Psychiatry Management Research Articles

DESAFIOS DO MANEJO DO LÍTIO NO PACIENTE PSIQUIÁTRICO: ESTRATÉGIAS PARA GARANTIR A SEGURANÇA E EFICÁCIA DO TRATAMENTO

Although lithium has been used for decades, its management remains a clinical challenge, since it is a drug with narrow therapeutic indices and with possible adverse effects. Therefore, this study aims to present evidence and clinical challenges of lithium management in psychiatry, in order to contribute to a better understanding of the use of this drug and the conscious management of patients who use this medication. This is a retrospective, documental Integrative Literature Review about the challenges of lithium management in psychiatric patients. For the development of this work, the following steps were followed: 1) Construction of the theme and the guiding question; 2) Establishment of inclusion and exclusion criteria; 3) Collection of studies in the scientific bases; 4) Evaluation of the selected abstracts; 5) Evaluation and categorization of studies in full; 6) Analysis and interpretation of the results. Lithium, as a mood stabilizer, was a great historical discovery and its importance lies in its effectiveness in controlling the symptoms of bipolarity, being considered a first-line mood stabilizer for the treatment of bipolar disorder and other psychopathologies. It is concluded, therefore, that the management of lithium in the treatment of psychiatric disorders requires a careful and individualized approach, taking into account the efficacy of the drug, patient safety and possible drug interactions and clinical conditions. Knowledge of the common and rare side effects of lithium is essential to ensure successful and safe treatment.

Informing the development of antipsychotic-induced weight gain management guidance: patient experiences and preferences - qualitative descriptive study.

Antipsychotic-induced weight gain (AIWG) is a substantial contributor to high obesity rates in psychiatry. Limited management guidance exists to inform clinical practice, and individuals with experience of managing AIWG have had no or minimal input into its development. A lack of empirical research outlining patient values and preferences for management also exists. Recommendations addressing weight management in psychiatry may be distinctly susceptible to ideology and sociocultural values regarding intervention appropriateness and expectations of self-management, reinforcing the need for co-produced management guidance. This study is the first to ask: how do individuals conceptualise preferred AIWG management and how can this be realised in practice? 1. Explore the management experiences of individuals with unwanted AIWG. 2. Elicit their values and preferences regarding preferred management. Qualitative descriptive methodology informed study design. A total of 17 participants took part in semi-structured interviews. Data analysis was undertaken using reflexive thematic analysis. Participants reported that clinicians largely overestimated AIWG manageability using dietary and lifestyle changes. They also reported difficulties accessing alternative management interventions, including a change in antipsychotic and/or pharmacological adjuncts. Participants reported current management guidance is oversimplified, lacks the specificity and scope required, and endorses a 'one-size-fits-all' management approach to an extensively heterogenous side-effect. Participants expressed a preference for collaborative AIWG management and guidance that prioritises early intervention using the range of evidence-based management interventions, tailored according to AIWG risk, participant ability and participant preference. Integration of this research into guideline development will help ensure recommendations are relevant and applicable, and that individual preferences are represented.

The MSc Psychiatry at Cardiff University: Introduction of New Modules Further Supporting Continuing Professional Development in Psychiatry

AimsThe MSc Psychiatry at Cardiff University is an established postgraduate programme offering students a sound theoretical basis in psychiatry as a medical science and specialty. The programme currently offers six taught modules (focusing on mood and anxiety disorders, psychosis, old age psychiatry, forensic psychiatry, substance misuse, and child and adolescent psychiatry), as well as a dissertation module that students complete towards the end of the programme. In catering for the professional needs of clinical students and students pursuing careers in academia, two additional taught modules have been proposed exploring Leadership and Management in Psychiatry and Advances in Psychiatric Research. Feedback on the proposed introduction of the new modules was collated from the current full-time and part-time student cohorts.MethodsA total of 57 students currently enrolled on the programme were surveyed in relation to the proposed additional taught modules. The survey was created using Microsoft Forms and deployed via the programme's virtual learning environment (i.e., Blackboard). A mixed methods design was employed, with both Likert scale and open-ended items included in the survey. Students were informed that future cohorts would be offered a choice between the existing Forensic Psychiatry & Substance Misuse module and the proposed Leadership and Management in Psychiatry module, as well as a choice between the existing Child and Adolescent Disorders module and the proposed Advances in Psychiatric Research module.ResultsResponses from the current student body were collated and analysed. A total of 29 (51%) students surveyed were medical professionals, with the remaining 28 (49%) students being science graduates or other clinical professionals. Descriptive analysis of the quantitative data revealed that an overwhelming majority of students viewed the introduction of the new modules as a positive development that would further enhance the student learning experience and continuing professional development. Content analysis of the qualitative data revealed further insights on the nature of the proposed modules and preferences on how these should be included within the existing programme schedule.ConclusionStudents currently enrolled on the MSc Psychiatry favour the introduction of the proposed modules tailored to support professional development. Specifically, students view the proposed module on Leadership and Management in Psychiatry as catering to the needs of clinicians working in a variety of healthcare settings, whilst the proposed module exploring Advances in Psychiatric Research was considered to supplement existing course content on evidence-based medicine and caters for students with an interest in pursuing a career in academia.

Psychiatric Induction Programme in Fife

AimsTo improve the Psychiatry induction for DiTs in Fife.MethodsThe purpose of induction is to provide Doctors in Training (DiT) with a smooth, supported transition between roles. Delivered well, it will promote confidence and also provide a thorough grounding in the key requirements of the role and clarity regarding sources of help.A recent report, commissioned by the GMC, identified the key areas which should be covered in induction. The findings demonstrated a clear link between inadequate inductions to the impact on doctors’ well-being and patient safety issues.A questionnaire was issued to DiTs completing Psychiatry inductions in August and December 2021. Questions focused on the following key areas highlighted in the GMC report: •Gaining access to workplace settings and systems•Physical orientation of workplace•Team inductions•Daytime role and out of hours working and rotas.•Familiarisation with common cases/procedures that doctors may deal with in this speciality: risk management, use of the MHAResultsQuestionnaire Results: Key Issues highlightedAugust 2021 •FY2 to ST6 inducted together: differing experience levels•Differences in site inductions (psychiatry is spread across 3 hospitals in Fife)•Issues obtaining swipe cards/keys•IT access for emails and various computer systems delayed•Computer systems training not doneDecember 2021 •Lack of psychiatry experience of FY2s•Continued IT access issues initiallyConclusionIn September 2021, a working group was established comprising DiT representatives and those responsible for induction. The August 2021 results were disseminated and key improvements were identified in areas covered by the clinical induction: •An improved induction check list universal for all sites.•Induction documents for each role detailing responsibilities and useful information.•Integration of IT training.The December results highlighted improvements in many areas but continued a theme of concerns for FY2s starting in Psychiatry. The transition to this speciality is a significant adjustment as it operates differently to most specialities, requiring different skills and knowledge.Plans have been made to provide simulation events which would give DiTs practical experience in a safe environment of various topics e.g., risk management in psychiatry. Additionally, there are plans to revise induction for speciality trainees.

Access to firearms: essential factor for risk management in psychiatry

ObjectiveIncrease awareness of the risk associated with access to firearms in clinical practice.Case reportA 57-year-old man, with a 30 year history of schizophrenia, was reviewed routinely at home. His illness is predominantly characterised by chronic delusions of a grandiose nature. He believes he has been offered various senior employment positions and has acted on these beliefs by presenting at workplaces in business attire. He has no insight into his condition. At review, he described awakening a week earlier in a panic and seizing hold of his legally held shotgun. He planned to shoot out the window as he believed people were breaking in. His wife prevented him from doing so by taking the gun and hiding it. A few days later he found the gun and intended to frighten off potential pursuers by pretending to shoot birds. He was persuaded to surrender the gun and it was taken to the local Garda (Police). A short time later, he presented to Garda Headquarters, over an hour away, seeking the return of his gun. At review, he had limited insight into the potential seriousness of the situation. The team immediately liaised with Gardaí, a HCR- 20 risk assessment was completed and clozapine levels checked.DiscussionWe had not know that our patient owned a shotgun despite very regular contact with him. During a comprehensive psychiatric history we routinely ask about risk of harm to self and others, but rarely ask specifically about access to or ownership of guns. Working on a farm, rural living or having an interest in shooting sports may raise the issue. Suicide, security breaches and homicide are the main risks conferred by firearms in mental illness. Mental illness is not necessarily prohibitive to gun ownership. Applicants for gun certificates in the UK must disclose specific medical conditions, including a psychotic illness, and an automatic medical report is sought. In the Irish Republic it is the responsibility of the applicant to declare any specific physical or mental health condition. Although a medical report may be sought, it is not automatic in all cases. Lack of insight into psychotic illness may potentially influence self-declaration upon application for a certificate.ConclusionAwareness of a persons access to firearms should be part of our routine risk assessment.

Bed management in psychiatry: ensuring that the patient perspective is not forgotten

SUMMARYBed management and the transfer of patients is an area of clinical care that is frequently overlooked. Often, the lack of discussion leads to the patient perspective being ignored and to transfers to new hospitals without appropriate handovers, both to the detriment of patient outcomes. This article reflects on the real-world consequences of the bed management systems used within the UK's National Health Service (NHS), using the example of a patient in psychiatric services.

The Use of Atypical Neuroleptics in Drugs Management in Fann’s Psychiatry Department

Background and Objectives: Neuroleptics have revolutionized pharmacological management in psychiatry. The advent of atypical neuroleptics constitutes a major turning point in this therapeutic challenge. The objective of our study was to determine the prescription of these atypical neuroleptics in Fann’s psychiatry department. Methodology: It was a descriptive retrospective cross-sectional study that involved 223 patients hospitalized in the psychiatry department of Fann Hospital during the period from January 2015 to December 2017. Results: Our study shows a majority prescription of classic neuroleptics in combination Haloperidol-Chlorpromazine 53% and 14% in monotherapy and a prescription of atypical neuroleptics at 4%. They are prescribed in combination with the classics at 4%. Conclusion: These results show a still low prescription of atypical neuroleptics which raises questions about the availability and affordability of such drugs, but also about prescription habits in the context of developing country.

Rauvolfia vomitoria Afzel. disrupts dentate gyrus cells

Herbal remedy for neurological problems may have adverse effects, and could prove detrimental if not regulated properly. Rauvolfia vomitoria (RV) is a herb commonly associated with psychiatry management because of its antipsychotic and sedative properties. Here, we studied the effects of the root bark extract of R. vomitoria on the dentate gyrus of adult Wistar rats. Twenty four adult Wistar rats (220 g average) were divided into four groups (n=6); control (placebo), 200, 300 and 400 mg/kg RV root bark extract, respectively for 7 days. The animals were sacrificed 24 h after last administration, and the brains were processed for histology and immunoreactivity. Results showed hypertrophy and atrophy of granule cells in all 200, 300 and 400 mg/kg RV groups, respectively. There was increased neuron specific enolase and glial fibrillary acidic protein expressions in the 200 and 300 mg/kg RV groups, while these proteins expression were decreased in the 400 mg/kg RV group. These results suggest that RV cause dentate gyrus cell injury in a dose-dependent pattern, and may lead to degeneration and disruption of functions.

Patient perspectives of helpful risk management practices within mental health services. A mixed studies systematic review of primary research.

WHAT IS KNOWN ABOUT THE SUBJECT?: Risk in psychiatry involves harm to self or others owing to mental health difficulties, for example iatrogenic effects of treatment, self-harm, suicide and violence. Risk management is a framework to minimize risks, comprising of risk assessment, generation of risk management plans and evaluation of interventions. Literature has extensively explored risk management and presented a critique that its practices can lead to patient harm. However, there is a paucity of literature about what patients identify as helpful risk management practices, despite the potential for such patient views to ameliorate harm and improve mental health care. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE: Interpersonal relationships with clinicians, and communication that keeps patients involved and informed of management processes, were found to be central to beneficial risk management practices, while patients having agency and autonomy to influence their participation was also important. Beneficial interpersonal relationships and connectivity in the form of patients' wider community of support were found to be influential in aiding risk management. Meaningful relationships, and particularly peer support, that maintained personal and collective identities were prevalent in the literature. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Rendering risk management more visible and accessible in practice might cultivate an openness that promotes patient participation. This includes drawing on a wider network of support, for example the patient's friends and family, as well as having advocacy utilizing peer support. Abstract Introduction Minimizing the harm that patients pose to themselves and others, due to mental health difficulties, is a central component of risk management in psychiatry. However, risk management itself can cause patient harm, but despite this and the potentially informative value of lived experience, little is known about what patients want or expect from risk management. Aim To review research and explore what patients consider beneficial in risk management practice. Method A mixed studies systematic review utilizing PRISMA guidelines, alongside a convergent qualitative design to categorize findings. Results Twelve papers were identified, generating two categories of beneficial practices: interpersonal relationships and communication with clinicians; coupled with patient agency in their own risk management. Discussion Connectivity appears important. Particularly patients feeling involved, and their voices being heard in both the identification of risks and then shaping risk management practice. Moreover, this included involvement of friends, family and peers to widen input and supportive networks beyond clinical relationships. Implications for Practice Risk management needs to be an accessible part of care, which is more inclusive of patient views and needs. The latter might also be aided by drawing on the patient's wider community in order to provide more effective support and risk management.

The Snoezelen approach in pain management in psychiatry

The approach or practice known as Snoezelen is defined asthe controlled multi-sensory stimulation of a person's sensoriality in a safe space. It has recognised benefits in the management of severe mental healthdisabilities. But, can it have a more specific benefit in psychiatry in terms of pain managment? Hospital caregivers go some way to answering the question by sharing their thoughts and experience regarding aninnovative clinical experimentusing the Snoezelen approachfor this purpose.

Uncertainty work and temporality in psychiatry: how clinicians and patients experience and manage risk in practice?

In psychiatric clinical practice, professionals pursue risk management alongside various uncertainties concerning diagnoses and treatment decisions. In this article, I draw on an ethnographic study of understandings of bipolar disorder in Finland to argue that risk management in psychiatry is better characterised as practical uncertainty work. I show how both the clinicians and the patients coordinate the uncertainties of bipolar disorder symptoms, risks and treatment decisions, into something that can be managed. I examine the ways in which temporality structures this uncertainty work and I explore two different modes of framing time. Clinical time stems from the current psychiatric thinking committed to the standardised diagnosis and the ideals of evidence-based medicine. Through this, professionals frame a task-oriented and linear treatment path from diagnosis and treatment to a managed life with bipolar disorder. Experienced time, in contrast, relates to the logics of care and self-care amid the embodied experiences of different actors. This framing of time involves a cyclical process where the patient, the clinician and the treatment interventions each need to adjust to changing situations.

Change management in psychiatry: Reintroducing ECT after more than four decades of neglect

Change management in psychiatry: Reintroducing ECT after more than four decades of neglect

Pharmacogenetic Testing: Application in Mental Health Prescribing.

Despite extensive scholastic and professional training, medication management in psychiatry is often relegated to trial-and-error prescribing. Pharmacogenetic testing (PGT) may expedite identification of medications with maximal efficacy and minimal side effects by recognizing individual genetic variability in drug response. This article outlines the background of PGT, explains drug metabolism, and evaluates the impact of PGT. A review of the literature since 2010 found 42 articles regarding PGT in clinical nursing settings on PubMed and ProQuest. Despite continuing rises in health care costs, new biotechnology has led to a decrease in the cost of genetic sequencing and application of PGT to practice. As PGT becomes increasingly prevalent, nurses should be knowledgeable of its purpose, possibilities, and potential limitations to provide accurate and up-to-date patient information.

Managing Information

Doctors are required to document their examinations of the patient. This task is particularly important in psychiatry, where what the patient says is practically the only source of information available to the clinician. In our article we shall focus on the process of information management in psychiatry and trace the information which was recorded in the patients’ notes back to its origin in the interview. Our data consists of eight recordings of psychiatric interviews along with the patients’ notes. Our main argument is that the notes are not merely written from the point of view of the psychiatrist, but might have little or nothing to do with the interview. We demonstrate, first, that accurate notes are a record of how the doctor conducted the interview. Second, the notes doctors made also misrepresent the interview with the patient: doctors record false information, distort it, take out of its context.

Advances in electrophysiology in the diagnosis of behavioral disorders

Diagnosis in psychiatry remains largely subjective. Developing biological observations in psychiatric disorders into laboratory-based diagnostic tests can significantly impact diagnosis and management of these disorders. Diagnostic electrophysiological techniques are non-invasive and relatively inexpensive. In this review, the authors propose that enough knowledge has accumulated to allow the establishment of psychiatry-based clinical electrophysiology laboratories (PCELs). A brief summary of established clinical indications for electrophysiology tests, summary of highly promising technologies and a presentation of a proposed four-step approach to facilitate the translation of promising biological observations into diagnostic tests are provided. The reader should develop an appreciation of the current status of the clinical applications of psychiatric electrophysiology. The authors propose to capitalize on the widely accepted indication to rule out medical causes of psychiatric symptoms (e.g., epileptic activity) to begin developing PCELs as the equipment and skills necessary are basic to the entire discipline. The potential impact of the growing knowledge on the practice of psychiatry is explored to update clinicians and administrators as they develop laboratory and service plans. Psychiatric electrophysiology currently plays a limited role in the diagnosis and management in psychiatry. This status is not supported by the existing literature. The underutilization of electrophysiological tests in psychiatry is propagated by the fact that the laboratories providing the service are not managed by psychiatrists. The authors propose that the first steps are to establish such laboratories and train psychiatrists to competently provide the service.

Les représentations du «fou» du «malade mental», du «dépressif» et les opinions vis-à-vis des hôpitaux psychiatriques sont-elles homogènes selon les populations des sites enquêtés ?

Introduction The concept of policy management in psychiatry requires knowledge representations of the «mad», the «mentally ill» and «depressed» by the people. It is therefore to highlight the diversity of definitions that it attributes to individual psychiatric disorders, particularly by cultural norms typically associated with geographic locations. To do this, we successively study the forms of stigmatisations broadly, and then by site, and the causes of thereof. But this does not suffice for the design of any policy in this area must also take into account the attitudes and behaviours of the population vis-à-vis the existing psychiatric facilities globally and per site. Design of study The treatments were carried out using data from the socio-anthropological and epidemiological «Mental Health in the general population: images and realities» made by the French Collaborating Centre of WHO for research and training Mental Health (WHOCC, Lille, France) and the Directorate of Research, Studies, Evaluation and Statistics (DREES) with 40 000 people aged 18 and older in metropolitan France and in the departments of ‘overseas between 1999 and 2003 1 [1,2]. The techniques used range from descriptive statistics to multivariate analysis (correspondence analysis and multiple ascending hierarchical classification). Results The images of the «madness», the «mentally ill» or the «depression» in the French population are disparate. Nevertheless, some characteristics are found with high frequency: the «depressive» is rather seen as an isolated person, the «mentally ill» as a mental defective with bizarre speech, while «crazy» would rather characterized by violence (delusions and violent towards others, beat his family, incest). The «mentally ill» is sometimes defined by these last criteria. These images are not influenced by knowledge of a relative suffering from mental illness or a psychiatric episode experienced by the interviewee. The causes of mental illness (the «madness» and «mentally ill»), two contradictory trends have expressed. Some believe it has a physical origin, and in that case the healing is difficult and care must be hospitable. Others believe it was originally a non-physical (social), and in this case, recovery is possible, and care must be ambulatory. People surveyed in some sites have homogeneous opinions in this regard: Berk, Thuir or Guéret, the first opinion is mainly expressed, whereas the opposite trend was observed in Villejuif, Niort, Lille, Poitiers, Paris15, Paris10. In contrast, for depression, the cause is, for almost the entire population, non-physical. Overall, 41% of French people support psychiatric hospitals, while 32% oppose, preferring ambulatory solutions. In fact, opinions differ so widely among survey sites. They are not influenced by the images of people surveyed vis-à-vis the «madness», the «mentally ill» or the «depression». The way of organizing psychiatric sectorization (taken care rather intra-hospital versus extra-hospital, number of agents, etc.) does not influence either the image of «mad», the «mentally ill» or «depression» in population, nor the opinions vis-à-vis psychiatric hospitals. We deduce that these images are generated by other factors, probably cultural factors.

Best Practices: A Program to Support Shared Decision Making in an Outpatient Psychiatric Medication Clinic

This column presents preliminary findings of an intervention to support shared decision making in psychopharmacology consultation. The waiting area in an urban psychiatric medication clinic was transformed into a peer-run Decision Support Center featuring a user-friendly, Internet-based software program with which clients could create a one-page computer-generated report for use in the medication consultation. The Decision Support Center was used 662 times by 189 unique users from a young-adult and general adult case management team from October 2006 to September 2007. All clients had severe mental disorders. Only ten clients refused to use the intervention at some point during the pilot study. Focus groups with medical staff (N=4), clients (N=16), case managers (N=14), and peer-specialist staff (N=3) reported that the intervention helped to create efficiencies in the consultation and empower clients to become more involved in treatment-related decision making. A randomized controlled trial is currently in process.

Clinical Manual of Pain Management in Psychiatry

The Journal of Nervous and Mental Disease 196(6):p 510, June 2008. | DOI: 10.1097/NMD.0b013e318178df08

Erratum: Vol. 48, No. 7, August 2003, Article Entitled Implementing Quality Management in Psychiatry. We have Noted an Error in Figure 2 (p 470). “Estimated Psychometric Properties,” Should Read “Established Psychometric Properties.”

Erratum: Vol. 48, No. 7, August 2003, article entitled Implementing Quality Management in Psychiatry. We have noted an error in Figure 2 (p 470). “Estimated Psychometric Properties,” should read “Established Psychometric Properties.”

Implementing quality management in psychiatry: from theory to practice--shifting focus from process to outcome.

With the increasing emphasis on the satisfaction of patient-clients balanced by the need for cost-efficient treatment, quality management is an ever-increasing concern for mental health care providers. It is now apparent that psychiatrists must follow treatment progress and outcome to assess and improve the quality of the care they provide. Most quality measurement and management programs to date have been carried out in research settings using process measures; however, it is clear that the focus must shift from research to practice and from process to outcome measurements. We discuss the notion of quality and outcome management and propose a model for selecting outcome measures. This model suggests 5 dimensions that are commonly assessed in outcome management. We successfully implemented a computerized documentation and quality measurement system in a psychiatric outpatient setting.