Smoking and mental health.

Aims – It used to be thought that the problems of psychosis were qualitatively difference from those of other disorders and therefore unamenable to psychological interventions. However more recent evidence will be summarised which suggests otherwise. Methods – A cognitive model of the positive symptoms of psychosis (Garety et al, 2001; Kuipers et al.,2006) is described which builds on work on the dimensions of symptoms of psychosis, the continuum between non-clinical and clinical populations, and the contribution of emotional processes, cognitive reasoning biases and social factors. Results – Evidence from both epidemiological and empirical studies from our research group and others, support some of the pathways of symptom formation and maintenance proposed by the model. Specifically there is evidence for the role of trauma, social adversity and stress. These may trigger emotional responses and unusual experiences and together with reasoning biases lead to appraisals that can be defined as positive symptoms such as delusions and hallucinations. Similar processes interact to maintain symptoms. Conclusions – Cognitive models of psychosis have led to the development of cognitive behavioural treatments for delusions and hallucinations, which show some evidence of efficacy. Such treatments need to be refined in the light of recent research.Declaration of Interest: none

Cognitive behaviour therapy for psychosis

Objective: Optimum outcome for those with psychosis will necessarily involve treatment with antipsychotic medication. Unfortunately this medication is associated with a high rate of adverse effects and as a consequence non-adherence. Maximizing symptomatic relief whilst minimizing side effects is the aim of treatment. In order to do this adequately prescribers need to be aware of the significant differences between men and women in response to antipsychotic treatment. These differences are not simply biologically mediated; both physiological and sociocultural factors contribute.Method: Findings from a variety of sources were used to summarize gender differences in antipsychotic treatment.Results: Pharmacokinetic and pharmacodynamic factors, the impact of reproductive phases in women and gender differences in antipsychotic prescription across the lifespan (from children and adolescents to the elderly) are discussed. Important ethnic and racial differences are also mentioned.Conclusion: Women require less a...

Gender differences in antipsychotic prescribing

Background: Forensic psychiatric services provide care for those with mental disorders and offending behaviour. Concerns have been expressed that patients may stay for too long in too high levels of security. The economic burden of these services is high, and they are highly restrictive for patients. There is no agreed standard for ‘long stay’; we defined a length of stay exceeding 5 years in medium secure care, 10 years in high secure care or 15 years in a combination of both settings as long stay.

Objectives: To (1) estimate the number of long-stay patients in secure settings; (2) describe patients’ characteristics, needs and care pathways and the reasons for their prolonged stay; (3) identify patients’ perceptions of their treatment and quality of life; and (4) explore stakeholders’ views on long stay.

Design: A mixed-methods approach, including a cross-sectional survey (on 1 April 2013) of all patients in participating units to identify long-stay patients [work package (WP) 1], file reviews and consultant questionnaires for long-stay patients (WP2), interviews with patients (WP3) and focus groups with other stakeholders (WP4).

Setting: All three high secure hospitals and 23 medium secure units (16 NHS and 9 independent providers) in England.

Participants: Information was gathered on all patients in participating units (WP1), from which 401 long-stay patients were identified (WP2), 40 patients (WP3), 17 international and 31 UK experts were interviewed and three focus groups were held (WP4).

Results: Approximately 23.5% of high secure patients and 18% of medium secure patients were long-stay patients. We estimated that there are currently about 730 forensic long-stay patients in England. The source of a patient’s admission and the current section of the Mental Health Act [Great Britain. Mental Health Act 1983 (as Amended by the Mental Health Act 2007). London: The Stationery Office; 2007] under which they were admitted predicted long-stay status. Long-stay patients had complex pathways, moving ‘around’ between settings rather than moving forward. They were most likely to be detained under a hospital order with restrictions (section 37/41) and to have disturbed backgrounds with previous psychiatric admissions, self-harm and significant offending histories. The most common diagnosis was schizophrenia, but 47% had been diagnosed with personality disorder. Only 50% had current formal psychological therapies. The rates of violent incidents within institutions and seclusion were high, and a large proportion had unsuccessful referrals to less secure settings. Most patients had some contact with their families. We identified five classes of patients within the long-stay sample with different characteristics. Patients differed in their attribution of reasons for long stay (internal/external), outlook (positive/negative), approach (active/passive) and readiness for change. Other countries have successfully developed specific long-stay services; however, UK experts were reluctant to accept the reality of long stay and that the medical model of ‘cure’ does not work with this group.

Limitations: We did not conduct file reviews on non-long-stay patients; therefore, we cannot say which factors differentiate between long-stay patients and non-long-stay patients. 

Conclusions: The number of long-stay patients in England is high, resulting in high resource use. Significant barriers were identified in developing designated long-stay services. Without a national strategy, these issues are likely to remain.

Future work: To compare long-stay patients and non-long-stay patients. To evaluate new service models specifically designed for long-stay patients.

Study registration: The National Institute for Health Research (NIHR) Clinical Research Network Portfolio 129376.

Funding: The NIHR Health Services and Delivery Research programme

A mixed-methods study exploring the characteristics and needs of long-stay patients in high and medium secure settings in England: implications for service organisation

A substantial body of evidence supports the role of exercise interventions for people with a mental illness. However, much of this literature is conducted using outpatient and community-based populations. We undertook a systematic review examining the effect of exercise interventions on the health of people hospitalized with depression, schizophrenia, bipolar disorder, or anxiety disorders. Eight studies met our inclusion criteria. Several studies show positive health outcomes from short-term and long-term interventions for people hospitalized due to depression. Although positive, the evidence for inpatients with schizophrenia, bipolar disorder, or anxiety disorders is substantially less. There is an urgent need to address the paucity of literature in this area, in particular the optimal dose and delivery of exercise for people hospitalized as a result of mental illness. Standardization of reporting exercise programme variables, the assessment of mental illness, and the reporting of adverse events must accompany future studies.

Exercise for mental illness: A systematic review of inpatient studies

AIMS AND METHOD 

To evaluate the physical health and health risk factors in long-stay psychiatric patients in a high secure psychiatric hospital. A cross-sectional survey of consenting patients was undertaken using a semi-structured questionnaire, a brief physical examination and review of patient case notes. A comparison was made with data collected on admission and held on the Special Hospitals’ Case Register.

RESULTS 

Main findings were: a mean increase in weight since admission, in men of 10.62 kg and in women of 12.74 kg; high rates of smoking, obesity and large waist size; 54% of patients had one or more health problems.

CLINICAL IMPLICATIONS 

The study’s profile of the physical health of psychiatric in-patients indicates the need for health promotion initiatives in such hospitals and the need for primary care services.

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/EB53705168DD8417B6913466B743F4F6/S0955603600007303a.pdf/div-class-title-physical-health-and-health-risk-factors-in-a-population-of-long-stay-psychiatric-patients-div.pdf

Physical health and health risk factors in a population of long-stay psychiatric patients

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Physical health and health risk factors in a population of long-stay psychiatric patients