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Risk management in Psychiatry

Christoph U Correll, Leslie Citrome, Peter M Haddad, John Lauriello, Mark Olfson, Stephen M Calloway, John M Kane
Long-acting injectable antipsychotics (LAIs) are among the most effective treatments in psychiatry, yet they remain underutilized in clinical practice. Although LAIs are typically used to maintain treatment adherence in patients with chronic schizophrenia, recent research has suggested that they may also provide an effective treatment strategy for patients with early-phase or first-episode disease. In October 2015, a group of 8 experts on the management of schizophrenia and LAIs met to evaluate the evidence surrounding the efficacy, safety, and cost-effectiveness of LAIs and to develop practical recommendations regarding the clinical use, education, and unmet needs related to LAIs...
2016: Journal of Clinical Psychiatry
D Galland, I Tisserant, L Notardonato
INTRODUCTION: Attention deficit hyperactivity disorder (ADHD) is one of the most common and challenging childhood neurobehavioral disorders. ADHD may have behavioral consequences and involvements in minor and serious crimes. Our work aims to establish links between ADHD and forensic psychiatry. METHODS: A review of international scientific literature concerning the relationship between ADHD and forensic psychiatry was conducted using the PudMed electronic database...
September 13, 2016: L'Encéphale
D Leguay
This article attempts to identify and put into perspective the different approaches that could globally prevent the suffering induced by schizophrenia, from the detection of early psychosis to the impact on individual and family functioning and emotional health. Schizophrenia causes, at the community level, a number of difficult consequences and associated costs, which likely could be reduced if specific strategies, already known and documented internationally, were applied. Two areas not explored in this article: the role of medication and the issue of suicide prevention...
September 9, 2016: L'Encéphale
Kumiko Ando, Takahiro Soshi, Kanako Nakazawa, Takamasa Noda, Takayuki Okada
The Medical Treatment and Supervision Act (MTSA) was enacted in 2005 in Japan to promote the reintegration of clinical offenders with mental disorders into society. Under the MTSA, individuals who committed serious crimes in a state of insanity or diminished responsibility are diverted from the criminal justice system to the mental health system. Based on court decisions about MTSA-based treatment, clinical offenders have an obligation to engage in rehabilitation within their local community under the guidance of mental health professionals...
2016: Frontiers in Psychiatry
Michael Berk, R L Woods, M R Nelson, R C Shah, C M Reid, E Storey, S M Fitzgerald, J E Lockery, R Wolfe, M Mohebbi, A M Murray, B Kirpach, R Grimm, J J McNeil
BACKGROUND: Not only is depression associated with increased inflammation but inflammation is a risk factor for the genesis of depression. Many of the environmental risk factors for depression are transduced through inflammatory signaling. Anti-inflammatory agents show promise for the management of depression in preclinical, epidemiological, and early clinical studies. This opens the door to the potential for anti-inflammatory agents to treat and prevent depression. There are no evidence-based pharmacotherapies for depression prevention...
October 2016: International Psychogeriatrics
Deanna P Sams, David Garrison, Joanne Bartlett
PROBLEM: Child and adolescent psychiatric units serve the highest risk, most vulnerable populations in the mental health delivery system. This article describes the integration of a strength-based approach with a traditional, medical model of psychiatric care on an acute inpatient unit. A strength-based framework allows for increased focus on exploring patients' goals, strengths, relationships, skills, and family communication within the hospital setting. METHODS: The process of integration of strength-based care is described, followed by discussion of the implementation and evaluation of interventions, including mindfulness, family movie, narrative, and animal-assisted therapies...
August 2016: Journal of Child and Adolescent Psychiatric Nursing
Elspeth Guthrie, Aaron McMeekin, Rachel Thomasson, Sylvia Khan, Sally Makin, Ben Shaw, Damien Longson
Aims and method To develop a simple, pragmatic typology to characterise the nature of liaison interventions delivered by a liaison service in a National Health Service setting. We carried out a retrospective electronic case-note review of referrals to a ward-based liaison psychiatry service. Results Three hundred and forty-four patients were referred to the service over a 12-month period. Ten different types of liaison interventions were identified, with the most common interventions being diagnosis (112 patients, 32...
August 2016: BJPsych Bulletin
Shannon M L Furbish, Miranda E Kroehl, Danielle F Loeb, Huong Mindy Lam, Carmen L Lewis, Jennifer Nelson, Zeta Chow, Katy E Trinkley
INTRODUCTION: Benzodiazepines are prescribed inappropriately in up to 40% of outpatients. The purpose of this study is to describe a collaborative team-based care model in which clinical pharmacists work with primary care providers (PCPs) to improve the safe use of benzodiazepines for anxiety and sleep disorders and to assess the preliminary results of the impact of the clinical service on patient outcomes. METHODS: Adult patients were eligible if they received care from the academic primary care clinic, were prescribed a benzodiazepine chronically, and were not pregnant or managed by psychiatry...
August 1, 2016: Journal of Pharmacy Practice
Carianne M Hunt, Michael Spence, Anne McBride
BACKGROUND: On average, people with schizophrenia and psychosis die 13-30 years sooner than the general population (World Psychiatry 10 (1):52-77, 2011). Mental and physical health care is often provided by different organisations, different practitioners and in different settings which makes collaborative care difficult. Research is needed to understand and map the impact of new collaborative ways of working at the primary/secondary care interface (PloS One 7 (5); e36468). The evaluation presented in this paper was designed to explore the potential of a Community and Physical Health Co-ordinator role (CPHC) (CPHCs were previously Care Co-ordinators within the Community Mental Health Team, Community in the title CPHC refers to Community Mental Health) and Multi-Disciplinary Team (MDT) meetings across primary and community care, with the aim of improving collaboration of mental and physical health care for service users with Severe Mental Illness (SMI)...
2016: BMC Family Practice
Manuel Trachsel, Scott A Irwin, Nikola Biller-Andorno, Paul Hoff, Florian Riese
BACKGROUND: As a significant proportion of patients receiving palliative care suffer from states of anxiety, depression, delirium, or other mental symptoms, psychiatry and palliative care already collaborate closely in the palliative care of medical conditions. Despite this well-established involvement of psychiatrists in palliative care, psychiatry does not currently explicitly provide palliative care for patients with mental illness outside the context of terminal medical illness. DISCUSSION: Based on the WHO definition of palliative care, a, a working definition of palliative psychiatry is proposed...
2016: BMC Psychiatry
S E Legge, M L Hamshere, S Ripke, A F Pardinas, J I Goldstein, E Rees, A L Richards, G Leonenko, L F Jorskog, K D Chambert, D A Collier, G Genovese, I Giegling, P Holmans, A Jonasdottir, G Kirov, S A McCarroll, J H MacCabe, K Mantripragada, J L Moran, B M Neale, H Stefansson, D Rujescu, M J Daly, P F Sullivan, M J Owen, M C O'Donovan, J T R Walters
The antipsychotic clozapine is uniquely effective in the management of schizophrenia; however, its use is limited by its potential to induce agranulocytosis. The causes of this, and of its precursor neutropenia, are largely unknown, although genetic factors have an important role. We sought risk alleles for clozapine-associated neutropenia in a sample of 66 cases and 5583 clozapine-treated controls, through a genome-wide association study (GWAS), imputed human leukocyte antigen (HLA) alleles, exome array and copy-number variation (CNV) analyses...
July 12, 2016: Molecular Psychiatry
Yesie Yoon, Logan K Wink, Ernest V Pedapati, Paul S Horn, Craig A Erickson
OBJECTIVE: Irritability (aggression, self-injury, and severe tantrums) associated with autism spectrum disorder (ASD) is often treated with second-generation antipsychotics (SGAs), which are well known for their associated risk of weight gain in youth. Recent reports suggest that youth with ASD treated with SGAs may suffer more pronounced weight gain than typically developing children. In this study, we present a comprehensive comparison of weight gain effects of five SGAs in a clinical population of youth with ASD...
July 7, 2016: Journal of Child and Adolescent Psychopharmacology
Francesco Panza, Madia Lozupone, Eleonora Stella, Lucia Lofano, Carolina Gravina, Maria Urbano, Antonio Daniele, Antonello Bellomo, Giancarlo Logroscino, Antonio Greco, Davide Seripa
INTRODUCTION: Therapeutic failures (TFs) and adverse drug reactions (ADRs), together with the recurring nature of the clinical course of psychiatric disorders, mainly bipolar disorders (BDs), strongly contributed to the prevalence and frequency of hospital readmissions observed in these patients. This is the revolving door (RD) condition, dramatically rising costs for the management of these patients in psychiatric settings. AREAS COVERED: In the present review article, we underlined the role of functional variants in the cytochrome P450 (CYP) 2D6 gene on observed ADRs and TFs in RD patients with BDs, conferring a different capacity to metabolize psychotropic drugs...
July 4, 2016: Expert Review of Neurotherapeutics
R Pacifico, R L Davis
Bipolar disorder (BD) is a highly heritable and heterogeneous mental illness whose manifestations often include impulsive and risk-taking behavior. This particular phenotype suggests that abnormal striatal function could be involved in BD etiology, yet most transcriptomic studies of this disorder have concentrated on cortical brain regions. We believe we report the first transcriptome sequencing of the postmortem human dorsal striatum comparing bipolar (18) and control (17) subjects. Fourteen genes were detected as differentially expressed at a 5% false discovery rate, including a few immune response genes such as NLRC5, S100A12, LILRA4 and FCGBP, as well as an assortment of non-protein coding genes...
June 28, 2016: Molecular Psychiatry
J J Sandra Kooij, Marieke Michielsen, Henk Kruithof, Denise Bijlenga
INTRODUCTION: ADHD is an often heritable, neurodevelopmental disorder with a prevalence of 4-5% in children and adults and about 3% in older adults. The disorder in older adults (> 55 years) is accompanied by similar comorbidities such as anxiety and depression, and social impairment as in younger age groups. AREAS COVERED: An overview of the literature on diagnostic assessment, differential diagnosis, and treatment of older adults with ADHD is described. Case studies show that stimulant treatment is beneficial for ADHD in old age, but randomized controlled trials are lacking...
July 4, 2016: Expert Review of Neurotherapeutics
Camille C Gunderson, Adam C Walter, Rachel Ruskin, Kai Ding, Kathleen N Moore
PURPOSE: The purposes of the present study are to describe the demographic and treatment characteristics of women on the gynecologic oncology service who required intensive care and assess prevalence of risk factors for post-intensive care syndrome (PICS). METHODS: A retrospective chart review was performed encompassing patients requiring admission to the intensive care unit (ICU) on the gynecology oncology service between 1/2008 and 12/2012. Descriptive statistics were computed using SAS version 9...
November 2016: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Kaoru Arai, Ayumi Takano, Takako Nagata, Naotsugu Hirabayashi
BACKGROUND: Most structured assessment tools for assessing risk of violence were developed in Western countries, and evidence for their effectiveness is not well established in Asian countries. AIMS: Our aim was to examine the predictive accuracy of the Historical-Clinical-Risk Management-20 (HCR-20) for violence in forensic mental health inpatient units in Japan. METHODS: A retrospective record study was conducted with a complete 2008-2013 cohort of forensic psychiatric inpatients at the National Center Hospital of Neurology and Psychiatry, Tokyo...
June 13, 2016: Criminal Behaviour and Mental Health: CBMH
Suzanne Timmons, Emma O'Shea, Desmond O'Neill, Paul Gallagher, Anna de Siún, Denise McArdle, Patricia Gibbons, Sean Kennelly
BACKGROUND: Admission to an acute hospital can be distressing and disorientating for a person with dementia, and is associated with decline in cognitive and functional ability. The objective of this audit was to assess the quality of dementia care in acute hospitals in the Republic of Ireland. METHODS: Across all 35 acute public hospitals, data was collected on care from admission through discharge using a retrospective chart review (n = 660), hospital organisation interview with senior management (n = 35), and ward level organisation interview with ward managers (n = 76)...
2016: BMC Geriatrics
E Pompili, C Carlone, C Silvestrini, G Nicolò
This work aims to define the aggression in all its forms, with notes on management and rapid tranquilization. The pathological aggression is described as a non-homogeneous phenomenon, it is variable in according to social, psychological and biological agents. The distinction of violence between affective aggression and predatory aggression can be functional to the prediction of outcome of any treatment. In general, a pattern of predatory violence tend to match with patients unresponsive and not compliant to treatment, a low probability to predict future violence and, therefore, a difficulty in managing risk...
March 2016: La Clinica Terapeutica
Heather S Vestal, Gillian Sowden, Shamim Nejad, Joseph Stoklosa, Stephanie C Valcourt, Christopher Keary, Argyro Caminis, Jeff Huffman
OBJECTIVE: Simulations are used extensively in medicine to train clinicians to manage high-risk situations. However, to our knowledge, no studies have determined whether this is an effective means of teaching residents to manage acutely agitated patients. This study aimed to determine whether simulation-based training in the management of acute agitation improves resident knowledge and performance, as compared to didactic-based instruction. METHODS: Following a standard lecture on the management of agitated patients, first-year psychiatry residents were randomized (in clusters of three to four residents) to either the intervention (n = 15) or control arm (n = 11)...
April 25, 2016: Academic Psychiatry
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