Severe Mental Illnesses: Training and Education

Transcription

1 Western University Psychiatry Publications Psychiatry Department Summer Severe Mental Illnesses: Training and Education Amresh Srivastava University of Western Ontario, Follow this and additional works at: Part of the Psychiatry and Psychology Commons Citation of this paper: Srivastava, Amresh, "Severe Mental Illnesses: Training and Education" (2015). Psychiatry Publications

2 SMI Complex & Community Care Parkwood Institute Overview Severe Mental Illnesses Amresh Srivastava Associate Professor of psychiatry

3 Overview Severe Mental Illnesses missed Amresh Srivastava Associate Professor of psychiatry Opportunities mental health

4 20% People have 1 Mental Disorder 30% Patients have no No Access to care for mental disorders WHO, Atlas 2011 and Canadian Mental health commission

5 Any Mental disorder 18.6% Severe mental 4.1% disorder About 25% of any mental disorder become severe mental disorder. All severe mental disorders are not serious mental disorder

6 NIH National Institute of Mental Health Severe mental illness Definition Patients with (1)DSM IV criteria for mental disorder (2) Serious functional impairment which (3) Substantially interferes with or limits one or more major life activity & (4) have a two year or longer history of mental illness or treatment

7 Delayed treatment & Comorbidity Severe mental illnesses Physical disorders Severe mental illnesses are not an isolated entities. These are complex, treatment resistant, with high mortality, suicide, premature death and repeated hospitalisations

8 Impact of severe mental illness Clinical." SMI Social Public health

9 Severe mental illnesses are Clinically complex with serious psychopathology Suicide mortality Comorbidity Premature death Rehospitalization

10 Common Clinical conditions seen in Severe mental illnesses Physical disorders Treatment resistance Substance abuse Side effects Polypharmacy Comorbidity Axis I and II Comorbidity Axis I, II and III Disability

11 Jail & Prison Rehabilitation centres Nursing homes SMI Substance abuse programes Most of the patients of severe mental illnesses come from specialised centres for management

12 Pregnancy Hepatitis C Post Partum Special clinical conditions HIV Post Myocardial Post Stroke

13 Metabolic syndrome Caregivers burden Multiple hospitalisation! Severe mental disorder Nutritional deficiency Frequent crisis Smoking

14 Important constituents of management of severe mental disorder." Case management Nursung." care." Multidisciplinary decision making." Screening." Prevention." Community service." Recovery model

15 SUICIDE 11 Every day Every SUICIDE 1 No conflict of Attempted interest suicide for this211 program! 40 SECONDS 3 65 times increase years CANADA

16 Post-discharge suicide Percentage of suicide days after discharge

17 Suicide Prevention Crisis intervention Early intervention

18 Rehospitalization Rate Canada 11.1% Mental health Indicator, CMHC, 2015

19 Illness related Unknown Causes' Re-." Hosp Patient related System related Treatment related

20 Possible causes of Rehospitalization All of these The illness." The system The patient."." The treatment."

21 ." Late-onset treatment The treatment related causes." Inadequate assessment Inadequate treatment Early Discharge

22 Non# Compliance$$ Poor$ acceptance$$ Unknown$ Causes$ Medica.on$ Re#Hospitaliza.on:$$ The$Illness$ Wrong$ aetude$ towards$ medica.on$ Re#$ Re#$ Hospitaliza.on$ Hospitaliza.on$ The$ pa.ent$ Complex$ drug$ regime$ Poor$ dialogue$ The$ System$ Lack$of$ informa.on$$ The$ Treatment$

23 Re#Hospitaliza.on:$$ Possible$Causes$ Poor$ course$$ Unknown$ Causes$ Severity$ $ The$Illness$ $.$ Re#$ Hospitaliza.on$ Nature$$ Resistant$$ Frequent$ relapse$ The$ pa.ent$ The$ System$ The$ Treatment$ Re#Hospitaliza.on$$

24 Re#Hospitaliza.on:$$ Possible$Causes$ The$Illness$ Lack$of$ resources$$ Unknown$ Causes$ Early$ Discharge$ Inadequate$ assessment$ Re#$ Hospitaliza.on$ Inadequate$ treatment$$ The$ pa.ent$ Late#onset$ treatment$ The$ System$ The$ Treatment$

25 Assisted'employment' Disability' Insurance' Finance' Peer'support' Family'involvement' Partnership'with'caregivers' Housing' Interdisciplinary' CollaboraBon' Clinical'Monitoring'' Therapy' Forensic'ma?ers' Ethical'issues'' Human'rights' networking'

26 Risk factors for mental disorders." Side%% Effects%%."." Physical disorders Onset Treatmentphysical disorder Treatment Onset Treatment- Mental disorder." Mental disorder Risk factors for physical disorder

27 Risk factors for Physical disorders Nutritional and metabolic diseases, cardiovascular diseases, viral diseases, respiratory tract diseases, musculoskeletal diseases, sexual dysfunction, pregnancy complication stomatognathic diseases, and possibly obesity-related cancers are, more prevalent among people with SMI. It seems that lifestyle as well as treatment specific factors

28 Outcome of SMI ( Schizophrenia) Short term and long term outcome Compiled from studies published in last 10 years Outcome on specific domains Amresh Shrivastava et al, Clinical Schizophrenia an related psychosis, 2012

29 Step-wise therapeutic methods used in management of SMI Remission Response State of Well-being Recovery 1 2 Program-based intervention Relapse prevention Crisis intervention Active treatment 3 Early intervention

30 Way forward in Prevention of mental disorders Severe mental illness Illness Wellness

31 Not Concluded Amresh Srivastava in the next issue we will discuss management of SMI