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Risk management in Psychiatry

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https://www.readbyqxmd.com/read/28817488/risk-management-of-hospitalized-psychiatric-patients-taking-multiple-qtc-prolonging-drugs
#1
Eline Vandael, Bert Vandenberk, Rik Willems, Johan Reyntens, Joris Vandenberghe, Veerle Foulon
PURPOSE/BACKGROUND: Drug-related QTc prolongation has been linked with Torsade de Pointes and sudden cardiac death. The objective of this study was to investigate the impact of starting an additional QTc-prolonging drug on the QTc interval of psychiatric inpatients. METHODS: An observational study was performed between May 2011 and December 2014 in 6 Belgian psychiatric hospitals. Inpatients who were already taking 1 QTc-prolonging drug or more could be included in the study when an additional QTc-prolonging drug was started...
August 16, 2017: Journal of Clinical Psychopharmacology
https://www.readbyqxmd.com/read/28805175/outcomes-of-a-psycho-education-and-monitoring-programme-to-prevent-compulsory-admission-to-psychiatric-inpatient-care-a-randomised-controlled-trial
#2
B Lay, W Kawohl, W Rössler
BACKGROUND: There is a need for interventions that effectively reduce compulsory admission to psychiatry. We conducted a randomised controlled trial to investigate whether an innovative intervention programme prevents compulsory re-admission in people with serious mental illness. METHODS: The programme addresses primarily patients' self-management skills. It consists of individualised psychoeducation focusing on behaviours prior to and during illness-related crises, crisis cards and, after discharge from the psychiatric hospital, a 24-month preventive monitoring...
August 14, 2017: Psychological Medicine
https://www.readbyqxmd.com/read/28801871/pediatric-delirium-evaluation-management-and-special-considerations
#3
REVIEW
Nasuh Malas, Khyati Brahmbhatt, Cristin McDermott, Allanceson Smith, Roberto Ortiz-Aguayo, Susan Turkel
Delirium describes a syndrome of acute brain dysfunction with severe consequences on patient outcomes, medical cost, morbidity, and mortality. It represents a final common pathway of numerous pathophysiologic disturbances disrupting cerebral homeostasis. The diagnosis is predicated on recognition of the clinical features of the syndrome through ongoing clinical assessment. Early identification can be aided by routine screening, particularly in high-risk populations. Evaluation and management are continuous and simultaneous processes involving a multidisciplinary care team including child psychiatry consultation...
August 12, 2017: Current Psychiatry Reports
https://www.readbyqxmd.com/read/28800809/legal-and-ethical-challenges-in-emergency-psychiatry-part-2-management-of-inmates
#4
REVIEW
Andrew Foote, Britta Ostermeyer
Psychiatrists and clinicians encounter unique situations, challenges, and requirements in the treatment of jail and prison inmates in the emergency department. This article reviews the historical legal highlights pertaining to medical and psychiatric care of inpatients, as well as the professional, ethical, and legal aspects that allow clinicians to evaluate, treat, and properly disposition their inmate patients. In particular, this article discusses the specific suicide risk factors related to inmates and correctional facilities that should be ascertained and managed in a clinician's suicide risk assessment and intervention planning in this special high suicide risk patient population...
September 2017: Psychiatric Clinics of North America
https://www.readbyqxmd.com/read/28762507/increasing-physical-activity-for-veterans-in-the-mental-health-intensive-case-management-program-a-community-based-intervention
#5
S Akeya Harrold, Julian Libet, Charlene Pope, Joy A Lauerer, Emily Johnson, Barbara J Edlund
AIMS AND OBJECTIVES: Individuals with severe mental illness (SMI), experience increased mortality-20 years greater disparity for men and 15 years greater disparity for women-compared to the general population (Thornicroft G. Physical health disparities and mental illness: The scandal of premature mortality. Br J Psychiatr. 2011;199:441-442). Numerous factors contribute to premature mortality in persons with SMI, including suicide and accidental death (Richardson RC, Faulkner G, McDevitt J, Skrinar GS, Hutchinson D, Piette JD...
August 1, 2017: Perspectives in Psychiatric Care
https://www.readbyqxmd.com/read/28729304/effectiveness-of-the-management-of-major-depressive-episodes-disorder-in-adults-with-comorbid-chronic-physical-diseases-a-protocol-for-a-systematic-review-and-meta-analysis
#6
Pablo Martínez, Ariel Castro, Diego Alonso, Paul A Vöhringer, Graciela Rojas
INTRODUCTION: Depression is a global-scale public health problem, and a significant association has been established between depression and chronic physical diseases. This growing comorbidity poses a challenge to healthcare systems. We aim to assess the effectiveness of the management of major depressive episodes/disorder in adults with comorbid chronic physical diseases. METHODS AND ANALYSIS: We will conduct a systematic review and meta-analysis of randomised clinical trials...
July 20, 2017: BMJ Open
https://www.readbyqxmd.com/read/28726526/integrated-care-coordination-by-an-interprofessional-team-reduces-emergency-department-visits-and-hospitalisations-at-an-academic-health-centre
#7
Anne H Gaglioti, Patrick Barlow, Kate DuChene Thoma, George R Bergus
People with chronic behavioural and physical health conditions have higher healthcare costs and mortality rates than patients with chronic physical conditions alone. As a result, there has been promotion of integrated care for this group. It is important to train primary care residents to practice in integrated models of care with interprofessional teams and to evaluate the effectiveness of integrated care models to promote high-quality care for this at-risk group. We implemented an integrated, interprofessional care management programme for adults with chronic mental and physical health needs as part of a curriculum for family medicine and family medicine psychiatry residents...
July 20, 2017: Journal of Interprofessional Care
https://www.readbyqxmd.com/read/28723956/psychosis-risk-research-versus-daily-prognosis-uncertainties-a-qualitative-study-of-french-youth-psychiatrists-attitudes-toward-predictive-practices
#8
Laelia Benoit, Marie Rose Moro, Bruno Falissard, Nicolas Henckes
BACKGROUND: Over the last twenty years, predicting psychosis has become a priority of both research and policies. Those approaches include the use of the At Risk Mental State category (ARMS) and of standardized predictive tools. In comparison to most developed countries, early interventions programs are only little developed in France. However, cases of young patients presenting unclear symptoms that might be a beginning psychosis or might as well reflect some adolescent unease are commonplace in psychiatry...
2017: PloS One
https://www.readbyqxmd.com/read/28689196/love-as-delusion-delusions-of-love-erotomania-narcissism-and-shame
#9
Brendan D Kelly
Erotomania has a long, colourful history in psychiatry. It is a rare condition in which the patient ('subject') develops the belief that he or she is loved from afar by another person ('object'). The subject is generally female, though men predominate in forensic samples. The object is generally perceived to belong to a higher social class, reflecting a sociopolitical element in the construction of love. Erotomania requires active treatment and risk management as it can be associated with stalking and other offending behaviour...
July 8, 2017: Medical Humanities
https://www.readbyqxmd.com/read/28675999/subduing-the-green-eyed-monster-bridging-the-psychopharmacological-and-psychosocial-treatment-perspective-in-understanding-pathological-jealousy
#10
Farah Deena Abdul Samad, Hatta Sidi, Jaya Kumar, Srijit Das, Marhani Midin, Nurul Hazwani Hatta
Human being is not spared from a broad-ranged emotional state, including being jealous. Jealousy has both affective-cognitive and behavioural-evaluative dimension where the person perceives, or experiences a real threat on a valued relationship. As this complex emotion becomes irrational and not amenable to reason, it later transforms into a dangerously 'green-eyed monster'. This perilous situation which is viewed as pathological jealousy is a form of delusion, which is maintained by a fixed and false reasoning in an originally entrusted intimate relationship...
July 4, 2017: Current Drug Targets
https://www.readbyqxmd.com/read/28646744/systematic-biobanking-novel-imaging-techniques-and-advanced-molecular-analysis-for-precise-tumor-diagnosis-and-therapy-the-polish-mobit-project
#11
Jacek Niklinski, Adam Kretowski, Marcin Moniuszko, Joanna Reszec, Anna Michalska-Falkowska, Magdalena Niemira, Michal Ciborowski, Radoslaw Charkiewicz, Dorota Jurgilewicz, Miroslaw Kozlowski, Rodryg Ramlau, Cezary Piwkowski, Miroslaw Kwasniewski, Monika Kaczmarek, Andrzej Ciereszko, Tomasz Wasniewski, Robert Mroz, Wojciech Naumnik, Ewa Sierko, Magdalena Paczkowska, Joanna Kisluk, Anetta Sulewska, Adam Cybulski, Zenon Mariak, Boguslaw Kedra, Jacek Szamatowicz, Paweł Kurzawa, Lukasz Minarowski, Angelika Edyta Charkiewicz, Barbara Mroczko, Jolanta Malyszko, Christian Manegold, Lothar Pilz, Heike Allgayer, Mohammed L Abba, Hartmut Juhl, Frauke Koch
Personalized and precision medicine is gaining recognition due to the limitations by standard diagnosis and treatment; many areas of medicine, from cancer to psychiatry, are moving towards tailored and individualized treatment for patients based on their clinical characteristics and genetic signatures as well as novel imaging techniques. Advances in whole genome sequencing have led to identification of genes involved in a variety of diseases. Moreover, biomarkers indicating severity of disease or susceptibility to treatment are increasingly being characterized...
June 21, 2017: Advances in Medical Sciences
https://www.readbyqxmd.com/read/28641817/-preventing-violence-in-schizophrenia-with-cognitive-remediation
#12
C Darmedru, C Demily, N Franck
OBJECTIVES: The association between schizophrenia and violence represents an important issue in psychiatry. Often highly publicized, violent acts raise the question of their detection, prevention, management and treatment. There is no single, direct and exclusive link between aggressiveness and the underlying psychiatric disorder. On the contrary, the processes underlying this violence are multiple and interlinked. In addition to static and dynamic risk factors, cognitive deficits play an important role in the genesis and maintenance of violent and aggressive behavior...
June 19, 2017: L'Encéphale
https://www.readbyqxmd.com/read/28637535/routine-hospital-management-of-self-harm-and-risk-of-further-self-harm-propensity-score-analysis-using-record-based-cohort-data
#13
S Steeg, R Emsley, M Carr, J Cooper, N Kapur
BACKGROUND: The care received by people presenting to hospital following self-harm varies and it is unclear how different types of treatment affect risk of further self-harm. METHOD: Observational cohort data from the Manchester Self-Harm Project, UK, included 16 456 individuals presenting to an Emergency Department with self-harm between 2003 and 2011. Individuals were followed up for 12 months. We also used data from a smaller cohort of individuals presenting to 31 hospitals in England during a 3-month period in 2010/2011, followed up for 6 months...
June 22, 2017: Psychological Medicine
https://www.readbyqxmd.com/read/28623183/phone-based-interventions-in-adolescent-psychiatry-a-perspective-and-proof-of-concept-pilot-study-with-a-focus-on-depression-and-autism
#14
Robert Yuzen Chen, Jordan Robert Feltes, William Shun Tzeng, Zoe Yunzhu Lu, Michael Pan, Nan Zhao, Rebecca Talkin, Kavon Javaherian, Anne Glowinski, Will Ross
BACKGROUND: Telemedicine has emerged as an innovative platform to diagnose and treat psychiatric disorders in a cost-effective fashion. Previous studies have laid the functional framework for monitoring and treating child psychiatric disorders electronically using videoconferencing, mobile phones (smartphones), and Web-based apps. However, phone call and text message (short message service, SMS) interventions in adolescent psychiatry are less studied than other electronic platforms. Further investigations on the development of these interventions are needed...
June 16, 2017: JMIR Research Protocols
https://www.readbyqxmd.com/read/28612089/the-intensive-care-delirium-research-agenda-a-multinational-interprofessional-perspective
#15
REVIEW
Pratik P Pandharipande, E Wesley Ely, Rakesh C Arora, Michele C Balas, Malaz A Boustani, Gabriel Heras La Calle, Colm Cunningham, John W Devlin, Julius Elefante, Jin H Han, Alasdair M MacLullich, José R Maldonado, Alessandro Morandi, Dale M Needham, Valerie J Page, Louise Rose, Jorge I F Salluh, Tarek Sharshar, Yahya Shehabi, Yoanna Skrobik, Arjen J C Slooter, Heidi A B Smith
Delirium, a prevalent organ dysfunction in critically ill patients, is independently associated with increased morbidity. This last decade has witnessed an exponential growth in delirium research in hospitalized patients, including those critically ill, and this research has highlighted that delirium needs to be better understood mechanistically to help foster research that will ultimately lead to its prevention and treatment. In this invited, evidence-based paper, a multinational and interprofessional group of clinicians and researchers from within the fields of critical care medicine, psychiatry, pediatrics, anesthesiology, geriatrics, surgery, neurology, nursing, pharmacy, and the neurosciences sought to address five questions: (1) What is the current standard of care in managing ICU delirium? (2) What have been the major recent advances in delirium research and care? (3) What are the common delirium beliefs that have been challenged by recent trials? (4) What are the remaining areas of uncertainty in delirium research? (5) What are some of the top study areas/trials to be done in the next 10 years? Herein, we briefly review the epidemiology of delirium, the current best practices for management of critically ill patients at risk for delirium or experiencing delirium, identify recent advances in our understanding of delirium as well as gaps in knowledge, and discuss research opportunities and barriers to implementation, with the goal of promoting an integrated research agenda...
June 13, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28541169/imagining-moral-bioenhancement-practices-drawing-inspiration-from-moral-education-public-health-ethics-and-forensic-psychiatry
#16
Jona Specker, Maartje H N Schermer
In this article, we consider contexts or domains in which (future) moral bioenhancement interventions possibly or most likely will be implemented. By looking closely at similar or related existing practices and their relevant ethical frameworks, we hope to identify ethical considerations that are relevant for evaluating potential moral bioenhancement interventions. We examine, first, debates on the proper scope of moral education; second, proposals for identifying early risk factors for antisocial behaviour; and third, the difficult balancing of individual freedom and third party concerns in (forensic) psychiatry...
July 2017: Cambridge Quarterly of Healthcare Ethics: CQ: the International Journal of Healthcare Ethics Committees
https://www.readbyqxmd.com/read/28476249/-therapeutic-restraint-and-freedom-of-movement-changing-practices
#17
Annick Perrin-Niquet
From confinement to the philosophy of care in the community, the history of psychiatry testifies to the evolution of practices in the matter of the restriction of freedom. The French National Health Authority still too often recommends practices based on restraint. Caregivers, in relation to the clinical aspect of the patients, need clearly identified therapeutic projects. While training can be vital for them, risk management policies can prove to be a hindrance to patients' freedom.
May 2017: Soins. Psychiatrie
https://www.readbyqxmd.com/read/28365002/national-survey-on-pediatric-acute-agitation-and-behavioral-escalation-in-academic-inpatient-pediatric-care-settings
#18
Nasuh Malas, Linden Spital, Jason Fischer, Yu Kawai, David Cruz, Patricia Keefer
BACKGROUND: Pediatric acute agitation and behavioral escalation (PAABE) is common and disruptive to pediatric inpatient health care. There is a paucity of literature on PAABE in noncritical care inpatient pediatric care settings with little consensus on its evaluation and management. METHODS: In January 2016, a 34-question survey was e-mailed to pediatric hospitalists and consultation-liaison psychiatrists through their respective professional listservs. Excluded responses included incomplete surveys, and surveys from providers in community care settings...
May 2017: Psychosomatics
https://www.readbyqxmd.com/read/28318493/-bipolar-disorders-in-oncology-characteristics-and-management
#19
Michel Reich, Nuria Kotecki
Bipolar disorders belong to the spectrum of mood disorders and represent a serious psychiatric comorbidity. Behaviors adopted by bipolar patients can foster cancer occurrence but also impact its management, especially during acute depressive or manic episode. Oncologists must adapt their protocols in order to obtain the best compliance for treatment and avoid any possible mood destabilization, with the inherent risk of suicidal attempt. Potential interactions between mood-stabilizing agents (lithium, divalproate, atypical antipsychotics, and anticonvulsivants) and oncologic treatment (chemotherapy, targeted therapy, immunotherapy, corticotherapy) will be particularly watched...
May 2017: Bulletin du Cancer
https://www.readbyqxmd.com/read/28302702/predictive-accuracy-of-risk-scales-following-self-harm-multicentre-prospective-cohort-study
#20
Leah Quinlivan, Jayne Cooper, Declan Meehan, Damien Longson, John Potokar, Tom Hulme, Jennifer Marsden, Fiona Brand, Kezia Lange, Elena Riseborough, Lisa Page, Chris Metcalfe, Linda Davies, Rory O'Connor, Keith Hawton, David Gunnell, Nav Kapur
BackgroundScales are widely used in psychiatric assessments following self-harm. Robust evidence for their diagnostic use is lacking.AimsTo evaluate the performance of risk scales (Manchester Self-Harm Rule, ReACT Self-Harm Rule, SAD PERSONS scale, Modified SAD PERSONS scale, Barratt Impulsiveness Scale); and patient and clinician estimates of risk in identifying patients who repeat self-harm within 6 months.MethodA multisite prospective cohort study was conducted of adults aged 18 years and over referred to liaison psychiatry services following self-harm...
June 2017: British Journal of Psychiatry: the Journal of Mental Science
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