality disorder. Focussed support for these issues may decrease ED attendance due to self-harm/suicidality.
Non-attendance at psychiatric outpatient clinics: comparison of clinical, risk and demographic factors between attenders and non-attenders
- Mahum Kiani, Nilamadhab Kar
-
- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, p. S35
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Aims
With an overarching aim of decreasing the incidence of non-attendance in psychiatric outpatient clinics, this service evaluation was intended to explore the profile of non-attenders. Specifically, the clinical, risk and demographic features of patients who did not attend their psychiatric outpatient appointments were compared with those of attenders. The outcome of patients who did not attend was also studied.
MethodAll the consecutive non-attenders (n = 32) in November 2020 in a psychiatric outpatient clinic were compared with 32 consecutive attenders. The groups were compared based on clinical features (diagnosis, medical treatment, psychological treatment, care programme approach, first contact), risk profile (self or others) and demographic features (age, gender, ethnicity, accommodation, occupation, benefits). The non-attender sample was also analysed to consider the outcome after their missed appointment, following local Trust protocols.
ResultThe overall rate of patients who did not attend their appointment was 22%. There was a statistically significant difference between the age and gender of non-attenders. Males were less likely to attend their appointment than females (p = 0.024). The mean age of patients who did not attend their appointment was 36.4 compared with 44.8 years in the attenders (p = 0.005). There were a few clinically relevant findings. Around one third (34%) of patients who did not attend their appointments had a history of risk of self-harm noted in previous appointments. The results also showed that 75% of individuals who did not attend their outpatient appointments were unemployed. There were no significant differences based on the type of treatments (depot injections, lithium, clozapine, antipsychotics or antidepressants) patients received. Patients who did not attend were more likely to have a mood disorder (59% compared with 40%), and less likely to have a psychotic disorder (25% compared with 44%). Of the patients who did not attend, all were appropriately contacted as per the local Trust guidelines via a letter, and were provided with appointments where appropriate; 34% of non-attenders were discharged from services.
ConclusionNon-attendance at psychiatric outpatient appointments is a concern, particularly for younger and male patients. Considering the clinical risks associated with this patient population, efforts need to be taken to improve their engagement with mental health services. Future studies may explore patients’ perspectives of non-attendance and how to ameliorate any hindrances to attending.
Anxiety, Depression, and Post-traumatic Stress a month after 2019 Cyclone Fani in Odisha, India
- Nilamadhab Kar, Narendra Nath Samantaray, Shreyan Kar, Brajaballav Kar
-
- Journal:
- Disaster Medicine and Public Health Preparedness / Volume 16 / Issue 2 / April 2022
- Published online by Cambridge University Press:
- 15 February 2021, pp. 670-677
-
- Article
- Export citation
-
Background:
Early Identification of disaster victims with mental health problems may be useful, but information within a short period after a disaster is scarce in developing countries. This study examined anxiety, depression, and post-traumatic stress symptoms at 1 month following 2019 Cyclone Fani in Odisha, India.
Method:Post-traumatic stress symptoms (PTSS) were assessed by the Primary care PTSD screen for DSM 5 (PC-PTSD-5), anxiety symptoms by the Generalised Anxiety Disorder (GAD-7), and depression by the Patient Health Questionnaire (PHQ-9). The survey included participants’ disaster experience e.g., evacuation, fear of death, injury, death in family, damage to house, difficulty for food, displacement, and effect on livelihood.
Results:Proportion of sample (n = 80) with probable PTSD was 42.9%, with severe anxiety was 36.7%, moderately severe depression was 16.5%, and severe depression was 3.8%. Suicidal cognitions were reported to increase by 14%. Comorbidity was common; with significant (P < 0.01) correlation between PTSS and anxiety (r = 0.69), depression (r = 0.596), and between anxiety and depression (r = 0.63). Damage of house and displacement were associated significantly with PTSD; evacuation and displacement with moderate and severe depression; and displacement with severe anxiety. No specific demographic factors were significantly linked to the psychiatric morbidities.
Conclusion:A considerable proportion of victims had psychiatric morbidities at 1 month. Associated risk factors included housing damages, evacuation, and displacement, suggesting the need to improve the disaster-management process.
Posttraumatic Stress, Depression, and Coping Following the 2015 Nepal Earthquake: A Study on Adolescents
- Asmita Sharma, Nilamadhab Kar
-
- Journal:
- Disaster Medicine and Public Health Preparedness / Volume 13 / Issue 2 / April 2019
- Published online by Cambridge University Press:
- 24 May 2018, pp. 236-242
-
- Article
- Export citation
-
Objective
The study aimed to gather data on posttraumatic stress and depression in adolescents following the 2015 Nepal earthquake and explore the adolescents’ coping strategies.
MethodsIn a questionnaire-based, cross-sectional study about 1 year after the earthquake, adolescents in two districts with different degrees of impact were evaluated for disaster experience, coping strategies, and symptoms of posttraumatic stress and depression measured with the Child Posttraumatic Stress Scale and the Depression Self Rating Scale.
ResultsIn the studied sample (N=409), the estimated prevalence of posttraumatic stress disorder (PTSD) (43.3%) and depression (38.1%) was considerable. Prevalence of PTSD was significantly higher in the more affected area (49.0% v 37.9%); however, the prevalence figures were comparable in adolescents who reported a stress. The prevalence of depression was comparable. Female gender, joint family, financial problems, displacement, injury or being trapped in the earthquake, damage to livelihood, and fear of death were significantly associated with a probable PTSD diagnosis. Various coping strategies were used: talking to others, praying, helping others, hoping for the best, and some activities were common. Drug abuse was rare. Most of the coping strategies were comparable among the clinical groups.
ConclusionsA considerable proportion of adolescents had posttraumatic stress and depression 1 year after the earthquake. There is a need for clinical interventions and follow-up studies regarding the outcome. Disaster Med Public Health Preparedness. 2019;13:236–242)
Disaster Psychiatry: Readiness, Evaluation, and Treatment Edited by Frederick J. StoddardJr , Anand Pandya & Craig L. Katz. American Psychiatric Publishing. 2011. US$69.00 (pb). 418pp. ISBN: 9780873182171
- Nilamadhab Kar
-
- Journal:
- The British Journal of Psychiatry / Volume 200 / Issue 1 / January 2012
- Published online by Cambridge University Press:
- 02 January 2018, p. 84
- Print publication:
- January 2012
-
- Article
-
- You have access Access
- HTML
- Export citation
Efficacy of antidepressants in treating the negative symptoms of chronic schizophrenia: meta-analysis
- Surendra P. Singh, Vidhi Singh, Nilamadhab Kar, Kelvin Chan
-
- Journal:
- The British Journal of Psychiatry / Volume 197 / Issue 3 / September 2010
- Published online by Cambridge University Press:
- 02 January 2018, pp. 174-179
- Print publication:
- September 2010
-
- Article
-
- You have access Access
- HTML
- Export citation
-
Background
Treatment of negative symptoms in chronic schizophrenia continues to be a major clinical issue.
AimsTo analyse the efficacy of add-on antidepressants for the treatment of negative symptoms of chronic schizophrenia.
MethodSystematic review and meta-analysis of randomised controlled trials comparing the effect of antidepressants and placebo on the negative symptoms of chronic schizophrenia, measured through standardised rating scales. Outcome was measured as standardised mean difference between end-of-trial and baseline scores of negative symptoms.
ResultsThere were 23 trials from 22 publications (n = 819). The antidepressants involved were selective serotonin reuptake inhibitors, mirtazapine, reboxetine, mianserin, trazodone and ritanserin; trials on other antidepressants were not available. The overall standardised mean difference was moderate (–0.48) in favour of antidepressants and subgroup analysis revealed significant responses for fluoxetine, trazodone and ritanserin.
ConclusionsAntidepressants along with antipsychotics are more effective in treating the negative symptoms of schizophrenia than antipsychotics alone.