The aim of the study was to evaluate the open referral system from social services to a community mental health team (CMHT) for older people. Referral letters from social services to the specialist team were reviewed, as were the case notes.
RESULTS
Of the 40 referrals, 95% (n=38) were accepted by the CMHT. Only 15% (n=6) fulfilled the team’s existing referral criteria. The majority of referrals (n=36, 90%) had details of the patient’s mental health problems. None of the referrals with memory problems had a cognitive assessment. Of the 38 referrals accepted by the CMHT, 36 were found to be suffering from a mental illness. The open referral system from social services did not increase the total number of annual referrals.
CLINICAL IMPLICATIONS
Social services play an important role in identifying and referring older people with mental illness and ensure a potentially rapid referral route bypassing primary care. The practice of accepting direct referrals from social services should be encouraged and made an integral part of the referral system.
]]>To explore the smoking habits of in-patients on psychiatric wards, their beliefs about the effects of smoking on health, and their attitudes towards hospital and government smoking policies. Face-to-face interviews with 135 in-patients were conducted.
RESULTS
A total of 54.1% of participants smoked. Smoking was less prevalent in those aged 65 years and older (P<0.001). Non-smokers were more likely to believe smoking to be harmful to health (P=0.002). Overall, 71.1% of the participants favoured the existing smoking policy, with only 3.0% wanting a complete ban on smoking and 54.1% agreeing with banning smoking in public places.
CLINICAL IMPLICATIONS
Further studies are warranted into the views of in-patients elsewhere and to see whether attitudes change as trusts tighten their smoking policies. Outdoor smoking areas may need to be considered, although in practice this may not be possible in all trusts.
]]>To examine the quality of information concerning depression available on the internet, identify factors associated with ‘good’ quality, and develop a simple-to-use instrument for assessing websites on depression. The Depression-Website Content Checklist was developed and compared with a previously validated, yet too complex, scale. Websites were assessed using both instruments.
RESULTS
Good quality information is more likely to be found on websites provided by governmental, professional and charitable organisations. The differences we observed in the median scores for these websites using the Depression-Website Content Checklist are significant at the 0.05 level (Ctot; Mann-Whitney, U=24.00; P=0.013). The Depression-Website Content Checklist is a valid and reliable user-friendly tool.
CLINICAL IMPLICATIONS
Patients can be directed towards better quality information by diverting them to public and non-sponsored websites. Clinicians can use the Depression-Website Content Checklist to determine website quality.
]]>To calculate the prevalence of metabolic syndrome in patients receiving clozapine in community and long-stay in-patient settings. Patients were assessed using measures specified by the Expert Panel of the US National Cholesterol Education Program.
RESULTS
The prevalence of the metabolic syndrome was calculated as 53% in the community groups and 11% in the in-patient group, although both sample sizes (particularly the in-patient group) were small. Women were more frequently affected than men in the community population.
CLINICAL IMPLICATIONS
The higher percentage of metabolic syndrome in the community patients receiving clozapine has implications with respect to physical health. The reasons for the lower percentage in the in-patient group are unclear. Our findings point to a possible difference in the physical health of long-stay psychiatric in-patients and patients in the community.
]]>To compare two groups of older people with chronic schizophrenia or
delusional disorder living in the community and in care homes, along the
domains of morbidity suggested by prior research. From the case-load of one
old age psychiatrist, 22 individuals with chronic psychosis residing in care
homes were compared to 23 living in their own homes. The measures used were:
the Positive and Negative Symptom Score (PANSS;
RESULTS
Those in care homes had significantly higher PANSS scores (38.9 v. 21.0, P<0.01), largely accounted for by significantly more deficit symptoms (14.2 v. 5.6, P<0.01). They also had poorer cognition and significantly greater impairment in daily-life activities but their medical condition was not significantly worse. Most were seen only by a psychiatrist.
CLINICAL IMPLICATIONS
The greater morbidity and disablement of older people with chronic schizophrenia or delusional disorder living in care homes is likely to be intrinsic to the disorder but does not appear to be taken into account in current service planning or delivery.
]]>To ascertain attitudes, awareness, knowledge and variations in prescribing habits of psychiatrists when addressing issues of faith, culture and dietary requirements (in keeping with the General Medical Council’s and the Royal College of Psychiatrists’ guidelines), and how these may affect the trust in doctor-patient relations. We undertook a cross-sectional postal survey aimed at clinicians in South West Yorkshire Mental Health Trust.
RESULTS
We obtained 38 responses (40% of the total number of questionnaires sent out) from two mailshots. Although the majority of respondents indicated that they were aware of the presence of potentially forbidden animal-derived ingredients in medication, only half expressed the view that a discussion regarding the above should take place prior to prescribing such medication.
CLINICAL IMPLICATIONS
Diversity training combined with taking a genuine interest in patients’ wishes will not only minimise ‘mistrust’ but also facilitate prescribing in a therapeutic relationship.
]]>We studied the impact of an evidence-based multidisciplinary intervention to reduce six sub-optimal aspects of psychotropic prescribing, combined as a Prescribing Practice Quality (PPQ) score over a 5-year follow-upperiodinacommunity mental health service.
RESULTS
Sub-optimal prescribing practices were significantly reduced after 1 year and these improvements were sustained at 5-year follow-up. The PPQ scores were significantly reduced (P<0.001) in both the overall population attending at each follow-up point as well as in the ever-present population (n=163). Use of high-dose antipsychotics and thioridazine ceased entirely; use of sedative hypnotic agents was less amenable to reduction.
CLINICAL IMPLICATIONS
Multifaceted interventions can achieve sustained improvements in prescribing practices in real-world settings.
]]>Specialist registrars in psychotherapy, at various stages of their training, attended a 1-day experiential group relations conference. The aim was to provide a training context in which trainees could reflect, through direct experience, on their capacity for leadership and teamwork, and the difficulties in taking up one’s own authority in role.
RESULTS
Participants rated (on a 5-point Likert scale) the various structured elements of the conference as being greater than moderately useful for their learning. At 9-month follow-up, median scores were 4, indicating that the conference had a moderate to high impact on the participants’ learning in four key dimensions: effective communication, taking up a leadership role, dealing with task- and role-related anxiety, and containing others’ psychological projections.
CLINICAL IMPLICATIONS
There is often little time to reflect on one’s experiences or
behaviour in professional environment. The study demonstrates that learning
about one’s behaviour, capacity for leadership, performing various roles
and the ability to act with authority, in a facilitated experiential learning
environment can make a significant contribution to the development of future
consultant psychiatrists in psychotherapy. In the light of the new curriculum
(