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Alcohol-related brain damage: a 21st-century management conundrum

  • Kenneth Wilson (a1)

Summary

Alcohol-related brain damage has a growing impact on service provision. Despite the benefit of therapeutic interventions and a relatively good prognosis in the context of service provision, few services exist. Both national and local initiatives are required in order to provide psychosocial rehabilitation for this marginalised group of patients.

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References

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Alcohol-related brain damage: a 21st-century management conundrum

  • Kenneth Wilson (a1)
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eLetters

Alcohol Related Brain Damage : In the absence of a care pathway, where does the responsibility lie?

Sarah Jawad, Sarah Jawad CT2 in Psychiatry
04 April 2012

We read with interest the article entitled 'Alcohol-Related brain damage: a 21st century management conundrum'1. As highlighted, gaps in service provision exist nationally for young people with alcohol-related brain damage (ARBD). A Lack of basic understanding of this important diagnosis appears to delay therapeutic intervention.

We reviewed all referrals to Liaison Psychiatry Services at Leeds Teaching Hospitals with a diagnosis of ARBD between May and August 2011. We focused on pathways from assessment to subsequent management in workingage adult patients under the age of 65 with alcohol- related brain damage.Ten patients were identified with a diagnosis of ARBD. Referrals from the acute hospitals were made for multiple reasons including assessment of cognitive function, assessment of co-morbid psychiatric diagnoses, management of behavioural disturbance and assessment of capacity. Eighty percent of the cohort were male and the median age of our cohort was 58.5 years (range 41 to 62 years). Forty percent had concurrent psychiatric diagnoses.

Median length of hospital stay was 45 days (range 6 to 96 days). In seventy percent of cases the patient was reviewed 2 or more times by the Liaison Psychiatry team during their admission. Requested investigations, which included biochemistry, microbiology and radiology varied between cases. On admission, one hundred percent had received a blood test for Full Blood Count, Urea and Electrolytes, Liver Function Tests and Calcium.More than eighty percent were further tested for Clotting profile, C-Reactive protein and Phosphate. In less than forty percent a sample was obtained for Haematinics, Thyroid Function, Glucose and Magnesium sampling. In terms of radiological investigation, sixty percent had a CT Head scan with a further thirty percent undergoing MRI. Examples of involved inpatient services other than Liaison Psychiatry included Neurology and Orthopaedics both accounting for ten percent of cases. Upon discharge, less than fifty percent were referred on for neuro-rehabilitation and 20 percent received no community follow up.

In the absence of a defined protocol there appears to be significant variations in how patients with ARBD are managed in the immediate hospitalsetting and on referral to specialist services in the community upon discharge. At our Trust we are looking to establish a clear and appropriate care pathway for the inpatient teams and involved specialist services to follow.

References:1.Wilson, K. Alcohol-related brain damage: a 21st-century management conundrum. The BritishJournal of Psychiatry, 2011. 199: 176-177.

Correspondence to Dr Sarah Jawad, Department of Liaison Psychiatry, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX.

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Conflict of interest: None declared

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