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Risk management in Psychiatry

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https://www.readbyqxmd.com/read/29880047/a-clustered-controlled-trial-of-the-implementation-and-effectiveness-of-a-medical-home-to-improve-health-care-of-people-with-serious-mental-illness-study-protocol
#1
Alexander S Young, Amy N Cohen, Evelyn T Chang, Anthony W P Flynn, Alison B Hamilton, Rebecca Oberman, Merlyn Vinzon
BACKGROUND: People with serious mental illness (SMI) die many years prematurely, with rates of premature mortality two to three times greater than the general population. Most premature deaths are due to "natural causes," especially cardiovascular disease and cancer. Often, people with SMI are not well engaged in primary care treatment and do not receive high-value preventative and medical services. There have been numerous efforts to improve this care, and few controlled trials, with inconsistent results...
June 7, 2018: BMC Health Services Research
https://www.readbyqxmd.com/read/29866707/does-the-uk-medical-education-provide-doctors-with-sufficient-skills-and-knowledge-to-manage-patients-with-eating-disorders-safely
#2
Agnes Ayton, Ali Ibrahim
BACKGROUND: Eating disorders affect 1%-4% of the population and they are associated with an increased rate of mortality and multimorbidity. Following the avoidable deaths of three people the parliamentary ombudsman called for a review of training for all junior doctors to improve patient safety. OBJECTIVE: To review the teaching and assessment relating to eating disorders at all levels of medical training in the UK. METHOD: We surveyed all the UK medical schools about their curricula, teaching and examinations related to eating disorders in 2017...
June 4, 2018: Postgraduate Medical Journal
https://www.readbyqxmd.com/read/29796968/recommendations-for-the-use-of-ect-in-pregnancy-literature-review-and-proposed-clinical-protocol
#3
Heather Burrell-Ward, John A Fromson, Joseph J Cooper, Gildasio De Oliveira, Marcela Almeida
Psychiatric disorders are common in pregnancy, affecting 15-29% of pregnant women. Untreated depression has negative health consequences for mother and fetus. Electroconvulsive therapy (ECT) is an effective option for the treatment of severe depression, high suicide risk, catatonia, medication-resistant illness, psychotic agitation, severe physical decline, and other life-threatening conditions. To our knowledge, however, there is no literature that consolidates all the evidence on maternal and fetal risks associated with untreated depression, medications, and ECT then translating it into one cohesive protocol that could serve as a management guide and a source of reassurance to health-care providers involved in such practice...
May 23, 2018: Archives of Women's Mental Health
https://www.readbyqxmd.com/read/29745436/a-theory-driven-investigation-of-the-association-between-emotion-dysregulation-and-suicide-risk-in-a-clinical-adolescent-sample
#4
Michael Eaddy, Lucas Zullo, Sarah E Horton, Jennifer L Hughes, Betsy Kennard, Andrew Diederich, Graham J Emslie, Lisa Schuster, Sunita M Stewart
OBJECTIVE: Emotion dysregulation has been consistently linked to suicide ideation and attempt, but an explanatory model for this relationship has not been adequately investigated in adolescents. This study examined the concurrent relationship among emotion dysregulation, variables from the Interpersonal-Psychological Theory of Suicide (IPTS), and suicide risk (operationalized as a continuous variable that increases in intensity from nonspecific to active suicide ideation to suicide ideation with a plan) in a clinical adolescent sample...
May 10, 2018: Suicide & Life-threatening Behavior
https://www.readbyqxmd.com/read/29735241/use-of-a-gabapentin-protocol-for-the-management-of-alcohol-withdrawal-a-preliminary-experience-expanding-from-the-consultation-liaison-psychiatry-service
#5
Jonathan G Leung, Daniela B Rakocevic, Nicholas D Allen, Elliot M Handler, Bruno A Perossa, Kristin L Borreggine, Amy L Stark, Hannah K Betcher, Daniel K Hosker, Blaine A Minton, Benjamin R Braus, Ross A Dierkhising, Kemuel L Philbrick
BACKGROUND: Benzodiazepines are the conventional mainstay to manage alcohol withdrawal; however, patients are subsequently at increased risk for poor sleep, cravings, and return to drinking. Research on alternative pharmacologic agents to facilitate safe alcohol withdrawal is scant. Gabapentin is one medication shown in small studies to reduce the need for benzodiazepines in the setting of alcohol withdrawal. The continuation of gabapentin after alcohol withdrawal appears to be safe during early sobriety and may aid in reducing alcohol-related cravings or returning to alcohol consumption...
March 21, 2018: Psychosomatics
https://www.readbyqxmd.com/read/29674774/-psychiatrist-burnout-or-psychiatric-assistance-burnout
#6
Vincenzo Manna, Francesca Dicuonzo
In recent years, mature industrial countries are rapidly changing from production economies to service economies. In this new socio-economic context, particular attention has been paid to mental health problems in the workplace. The risk of burnout is significantly higher for certain occupations, in particular for health workers. Doctors and psychiatrists, in particular, quite frequently have to make quick decisions by dealing with a huge amount of requests, which often require considerable assumptions of responsibility...
March 2018: Rivista di Psichiatria
https://www.readbyqxmd.com/read/29662523/sexual-health-of-adolescent-patients-admitted-to-a-psychiatric-unit
#7
Megan E Harrison, Stephanie Veldhuijzen van Zanten, Ariana Noel, Louise Gresham, Mark L Norris, Amy Robinson, Jason Chan, Addo Boafo
Objective: To review sexual health screening practices during admission to an adolescent psychiatry unit. Method: Retrospective chart review of randomly selected youth admitted over a one-year period (2013). Data extracted included demographics, reasons for admission, sexual health history, as well as any comorbid behaviours noted. The main outcome measure was whether sexual health details were documented at any time during admission; if so, this information was extracted for analysis...
April 2018: Journal of the Canadian Academy of Child and Adolescent Psychiatry
https://www.readbyqxmd.com/read/29659068/evolving-standards-of-care-in-the-age-of-cybertechnology
#8
Frederic G Reamer
Behavioral health professionals are making increased use of cybertechnology to deliver services to patients, communicate with patients, gather information about patients, and communicate with colleagues. The advent of cybertechnology - included the Internet, text (SMS), email, video, cloud storage of electronic records, and other forms of electronic communication and documentation - has introduced novel and unprecedented ethical and risk-management challenges. This article provides an overview of emerging issues related to informed consent; delivery of services; privacy, confidentiality, and privileged communication; boundary issues and dual relationships; documentation; and practitioners' relationships with colleagues...
March 2018: Behavioral Sciences & the Law
https://www.readbyqxmd.com/read/29521406/-personalised-medicine-in-forensic-psychiatry-an-example-for-other-domains-of-psychiatry
#9
K R Goethals
Personalised medicine promises to provide us with a diagnostic predictive system of stratification that is based on a wide variety of tests; these can include biological, cognitive, demographic, psychopathological tests and other clearly defined tests. The purpose of forensic psychiatry is not only to take care of and treat mentally impaired patients but also to engage in risk assessment and risk management.<br/> AIM: To explain risk assessment in forensic psychiatry as a nomothetic approach to personalised medicine, and also to demonstrate the link with offence paralleling behaviour, which is an illustration of the ideographic approach...
2018: Tijdschrift Voor Psychiatrie
https://www.readbyqxmd.com/read/29438853/gastric-ulceration-and-perforation-secondary-to-large-trichobezoar-a-case-report-describing-the-role-of-magnetic-resonance-imaging-in-diagnosis
#10
M M Hennessy, I Ivanovski, C B Ó Súilleabháin
INTRODUCTION: Trichotillomania and trichotillophagia can result in huge intraluminal coagulations of hair. Rarely, these can present with gastric perforation. This work has been reported in line with the SCARE criteria (Agha et al., 2016) [1]. PRESENTATION OF CASE: We report the case of a 15 year old girl who attended the emergency department with abdominal pain and vomiting. Ultrasound abdomen and pelvis identified free fluid within the pelvis concerning for inflammatory bowel disease...
2018: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/29401052/psychiatric-aspects-of-extreme-sports-three-case-studies
#11
Ian R Tofler, Brandon M Hyatt, David S Tofler
Extreme sports, defined as sporting or adventure activities involving a high degree of risk, have boomed since the 1990s. These types of sports attract men and women who can experience a life-affirming transcendence or "flow" as they participate in dangerous activities. Extreme sports also may attract people with a genetic predisposition for risk, risk-seeking personality traits, or underlying psychiatric disorders in which impulsivity and risk taking are integral to the underlying problem. In this report, we attempt to illustrate through case histories the motivations that lead people to repeatedly risk their lives and explore psychiatry's role in extreme sports...
2018: Permanente Journal
https://www.readbyqxmd.com/read/29282230/deconstructing-risk-management-in-psychotherapy-supervision
#12
Jerome Kroll, Jennifer Radden
In the ongoing controversy over how much regulation and standardization to impose on clinical practice and research, it is not surprising that the activity of psychotherapy supervision should be swept up in the drive for uniformity. The managers amongst us want to regulate and institutionalize all aspects of practice. In opposition, many clinicians resist the relentless march toward the safety of uniformity travel alongside managerial imposition of regulations. Psychotherapy supervision's method of a close apprenticeship relationship between supervisor and trainee and its focus on the process and ethics of professional interaction stand at the humanistic core of what is otherwise becoming an increasingly mechanistic model of providing care to persons with mental illness...
December 2017: Journal of the American Academy of Psychiatry and the Law
https://www.readbyqxmd.com/read/29282229/current-risk-management-practices-in-psychotherapy-supervision
#13
Ilayna K Mehrtens, Kathleen Crapanzano, L Lee Tynes
Psychotherapy competence is a core skill for psychiatry residents, and psychotherapy supervision is a time-honored approach to teaching this skill. To explore the current supervision practices of psychiatry training programs, a 24-item questionnaire was sent to all program directors of Accreditation Council for Graduate Medical Education (ACGME)-approved adult psychiatry programs. The questionnaire included items regarding adherence to recently proposed therapy supervision practices aimed at reducing potential liability risk...
December 2017: Journal of the American Academy of Psychiatry and the Law
https://www.readbyqxmd.com/read/29281594/suicide-risk-assessment-and-management-in-the-psychiatry-emergency-service-psychiatric-provider-experience-and-perceptions
#14
Sruthi Chunduri, Sabrina Browne, David E Pollio, Barry A Hong, Writtika Roy, Kimberly Roaten, Fuad Khan, Carol S North
The objective of this study was to explore suicide risk identification and flow of patients with differing suicide risk through the Psychiatric Emergency Service (PES) to their clinical dispositions. 3 focus groups (N = 15 psychiatric providers working in the PES of a large urban teaching hospital) discussing suicide risk assessment in the PES were conducted, followed by thematic analysis. A total of 7 themes were identified in 624 coded passages. In focus groups conducted to explore suicide risk assessment, discussions shifted to broader matters, e...
December 27, 2017: Archives of Suicide Research: Official Journal of the International Academy for Suicide Research
https://www.readbyqxmd.com/read/29232248/endocarditis-in-the-setting-of-idu-multidisciplinary-management
#15
Bobby Yanagawa, Anees Bahji, Wiplove Lamba, Darrell H Tan, Asim Cheema, Ishba Syed, Subodh Verma
PURPOSE OF REVIEW: The purpose of this article is to provide a brief overview of the medical and surgical management of infective endocarditis secondary to IDU, with a focus on the underlying substance use disorder. RECENT FINDINGS: Patients with infective endocarditis secondary to IDU are often young with unique comorbidities including mental illness, chronic hepatitis C, HIV infection, which are often compounded by limited social and familial supports. The focus of management has been treatment of endocarditis using IV antibiotics alongside surgery...
March 2018: Current Opinion in Cardiology
https://www.readbyqxmd.com/read/29223515/-patients-assaulted-in-psychiatric-institutions-literature-review-and-clinical-implications
#16
A Ladois-Do Pilar Rei, S Chraïbi
BACKGROUND: The psychiatric ward is a place where all forms of violence are treated. Occasionally, this violence involves acts of aggression between patients in emergency psychiatric units or hospital wards. Such events can lead to the development or worsening of posttraumatic stress disorder. METHODS: To establish the context, we first examined the epidemiology data concerning posttraumatic stress disorder in psychiatric patients who were frequently exposed to assaults...
February 2018: Revue D'épidémiologie et de Santé Publique
https://www.readbyqxmd.com/read/29158581/improved-ethical-guidance-for-the-return-of-results-from-psychiatric-genomics-research
#17
G Lázaro-Muñoz, M S Farrell, J J Crowley, D M Filmyer, R A Shaughnessy, R C Josiassen, P F Sullivan
There is an emerging consensus that genomic researchers should, at a minimum, offer to return to individual participants clinically valid, medically important and medically actionable genomic findings (for example, pathogenic variants in BRCA1) identified in the course of research. However, this is not a common practice in psychiatric genetics research. Furthermore, psychiatry researchers often generate findings that do not meet all of these criteria, yet there may be ethically compelling arguments to offer selected results...
January 2018: Molecular Psychiatry
https://www.readbyqxmd.com/read/29098597/smart-r-a-prospective-cohort-study-of-a-resilience-curriculum-for-residents-by-residents
#18
Deanna Chaukos, Emma Chad-Friedman, Darshan H Mehta, Laura Byerly, Alper Celik, Thomas H McCoy, John W Denninger
OBJECTIVE: This study aimed to determine the feasibility of a resident-led resiliency curriculum developed by residents, for residents. METHODS: The Stress Management and Resiliency Training Program for Residents (SMART-R) is a 6-h group-based curriculum that teaches meditation, behavioral skills, and positive perspective-taking strategies. SMART-R was implemented for all medicine and psychiatry interns at a large US teaching hospital during the first 6 months of internship...
February 2018: Academic Psychiatry
https://www.readbyqxmd.com/read/29072182/social-challenges-of-contemporary-psychiatry
#19
N Bouras
Psychiatry and society are interrelated and the biopsychosocial model continues to dominate the clinical psychiatric practice. Some doubts have been expressed in recent years about the value and the wide acceptance of the biopsychosocial model. Ghaemi (2009)1 considers it to be anti-humanistic and advocates the use of less eclectic, less generic, and less vague alternatives. The fundamental changes that have been witnessed in our times across the spectrum of biology, psychology and sociology have made necessary that a conceptual clarity should prevail...
July 2017: Psychiatrikē, Psychiatriki
https://www.readbyqxmd.com/read/29061403/neuroleptic-malignant-syndrome-a-neuro-psychiatric-emergency-recognition-prevention-and-management
#20
REVIEW
Raj Velamoor
Neuroleptic Malignant Syndrome (NMS) is a life threatening complication of antipsychotic therapy. It is often assumed to be rare. Observations suggest that rather than overestimating its frequency, we are more likely to underestimate it (Pope et al., 1986). It is a rare but potentially fatal disorder characterized by four principal symptoms. These are mental status changes, muscle rigidity, hyperthermia, and autonomic dysfunction. The diagnosis of NMS often presents a challenge because several medical conditions generate similar symptoms...
October 2017: Asian Journal of Psychiatry
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