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To compare differences in clozapine doses and plasma levels between Bangladeshi and White British patients. Following ethical approval we identified all current Bangladeshi and White British patients on clozapine maintenance in an east London clinic. We carried out univariate and multivariate regression analyses to examine associations between clozapine doses and ethnicity, age, gender, smoking status and weight. We also compared plasma clozapine levels of the two groups.
On univariate analysis White British patients had on average 85 mg higher doses than Bangladeshi patients (P = 0.004). Older age, male gender and smoking were also associated with higher dose. On multivariate analysis only age and smoking status remained significant. A greater proportion of Bangladeshi patients had high plasma clozapine levels compared with White British (30.76% v. 20.75%), although the difference was not statistically significant.
Our findings point to the need for the broadening of data collection on ethnic differences in clozapine prescribing within big data-sets such as Prescribing Observatory for Mental Health (POM-UK). Ethnopharmacological variations can inform more person-centred guidance on prescribing.
The Tower Hamlets Crisis House (voluntary sector), in partnership with the local home treatment team, offers a brief residential alternative to psychiatric hospital admission. Here, we review clinician-reported (Health of the Nation Outcome Scales; HoNOS) and patient-reported (DIALOG) outcome scores collected from successive admissions between June 2015 and December 2016, to assess the effectiveness of the service model. We identified 153 successive admissions, and of these, 85 (55.6%) and 91 (59.5%) patients completed both admission and discharge DIALOG and HoNOS questionnaires, respectively. We analysed ten out of twelve HoNOS domains and eight patient-reported outcome measure DIALOG domains.
We found a statistically significant improvement in nine out of ten domains of HoNOS and three out of eight domains of DIALOG.
A partnership between a home treatment team and crisis house can result in positive outcomes for patients, as determined by both clinicians and patients.
Culture is what makes us who we are. We are born into a culture and gradually absorb its cultural values and mores, often without realising it. Culture influences our cognitive schema, the way we deal with stress and respond to others. More importantly, culture influences the way individuals perceive and express distress and how they seek help. Cultures also dictate how healthcare systems develop and deliver care. In this era of globalisation, cultures are directly and indirectly influenced by each other. Under these circumstances, it is imperative that clinicians are aware of cultural factors in the genesis and management of psychiatric disorders. Every individual has a culture and cultural roots do go deep. It behoves clinicians to understand their patients in their social and cultural contexts so that the therapeutic alliance can be strengthened.
Advances in Psychiatric Treatment as a journal set a precedent in 1997 when it started a series of articles on culture and psychiatric disorders. Over the past decade or so it has published several contributions in this field and is continuing to do so. With the new curriculum developed by the Royal College of Psychiatrists in 2005 and since, cultural psychiatry has become a significant part of training of psychiatrists. It was decided to put articles from Advances together in a single volume not only so that practising clinicians can benefit from the cumulative knowledge, but also that other mental health practitioners may have access, thereby helping to ensure that clinical teams can work together effectively and provide optimal care to their patients, irrespective of their ethnicity, culture or religion. We chose a number of existing articles and asked their authors to revise them. However, in the process we discovered that many subjects had not been previously covered so we commissioned several new chapters We are most grateful to all our authors, old and new, for providing updated reviews in a field that is changing fairly rapidly. Thanks are also due to Professor Peter Tyrer, Dr Joe Bouch and Dr Jonathan Green for their vision and encouragement.
Neuropsychiatry services remain underdeveloped and underprovided. Previous studies have shown variability in service provision in the UK. In this survey we approached all mental health and neuropsychiatric service providers within London to map current neuropsychiatric service provision and explore perceived barriers.
All the specialist mental health service providers responded. There was huge variability in neuropsychiatric service provision within different parts of London. There was evidence of significant unmet need and variability in service pathways. Lack of earmarked funds for neuropsychiatry and disjointed funding stream for such services were identified by providers as a barrier.
This study provides further evidence of an ongoing lack of adequate neuropsychiatric service provision. Reasons for variability and unmet need are discussed. Adoption of a previously proposed hub-and-spoke model of service provision and the removal of commissioning barriers through uniform national commissioning may help deal with this problem.
Previous studies have shown variations in commissioning of neuropsychiatry services and this makes access to neuropsychiatric services a postcode lottery. In this survey, we approached all mental health and neuropsychiatric service commissioners within London to map current funding and commissioning arrangements, and explored perceived barriers to neuropsychiatric service commissioning.
Results 83% of commissioners within London responded. There was significant variability between neuropsychiatric services commissioned through the mental health stream. Contracting arrangements were variable. Lack of earmarked fund for neuropsychiatry and disjointed funding stream for such services were identified by commissioners as a barrier, as was the critical mass of neuropsychiatric cases.
Neuropsychiatric service development continues to be hindered by lack of clear commissioning process. Strategic drive is needed to promote more equitable neuropsychiatric services. National or regional commissioning covering a large population will provide a better model for neuropsychiatric services to be commissioned.