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There is global interest in the reconfiguration of community mental health services, including primary care, to improve clinical and cost effectiveness.
This study seeks to describe patterns of service use, continuity of care, health risks, physical healthcare monitoring and the balance between primary and secondary mental healthcare for people with severe mental illness in receipt of secondary mental healthcare in the UK.
We conducted an epidemiological medical records review in three UK sites. We identified 297 cases randomly selected from the three participating mental health services. Data were manually extracted from electronic patient medical records from both secondary and primary care, for a 2-year period (2012–2014). Continuous data were summarised by mean and s.d. or median and interquartile range (IQR). Categorical data were summarised as percentages.
The majority of care was from secondary care practitioners: of the 18 210 direct contacts recorded, 76% were from secondary care (median, 36.5; IQR, 14–68) and 24% were from primary care (median, 10; IQR, 5–20). There was evidence of poor longitudinal continuity: in primary care, 31% of people had poor longitudinal continuity (Modified Modified Continuity Index ≤0.5), and 43% had a single named care coordinator in secondary care services over the 2 years.
The study indicates scope for improvement in supporting mental health service delivery in primary care. Greater knowledge of how care is organised presents an opportunity to ensure some rebalancing of the care that all people with severe mental illness receive, when they need it. A future publication will examine differences between the three sites that participated in this study.
There has been a recent rise in antidepressant prescriptions. After the episode for which it was prescribed, the patient should ideally be supported in withdrawing the medication. There is increasing evidence for withdrawal symptoms (sometimes called discontinuation symptoms) occurring on ceasing treatment, sometimes having severe or prolonged effects.
To identify and compare current knowledge, attitudes and practices of general practitioners (GPs) and psychiatrists in Cornwall, UK, concerning antidepressant withdrawal symptoms.
Questions about withdrawal symptoms and management were asked of GPs and psychiatrists in a multiple-choice cross-sectional study co-designed with a lived experience expert.
Psychiatrists thought that withdrawal symptoms were more severe than GPs did (P = 0.003); 53% (22/42) of GPs and 69% (18/26) of psychiatrists thought that withdrawal symptoms typically last between 1 and 4 weeks, although there was a wide range of answers given; 35% (9/26) of psychiatrists but no GPs identified a pharmacist as someone they may use to help manage antidepressant withdrawal. About three-quarters of respondents claimed they usually or always informed patients of potential withdrawal symptoms when they started a patient on antidepressants, but patient surveys say only 1% are warned.
Psychiatrists and GPs need to effectively warn patients of potential withdrawal effects. Community pharmacists might be useful in supporting GP-managed antidepressant withdrawal. The wide variation in responses to most questions posed to participants reflects the variation in results of research on the topic. This highlights a need for more reproducible studies to be carried out on antidepressant withdrawal, which could inform future guidelines.
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.
To describe an outbreak of severe Group A Streptococcus (GAS) infections that appeared to be associated with use of a biologic dermal substitute on foot wounds
Retrospective cohort study of cases and similar uninfected patients
Patients attending the podiatry clinic at a Veterans Affairs Medical Center between July 2011 and November 2011
Microbiology laboratory data were reviewed for the calendar year, a case definition was established and use of the biologic dermal substitute was discontinued. Staff were cultured to identify potentially colonized employees. A case–cohort study was designed to investigate risk factors for disease. Emm typing and pulsed field gel electrophoresis (PFGE) were performed to identify strain similarity.
In 10 months, 14 cases were identified, and 4 of these patients died. All strains were emm type 28 and were identical according to PFGE. Discontinuation of biologic dermal substitute use halted the outbreak. A prior stroke was more common in the case cohort vs uninfected patient cohorts. The number of patients attending the clinic on 13 probable transmission days was significantly higher than on nontransmission days. We identified 2 patients who were present in the clinic on all but 1 probable transmission day. Surveillance cultures of podiatry clinic staff and cultures of the same lot of retained graft material were negative.
A carrier was not identified, and we believe the outbreak was associated with inter-patient transmission likely due to lapses in infection control techniques. No additional cases have been identified in >3 years following the resumption of dermal substitute use in May 2012.
Infect. Control Hosp. Epidemiol. 2016;37(3):306–312
Background: Post event processing (PEP) in social anxiety disorder involves rumination about social events after the fact, and is thought to be a crucial feature of the maintenance of the disorder. Aims: The current experiment aimed to manipulate the use of PEP in individuals with social anxiety disorder. Method: Forty-one individuals with social anxiety disorder completed a videotaped speech. Anxiety ratings and degree of PEP were measured after the task as well as the day following the experiment. Results: Individuals in the distract group reported a greater decrease in anxiety from baseline to post-experimental task than those asked to focus. Individuals in the distract group also reported higher PEP about the task than those instructed to complete a focus task, which appeared to be partially accounted for by baseline differences in symptom severity and state anxiety. Degree of PEP was positively correlated with anxiety ratings, both after the experimental task as well as 24 hours later. Conclusions: These findings suggest that naturalistic PEP is problematic for individuals with social anxiety disorder, especially for those with more severe symptoms. A distraction task, even with breakthrough PEP, appears to have useful short-term effects on anxiety reduction as compared to focus instructions.
When The Shepheardes Calender, Spenser’s first major work, appeared in 1579 it did so anonymously, but when its author died a mere twenty years later he was widely recognized as ‘the Prince of Poets in his time’. The various stages in that rapid journey from anonymity to fame trace the trajectory of a very public and highly controversial career. Spenser conducted his relationship with his readers, and indeed with his patrons, through a series of carefully manipulated personae. He was constantly auto-referential but seldom autobiographical. The ‘selves’ that he offered to public view were richly complex, poetic constructs acutely responsive to the demands of genre. And his generic range was dazzling: he wrote pastoral, heroic, mock heroic, panegyrical, satiric, visionary, and amatory verse.
Spenser introduced himself to the reading public in 1579 as the ‘new poet’, and innovation is the hallmark of his canon. He experimented with a wider range of metres, dialects, and stanza-structures than any English poet prior to John Donne, and his stylistic and generic inventions invariably purveyed unsettling social or political comment. Although he has frequently been accused, most notably, perhaps, by W. B. Yeats, of producing propaganda, it would be truer to say that his relationship to contemporary power-structures was one of conflicted fascination.
The present study tested several predictions related to the theory
that girls with conduct disorder (CD) follow a single delayed onset
pathway. The following hypotheses were tested among a high-risk,
stratified random sample of youth who used public services during a
6-month period: boys will be more likely to have childhood onset CD
(COCD) than girls; girls with COCD will be less common than girls with
adolescent onset CD (AOCD); COCD girls, AOCD girls, and COCD boys will
be similar in terms of risk profiles and AOCD boys will have a less
severe risk profile than COCD girls; and risk factors that
differentiate between COCD and AOCD among males will not differentiate
between COCD and AOCD among females. Among those youth who met the
criteria for CD, males were significantly more likely to have COCD than
females. However, close to half of females with CD met the criteria for
the COCD subtype. Of the seven risk factors that were examined, girls
with COCD scored higher than COCD boys on three factors and higher than
AOCD girls on four factors; however, only one significant difference
was found between AOCD girls and COCD boys. Finally, risk factors
appeared to differentiate between COCD and AOCD groups in a similar way
among males and females. These findings suggest that COCD is not rare
among females in public service sectors, COCD girls can be
distinguished from AOCD girls in terms of risk factors, and risk
factors for COCD among males are also relevant to females.The Patterns of Youth Mental Health Care in
Public Service Systems Study is supported by National Institute of
Mental Health (NIMH) Grant U01 MH55282. Preparation of this article was
supported by Research Scientist Development Awards K01MH01767 and
K01MH01924. The authors are most grateful for the comments and
suggestions on this manuscript that were provided by Dr. Persephanie
Silverthorn and Dr. Theodore Beauchaine.
During the course of their discussion of Irish customs in A View of the Present State of Ireland, Irenius informs Eudoxus that
the Gaules used to drinke theire enemyes blodd and to painte themselues therewith So allsoe they write that the owlde Irishe weare wonte And so have I sene some of the Irishe doe but not theire enemyes but friendes blodd as namelye at the execucion of A notable Traitour at Limericke Called murrogh Obrien I sawe an olde woman which was his foster mother take up his heade whilste he was quartered and sucked up all the blodd runninge theareout Sayinge that the earthe was not worthie to drinke it and thearewith allso steped her face, and breste and torne heare Cryinge and shrikinge out moste terrible (112)
As the execution of Murrogh O'Brien occurred in 1577 the passage has long been used as evidence for Spenser's presence in Ireland some three years before his officially documented arrival in 1580 as secretary to Lord Arthur Grey, the newly appointed Lord Deputy. But this is to make unwarranted assumptions about the relationship between Irenius and Spenser.