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Safety at work is a core issue for mental health staff working on
in-patient units. At present, there is a limited theoretical base
regarding which factors may affect staff perceptions of safety.
This study attempted to identify which factors affect perceived staff
safety working on in-patient mental health wards.
A cross-sectional design was employed across 101 forensic and
non-forensic mental health wards, over seven National Health Service
trusts nationally. Measures included an online staff survey, Ward
Features Checklist and recorded incident data. Data were analysed using
categorical principal components analysis and ordinal regression.
Perceptions of staff safety were increased by ward brightness, higher
number of patient beds, lower staff to patient ratios, less dayroom space
and more urban views.
The findings from this study do not represent common-sense assumptions.
Results are discussed in the context of the literature and may have
implications for current initiatives aimed at managing in-patient
violence and aggression.
National Mental Health Survey found that in India, the point prevalence
of major depressive disorder (MDD) was 2.7% and the treatment gap was
85.2%, whereas in Madhya Pradesh the point prevalence of MDD was 1.4% and
the treatment gap was 80%.
To describe the baseline prevalence of depression among adults,
association of various demographic and socioeconomic variables with
depression and estimation of contact coverage for the same.
Population-based cross-sectional survey of 3220 adults in Sehore district
of Madhya Pradesh, India. The outcome of interest was a probable
diagnosis of depression that was measured using the Patient Health
Questionnaire (PHQ-9) and the proportion of individuals with depression
(PHQ-9>9) who sought care for the same. The data were analysed using
simple and multiple log-linear regression.
Low educational attainment, unemployment and indebtedness were associated
with both moderate/severe depression (PHQ-9 score >9) and severe
depression only (PHQ-9 score >14), whereas age, caste and marital
status were associated with only moderate or severe depression. Religion,
type of house, land ownership and amount of loan taken were not
associated with either moderate/severe or only severe depression. The
contact coverage for moderate/severe depression was 13.08% (95% CI
There is an urgent need to bridge the treatment gap by targeting
individuals with social vulnerabilities and integrating evidence-based
interventions in primary care.
Transition from at-risk state to full syndromal mental disorders is
underexplored for unipolar and bipolar disorders compared with
Prospective, trans-diagnostic study of rates and predictors of early
transition from sub-threshold to full syndromal mental disorder.
One-year outcome of 243 consenting youth aged 15–25 years with a
sub-syndromal presentation of a potentially severe mental disorder.
Survival analysis and odds ratio (OR) for predictors of transition
identified from baseline clinical and demographic ratings.
About 17% (n=36) experienced transition to a major
mental disorder. Independent of syndromal diagnosis, transition was
significantly more likely in individuals who were NEET (not in education,
employment or training), in females and in those with more negative
psychological symptoms (e.g. social withdrawal).
NEET status and negative symptoms are modifiable predictors of illness
trajectory across diagnostic categories and are not specific to
transition to psychosis.
Insomnia treatment using an internet-based cognitive–behavioural therapy
for insomnia (CBT-I) program reduces depression symptoms, anxiety
symptoms and suicidal ideation. However, the speed, longevity and
consistency of these effects are unknown.
To test the following: whether the efficacy of online CBT-I was sustained
over 18 months; how rapidly the effects of CBT-I emerged; evidence for
distinct trajectories of change in depressive symptoms; and predictors of
A randomised controlled trial compared the 6-week Sleep Healthy Using the
Internet (SHUTi) CBT-I program to an attention control program. Adults
(N=1149) with clinical insomnia and subclinical
depression symptoms were recruited online from the Australian
Depression, anxiety and insomnia decreased significantly by week 4 of the
intervention period and remained significantly lower relative to control
for >18 months (between-group Cohen's d=0.63, 0.47,
0.55, respectively, at 18 months). Effects on suicidal ideation were only
short term. Two depression trajectories were identified using growth
mixture models: improving (95%) and stable/deteriorating (5%) symptoms.
More severe baseline depression, younger age and limited comfort with the
internet were associated with reduced odds of improvement.
Online CBT-I produced rapid and long-term symptom reduction in people
with subclinical depressive symptoms, although the initial effect on
suicidal ideation was not sustained.
Generalised joint hypermobility (GJH) is reportedly overrepresented among
clinical cases of attention deficit/hyperactivity disorder (ADHD), autism
spectrum disorder (ASD) and developmental coordination disorder (DCD). It
is unknown if these associations are dimensional and, therefore, also
relevant among non-clinical populations.
To investigate if GJH correlates with sub-syndromal neurodevelopmental
symptoms in a normal population.
Hakim-Grahame's 5-part questionnaire (5PQ) on GJH, neuropsychiatric
screening scales measuring ADHD and ASD traits, and a DCD-related
question concerning clumsiness were distributed to a non-clinical, adult,
Swedish population (n=1039).
In total, 887 individuals met our entry criteria. We found no
associations between GJH and sub-syndromal symptoms of ADHD, ASD or
Although GJH is overrepresented in clinical cases with neurodevelopmental
disorders, such an association seems absent in a normal population. Thus,
if GJH serves as a biomarker cutting across diagnostic boundaries, this
association is presumably limited to clinical populations.
There are no previous whole-country studies on mental health and
relationships with general health in intellectual disability populations;
study results vary.
To determine the prevalence of mental health conditions and relationships
with general health in a total population with and without intellectual
Ninety-four per cent completed Scotland's Census 2011. Data on
intellectual disabilities, mental health and general health were
extracted, and the association between them was investigated.
A total of 26 349/5 295 403 (0.5%) had intellectual disabilities. In
total, 12.8% children, 23.4% adults and 27.2% older adults had mental
health conditions compared with 0.3, 5.3 and 4.5% of the general
population. Intellectual disabilities predicted mental health conditions;
odds ratio (OR)=7.1 (95% CI 6.8–7.3). General health was substantially
poorer and associated with mental health conditions; fair health OR=1.8
(95% CI 1.7–1.9), bad/very bad health OR=4.2 (95% CI 3.9–4.6).
These large-scale, whole-country study findings are important, given the
previously stated lack of confidence in comparative prevalence results,
and the need to plan services accordingly.
Optimal anti-epileptic drug (AED) treatment maximises therapeutic
response and minimises adverse effects (AEs). Key to therapeutic AED
treatment is adherence. Non-adherence is often related to severity of
AEs. Frequently, patients do not spontaneously report, and clinicians do
not specifically query, critical AEs that lead to non-adherence,
including sexual dysfunction. Sexual dysfunction prevalence in patients
with epilepsy ranges from 40 to 70%, often related to AEDs, epilepsy or
mood states. This case reports lamotrigine-induced sexual dysfunction
leading to periodic non-adherence.
To report lamotrigine-induced sexual dysfunction leading to periodic
lamotrigine non-adherence in the context of multiple comorbidities and
concurrent antidepressant and antihypertensive pharmacotherapy.
Case analysis with PubMed literature review.
A 56-year-old male patient with major depression, panic disorder without
agoraphobia and post-traumatic stress disorder was well-controlled with
escitalopram 20 mg bid, mirtazapine 22.5 mg qhs and alprazolam 1 mg tid
prn. Comorbid conditions included complex partial seizures, psychogenic
non-epileptic seizures (PNES), hypertension, gastroesophageal reflux
disease and hydrocephalus with patent ventriculoperitoneal shunt that
were effectively treated with lamotrigine 100 mg tid, enalapril 20 mg qam
and lansoprazole 30 mg qam. He acknowledged non-adherence with
lamotrigine secondary to sexual dysfunction. With lamotrigine 300 mg
total daily dose, he described no libido with
impotence/anejaculation/anorgasmia. When off lamotrigine for 48 h, he
described becoming libidinous with decreased erectile dysfunction but
persistent anejaculation/anorgasmia. When off lamotrigine for 72 h to
maximise sexual functioning, he developed auras. Family confirmed
patient's consistent monthly non-adherence for 2–3 days during the past
Sexual dysfunction is a key AE leading to AED non-adherence. This case
describes dose-dependent lamotrigine-induced sexual dysfunction with
episodic non-adherence for 12 months. Patient/clinician education
regarding AED-induced sexual dysfunction is warranted as are routine
sexual histories to ensure adherence.
Despite extensive clinical concern about rates of obesity in patients
with schizophrenia, there is little evidence of the extent of this
problem at a population level.
To estimate levels of obesity in a national population sample by
comparing patients with schizophrenia with matched controls.
We calculated levels of obesity for each patient with schizophrenia from
the national Primary Care Clinical Informatics Unit database (n=4658)
matched with age, gender and neighbourhood controls.
We demonstrated a significant increased obesity hazard for the
schizophrenia group using Cox regression analysis, with odds ratio (OR)
of 1.94 (95% CI 1.81–2.10) (under the assumption of missing body mass
index (BMI) indicating non-obesity) and OR=1.68 (95% CI 1.55–1.81) where
no assumptions were made for missing BMI data.
People with schizophrenia are at increased risk of being obese compared
with controls matched by age, gender and practice attended. Priority
should be given to research which aims to reduce weight and increase
activity in those with schizophrenia.
Material and social environmental stressors affect mental health in
adolescence. Protective factors such as social support from family and
friends may help to buffer the effects of adversity.
The association of violence exposure and emotional disorders was examined
in Cape Town adolescents.
A total of 1034 Grade 8 high school students participated from seven
government co-educational schools in Cape Town, South Africa. Exposure to
violence in the past 12 months and post-traumatic stress disorder (PTSD)
symptoms were measured by the Harvard Trauma Questionnaire, depressive
and anxiety symptoms by the Short Moods and Feelings Questionnaire and
the Self-Rating Anxiety Scale.
Exposure to violence was associated with high scores on depressive (odds
ratio (OR)=6.23, 95% CI 4.2–9.2), anxiety (OR=5.40, 95% CI 2.4–12.4) and
PTSD symptoms (OR=8.93, 95% CI 2.9–27.2) and increased risk of self-harm
(OR=5.72, 95% CI 1.2–25.9) adjusting for gender and social support.
We found that high exposure to violence was associated with high levels
of emotional disorders in adolescents that was not buffered by social
support. There is an urgent need for interventions to reduce exposure to
violence in young people in this setting.