EARLY READMISSION IN PATIENTS AFTER ELECTROCONVULSIVE THERAPY IN A UNIVERSITY HOSPITAL SETTING - A RETROSPECTIVE STUDY
|
|
- Jean Mathews
- 5 years ago
- Views:
Transcription
1 ORIGINAL PAPER EARLY READMISSION IN PATIENTS AFTER ELECTROCONVULSIVE THERAPY IN A UNIVERSITY HOSPITAL SETTING - A RETROSPECTIVE STUDY Ng CG*, Amer Siddiq AN*, Salina M*, Koh OH*, Zuraida NZ* *Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur Abstract Electroconvulsive therapy (ECT) is an effective treatment for major mental illnesses. It is used to achieve rapid and short-term improvement of severe symptoms after an adequate trial of other treatment options have proven ineffective. Relapse rates following ECT are high and leading to early readmission. Objective: To study the early readmission rate in patients had received ECT and its relation with age, gender, race and clinical diagnosis. Methods: This is a retrospective descriptive study of patients who had received ECT in 1-year period. Subjects were identified from the ECT record book. Case notes of these patients were then traced and reviewed. Clinical diagnosis and demographic data were collected. Patients readmitted within 6 months after being discharged were identified. The data was compared for the readmitted and not readmitted group. Result: A total of 156 subjects who had received ECT were included in this study. Mean age was 40 years old, 51% were female and the main diagnosis was bipolar affective disorder (42.9%). Early readmission rate was 30.1%. Mean time to relapse was 5.3 months. Chi Square analysis indicated that younger age was significantly associated with early readmission among ECT patients. Conclusion: ECT patients had high early readmission rate. Adequate post ECT psychosocial intervention and pharmacotherapy may help to reduce the readmission rate. Keywords: electroconvulsive therapy, early readmission, mental illness Introduction Electroconvulsive therapy (ECT) is a treatment for mental illness, which involves the application of electrodes to the head to induce a generalized seizure. It was introduced in the 1930s as another treatment for psychiatric illnesses when psychotherapy fails. Its introduction was rife with controversy but its conception has helped psychiatrists then and today in treating some refractory psychiatric illnesses. 1 In the past, 1
2 this treatment was often administered to the most severely disturbed patients residing in the large mental institutions. 2 In the mid 1950s, the use of ECT began to decline due to the discoveries of various psychotropic drugs and the stigma attached on ECT1. However, of late, the use of ECT has increased due to improved delivery method and safety. This modest resurgence was also due to the acceptance by psychiatrists that despite psychotropic medications, some illnesses remained drug refractory 3. Furthermore, the speed of action of ECT with respect to alternative treatments has become of increasing interest in the present era of managed care and the ever increasing lengths of stay in hospital 4. Electroconvulsive therapy (ECT) is highly effective for treatment of major depression, however, without active treatment, virtually all remitted patients relapse within 6 months of stopping ECT with a relapse rate of 84% 5. The Royal College of Psychiatrists fact sheet states that more than 8 out of 10 depressive patients who receive ECT responded well. 6 Similarly, for mania, ECT is associated with remission or marked clinical improvement in 80% of manic patients and it is an effective treatment for patients who responded poorly to pharmacotherapy 7. ECT has been suggested to be use in patients with severe risk of suicide 8,9. The National Institute for Clinical Excellence (NICE) 10 recommended that electroconvulsive therapy (ECT) is used only to achieve rapid and short-term improvement of severe symptoms after an adequate trial of other treatment options has proven ineffective and/or when the condition is considered to be potentially lifethreatening, in individuals with severe depressive illness, catatonia and a prolonged or severe manic episode. ECT combined with treatment with antipsychotic drugs may be considered an option for people with schizophrenia, particularly when rapid global improvement and reduction of symptoms is desired as well as for those with schizophrenia who show limited response to medication alone. 11 Financial constraints on health care and the increasing number of psychiatric patients in the last decade causes the hospitals struggle to reduce inpatients length of stay. Electroconvulsive therapy (ECT) has been widely acknowledged as an effective and appropriate acute treatment for psychiatric illnesses which fail to respond to conventional treatment 12. The prompt effectiveness of ECT shortened the duration of stay of the patients in the hospital 12. One of the major drawbacks, however, is the high relapse rate in the use of ECT5. Reported relapse rates range widely, exceeding 50% in 6 to 12 months in (acute) ECT up to 95% 13. Using adequate pharmacotherapy after index ECT relapse rates between 20% and 68% have also been reported 14. Readmission is commonly used as an outcome and quality indicator for inpatient services. 15,16 Hospital readmission, particularly when it occurs within a relatively short time after previous discharge, is often seen as a failure of the earlier hospital admission. 17 In Malaysia, early readmission (within 6 months) is used 2
3 as one of the two National Indicators in Psychiatry (NIP-2). 18 The main objective of this study was to determine the rate of early readmission in patients who had received ECT in psychiatric ward in University Malaya Medical Centre (UMMC) Kuala Lumpur. We also aimed to study the relation of clinical diagnosis and certain demographic factors with early readmission. Method Sample The study was conducted at the psychiatric ward of UMMC. UMMC is a teaching hospital situated in Kuala Lumpur. Its patient catchment area includes those living in Kuala Lumpur and also Petaling Jaya, Selangor. Most of these patients are urbanized, young and affluent. UMMC psychiatry department is also one of the oldest in the country and the pioneer of psychiatrist training for Malaysia. It has close to 15 consultant and specialist psychiatrists and 25 medical officers, all whom are in the postgraduate training program in psychiatry. UMMC on the average, has close to outpatient visits and 1275 inpatients a year. 19 Study..design patients who received ECT in UMMC from 1st January 2007 till 31st December ECT is conducted 3 times per week in UMMC. Decision to provide ECT treatment is made by a team of psychiatrists after discussion in the management rounds. Subjects were identified from the ECT record book. Case notes of these patients were then traced and reviewed. All patients receiving ECT during the study period were included. Subjects were then determined whether they were readmitted within 6 month after being discharged. Those who were readmitted for clinical drug trial, for maintenance electroconvulsive therapy (ECT) and forensic case were excluded. The relevant demographic and clinical data including age, race, sex and diagnosis were collected. Analysis Data were analyzed using Statistical Package for Social Sciences (SPSS) version To test the statistical significance of difference, Chi Square test was used for categorical variables. All test of significance were two-tailed, with an alpha level of Results A total of one hundred and fifty six cases were identified and included in the study. This is a retrospective descriptive study of 3
4 Sample Description Table 1: Descriptive characteristics of the subjects Characteristic (N = 156) Mean (SD) Age 40.0 (13.8) Sex n (%) Male Female 77 (49.4) 79 (50.6) Race Malay Chinese Indian Others 36 (23.1) 86 (55.1) 30 (19.2) 4 (2.6) Diagnosis Schizophrenia Bipolar Disorder Major Depressive Disorder 51 (32.7) 67 (42.9) 38 (24.4) SD = standard deviation Table 1 shows the descriptive characteristics of the 156 subjects. The average age was 40 years (range =13-78). The study group was predominantly Chinese. 49% were males and 51% of them were females. Most of the patients were admitted with a primary diagnosis of bipolar disorder. They were discharged well from the ward after completed a course of ECT. Early Readmission A total of 47 (30.1%) cases readmitted within 6 months after being discharged. Result also showed the mean duration until readmission was 5.3 months (SD = 5.7, range = ). 4
5 Table 2 Relationship between the descriptive variables and early readmission Readmission Yes No p Descriptive Variables Age n (%) n (%) OR 95% CI value Less than 40 years 40 years and above Sex Male Female Race Malay Non Malay Diagnosis Schizophrenia Mood Disorder OR = odds ratio * p < (36.6) 17 (23.0) 26 (33.8) 21 (26.6) 14 (38.9) 33 (27.5) 32 (30.5) 15 (29.4) 52 (63.4) 57 (77.0) * 51 (66.2) 59 (73.4) (61.1) 87 (72.5) (69.5) 36 (70.6) Table 2 shows the Chi Square analysis of the relationship between the descriptive variables and early readmission. Younger age was the only factor significantly associated with early readmission (p < 0.1). Discussion The characteristics of the sample of current study were comparable with the previous retrospective study done in the same centre 20. The mean age of the patients in the psychiatric ward, UMMC was about 40 years old. Majority of the patients were found to be Chinese descent. This study revealed that there was not much difference between male and female subjects needing ECT who were admitted in UMMC. In contrast, study done by Bloch et al (2005), suggested that a possible gender difference in the implement of ECT treatment. Result of the study illustrated that hospitalized women were referred earlier to ECT. 21 5
6 Those subjects who received ECT in UMMC in this study were noted to be diagnosed mostly with bipolar mood affective disorder, followed by schizophrenia and major depressive disorder at 42.9%, 32.7% and 24.4%, respectively. When mood disorder diagnosis were summed up as a single entity i.e. both bipolar mood affective disorder and major depressive disorder, it made up 67.3% of those receiving ECT. Volpe et al (2004) suggested that manic episode usually yield severe psychological, moral and economic consequences. It causes more disruption to marital relationship and higher divorce rate. It might explain the higher rate of ECT use in bipolar patients. 22 Besides, in the same study conducted by the authors previously, UMMC has an annual admission of 1275 for which 47.6% of them were patients with mood disorders and 37.5% of them were psychosis related disorder mainly schizophrenia type. 19 The evidence for the use of ECT in mood related disorders were plenty 23,24 with even some calling for more aggressive management i.e. earlier intervention as opposed to most guideline recommendations. The evidence for the use of schizophrenia was however not as convincing. 12 The result of the current study shows that the early readmission rate in ECT patients within 6 months was 30%. It was two times higher than the readmission rate of 16% in the previous study conducted by the same authors. 20 In the previous study, the authors studied the early readmission rate of all psychiatric patients after discharged from UMMC. The higher readmission rate in ECT patients was reported in other studies. 22,23 Volpe et al (2004) found that if readmission occurred after ECT, it took place 6 months after the index episode. 22 Devanand et al (1991) reported that relapse rate following ECT are high and clustered in the first 4 months following clinical response. 23 An explanation for the higher relapse rate is related to the severity of illness in those patients underwent ECT. They usually are the more unmanageable ones with more chronic and severe illnesses. 12 For those with psychosis it may usually mean treatment refractory type. Often this group of patients did not do well with oral medication even after the ECT 5. Therefore this results them to relapse earlier. The result of current study illustrated that younger age was associated with higher early readmission. The similar finding was found in other study. 25 It might relate with higher risk of co-morbid substance abuse in younger age-group. Another possible explanation was that the levels of treatment adherence or insight had not been modified in the early stage of illness. 26 The current study found that gender, race and clinical diagnosis had no significant effect on early readmission in ECT patients. This was similar to the finding of the authors previous study. 20 Dixon et al (1997) and Lyons et al (1997) also reported that there was no significant association between socio-demographic predictors with readmission. 17,27 Limitation This is a retrospective study with small sample size. There was lack of information 6
7 on the psycho-social intervention and patients psychopathology during discharge. In addition, the author surmises the final finding of significant predicting variable (young age) at the p < 0.1 in Chi Square analysis represent a fairly debatable conclusion. Conclusion This study showed that 30% of patients underwent electro-convulsive therapy will be readmitted within 6 months after discharged from a psychiatric ward in UMMC. Younger age was significantly associated with higher early readmission in ECT patients. It also illustrated that gender, race and clinical diagnosis did not have significant effect on the early readmission rate. Adequate post ECT psychosocial intervention and pharmacotherapy may help to reduce the readmission rate. Acknowledgement We would like to take this opportunity to thank sister Jamilah Suleiman who was involved in data collection for the study. Reference: 1. Babigian HM, Guttmacher LB (1984). Epidemiologic considerations in electroconvulsive therapy. Archives of General Psychiatry. 41: Lalitanatpong D (2005) The use of electroconvulsive therapy and the length of stay of psychiatric inpatients a King Chulalongkorn Memorial Hospital, Thai Red Cross Society. J Med Assoc Thai 88 (Suppl 4): S Thompson JW, Weiner RD, Myers CP (1994). Use of ECT in the United States in 1975, 1980, and American Journal of Psychiatry. 151: Beyer JL, Weiner RD, Glenn MD (1998). Electroconvulsive therapy: A programmed text. Washington: American Psychiatric Press. 5. Sackeim HA. Haskett RF. Mulsant BH. Thase ME. Mann JJ. Pettinati HM. Greenberg RM. Crowe RR. Cooper TB. Prudic J (2001) Continuation pharmacotherapy in the prevention of relapse following electroconvulsive therapy: a randomized controlled trial, JAMA, 285(10): Royal College of Psychiatrists (1995) Fact sheet on ECT. London: RCP. 7. Mukherjee S. Sackeim HA. Schnur DB (1994). Electroconvulsive therapy of acute manic episodes: a review of 50 years' experience. American Journal of Psychiatry, 151(2): Maris RW (2002). Suicide. Lancet, 360: Tharyan P, Adams CE (2005). Electroconvulsive therapy for schizophrenia (Cochrane Review). In: The Cochrane Library, Issue 2. Oxford: Update Software. 10. National Institute for Clinical Excellence (NICE) (2005). Guidance on the use of electroconvulsive therapy. 11. Taylor MA, Fink M (2006). Melancholia: The Diagnosis, Pathophysiology, and Treatment of 7
8 Depressive Disorders. Cambridge, England: Cambridge University Press. 12. American Psychiatric Association (2001) Committee on Electroconvulsive Therapy. The Practice of Electroconvulsive Therapy. Recommendations for Treatment, Training and Privileging: A task force Report of The American Psychiatric Association, 2nd edition. 13. Bourgon LN, Kellner CH (2000) Relapse of depression after ECT: A review. Journal of ECT. 16(1): Petrides G, Dhossche D, Fink M, Francis A (1994) Continuation ECT: relapse prevention in affective disorders. Convuls Ther 10(3): Jenkins R (1991) Towards a system of outcome indicators for mental health care. Jenkins R, Griffiths (eds) Indicators for mental health in the population. Department of Health, London 16. Craig TJ, Kline NS (1982) Factors associated with recividism: Implications for a community support system. Community Support Serv J 2 : Lyons JS, O Mahoney MT, Miller SI, Neme J, Kabat J, Miller F (1997) Predicting readmission to the psychiatric hospital in a managed care environment: Implications for quality indicators. Am J Psychiatry 154 : Malaysia National Indicator in Psychiatry (NIP-2) 19. Aida SA, Ng CG, Amer Siddiq AN (2007) Patterns of Admission in Psychiatric Ward, University Malaya Medical Centre. Presented in Young Research Award Competition at the Post Graduate Conference, Sept Amer Siddiq AN, Ng C G, Aida SA, Zainal NZ, Abdul Kadir (2008) Factors Affecting Readmission in A Teaching Hospital in Malaysia. R. Australian And New Zealand Journal Of Psychiatry (2007) 41 (Suppl. 2). Malaysian Journal of Psychiatry, Bloch Y, Ratzoni G, Sobol D, Mendlovic S, Gal G, Levkovitz Y (2005) Gender differences in electroconvulsive therapy: a retrospective chart review. Journal of Affective Disorders 84: Volpe FM, Tavares A (2004) Manic patients receiving ECT in a Brazilian sample. Journal of Affectiv Disorders 79: Danavand DP, Sackeim HA, Prudic J (1991) Electroconvulsive therapy in the treatment resistant patient. Psychiatr Clin North Am 14(4): Rose D, Fleischmann P, Wykes T, Leese M, Blindman J (2003) patients perspectives on electroconvulsive therapy: systematic review. BMJ 326: Sanguineti VR, Samuel SE, Schwartz SL, Robeson MR (1996) Retrospective Study of 2,200 involuntary psychiatric admissions and readmissions. Am J Psychiatry 153 : Cougnard A, Parrot M, Grolleau S, Kalmi E, Desage A, Misdrahi D, Brun- Rosseau H, Verdoux H (2006) Pattern of 8
9 health service utilization and predictors of readmission after a first admission for psychosis: a 2 year follow up study. Acta Psychiatr Scand: 113; Dixon M, Robertson E, George M, Oyebode F (1997) Risk factors for acute psychiatric readmission. Psychiatr Bull 21 : Correspondence: Dr Ng Chong Guan, Department of Psychological Medicine,Faculty of Medicine,University of Malaya, 50603, Kuala Lumpur. 9
BIPOLAR DISORDER AND OTHER ASSOCIATED FACTORS IN POSTNATAL DEPRESSION. Ng CG*, Aida SA*, Aizura SA**, Salina M*, Nor Zuraida Z*, Koh OH*
ORIGINAL PAPER BIPOLAR DISORDER AND OTHER ASSOCIATED FACTORS IN POSTNATAL DEPRESSION Ng CG*, Aida SA*, Aizura SA**, Salina M*, r Zuraida Z*, Koh OH* *Department of Psychological Medicine, Faculty of Medicine,
More informationOUTCOMES OF DICHOTOMIZING A CONTINUOUS VARIABLE IN THE PSYCHIATRIC EARLY READMISSION PREDICTION MODEL. Ng CG
ORIGINAL PAPER OUTCOMES OF DICHOTOMIZING A CONTINUOUS VARIABLE IN THE PSYCHIATRIC EARLY READMISSION PREDICTION MODEL Ng CG Department of Psychological Medicine, Faculty of Medicine, University Malaya,
More informationAre they still doing that?
Are they still doing that? Why we still give ECT and when to refer Nicol Ferrier BSc (Hons), MD, FRCP(Ed), FRCPsych Emeritus Professor of Psychiatry Newcastle University Rates of prescribing ECT in the
More informationADMINISTRATIVE POLICY AND PROCEDURE
Page 1 of 6 SECTION: Medical SUBJECT: Electroconvulsive Therapy (ECT) DATE OF ORIGIN: 10/1/96 REVIEW DATES: 7/1/98, 10/1/99, 7/1/02, 7/1/04, 10/1/05, 5/1/09, 1/3/13, 7/1/15, 8/1/16 EFFECTIVE DATE: 3/24/17
More informationCondensed Clinical Practice Guideline Treatment Of Patients With Schizophrenia
Condensed Clinical Practice Guideline Treatment Of Patients With Schizophrenia I. Key Points a. Schizophrenia is a chronic illness affecting all aspects of person s life i. Treatment Planning Goals 1.
More informationElectroconvulsive therapy and its place in the management of depression Ankush Singhal MD, MRCPsych
ECT for depression z Review Electroconvulsive therapy and its place in the management of depression Ankush Singhal MD, MRCPsych Electroconvulsive therapy (ECT) is a psychiatric treatment with a controversial
More informationThere has been heightened concern in recent years
Article Racial Disparity in the Use of ECT for Affective Disorders William R. Breakey, M.B., F.R.C.Psych. Gary J. Dunn, M.A.S., M.S.N., R.N. Objective: Published reports indicate that African Americans
More informationSCHIZOPHRENIA, SUBSTANCE USE AND AGGRESSIONS: WHAT ARE THE RELATIONSHIPS?
University of Malaya From the SelectedWorks of Associate Prof. Dr. Noorzurani Robson January 21, 2010 SCHIZOPHRENIA, SUBSTANCE USE AND AGGRESSIONS: WHAT ARE THE RELATIONSHIPS? Rusdi Abd. Rashid Noorzurani
More informationAdult Mental Health Services applicable to Members in the State of Connecticut subject to state law SB1160
Adult Mental Health Services Comparison Create and maintain a document in an easily accessible location on such health carrier's Internet web site that (i) (ii) compares each aspect of such clinical review
More informationBipolar Disorder Clinical Practice Guideline Summary for Primary Care
Bipolar Disorder Clinical Practice Guideline Summary for Primary Care DIAGNOSIS AND CLINICAL ASSESSMENT Bipolar Disorder is categorized by extreme mood cycling; manifested by periods of euphoria, grandiosity,
More informationPattern of Acute Rheumatic Fever in a Local Teaching Hospital
Pattern of Acute Rheumatic Fever in a Local Teaching Hospital A Omar, FRCP Department of Paediatrics, Faculty of Medicine, University of Malaya, 59700 Kuala Lumpur Introduction Acute rheumatic fever (ARF)
More informationECT in Schizophrenia. Dr Richard Braithwaite Consultant Psychiatrist Isle of Wight NHS Trust
ECT in Schizophrenia Dr Richard Braithwaite Consultant Psychiatrist Isle of Wight NHS Trust ECT in Schizophrenia (not catatonia) Dr Richard Braithwaite Consultant Psychiatrist Isle of Wight NHS Trust Objectives
More informationNoncompliance with Treatment among Psychiatric Patients in Kuwait
Original Paper Med Principles Pract 1998;7:28 32 Received: December 12, 1996 Revised: March 22, 1997 Abdullahi A. Fido Abdulrazik M. Husseini Faculty of Medicine, Kuwait University, Kuwait Noncompliance
More informationMICHAEL PRITCHARD. most of the high figures for psychiatric morbidity. assuming that a diagnosis of psychiatric disorder has
Postgraduate Medical Journal (November 1972) 48, 645-651. Who sees a psychiatrist? A study of factors related to psychiatric referral in the general hospital Summary A retrospective study was made of all
More informationThe Prevalence of Depression Among the Elderly in Sepang, Selangor
The Prevalence of Depression Among the Elderly in Sepang, Selangor M S Sherina, MMed, L Rampal, PhD, A Mustaqim, BSc Department of Community Health, Faculty of Medicine and Health Sciences, Universiti
More informationAnxiety, Depression and Coping Strategies in Breast Cancer Patients on Chemotherapy
ORIGINAL PAPER Anxiety, Depression and Coping Strategies in Breast Cancer Patients on Chemotherapy Saniah AR, Zainal NZ Department of Psychological Medicine, Faculty of Medicine, University of Malaya,
More informationVO- PMHP Treatment Guideline 102: Electroconvulsive Therapy (ECT)
VO- PMHP Treatment Guideline 102: Electroconvulsive Therapy (ECT) Diagnostic Guidelines: Introduction: Electroconvulsive Therapy has been in continuous use for more than 60 years. The clinical literature
More informationORIGINAL ARTICLE Validation of the Hospital Anxiety and Depression Scale and the psychological disorder among premature ejaculation subjects
(2007) 19, 321 325 & 2007 Nature Publishing Group All rights reserved 0955-9930/07 $30.00 www.nature.com/ijir ORIGINAL ARTICLE Validation of the Hospital Anxiety and Depression Scale and the psychological
More informationSome newer, investigational approaches to treating refractory major depression are being used.
CREATED EXCLUSIVELY FOR FINANCIAL PROFESSIONALS Rx FOR SUCCESS Depression and Anxiety Disorders Mood and anxiety disorders are common, and the mortality risk is due primarily to suicide, cardiovascular
More informationTHE USE OF ELECTROCONVULSIVE THERAPY IN THE UNIVERSITY HOSPITAL, KUALA LUMPUR A STUDY OF 31 PATIENTS
Med. J. Malaysia Vol. 38 No. 2 June 1983 THE USE OF ELECTROCONVULSIVE THERAPY IN THE UNIVERSITY HOSPITAL, KUALA LUMPUR A STUDY OF 31 PATIENTS ANNA LAl LEE PIN 001 SZE THO YONG BOON HUN LILIAN KOH SUMMARY
More informationLIMITATIONS OF MOTOR SEIZURE MONITORING IN ECT
Indian J. Psychiat, 1998, 40 (1), 55-59 LIMITATIO OF MOTOR SEIZURE MONITORING IN ECT M.S. JAYAPRAKASH, B.N. GANGADHAR, N. JANAKIRAMAIAH & D.K. SUBBAKRISHNA ABSTRACT Seizures were monitored using both cuff
More informationKA-FAI CHUNG, mb bs, mrcpsych, fhkam Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China
Psychiatry and Clinical Neurosciences (2002), 56, 521 526 Regular Article Relationships between seizure duration and seizure threshold and stimulus dosage at electroconvulsive therapy: Implications for
More informationTreatment Efficacy and Quality of Life after Modified ECT in Manic Patients
International Journal of Scientific and Research Publications, Volume 8, Issue 2, February 2018 306 Treatment Efficacy and Quality of Life after Modified ECT in Manic Patients Dr. Madhu Shrama, Dept. of
More informationHospital Length of Stay and Readmission for Individuals Diagnosed With Schizophrenia: Are They Related?
April 17, 2008 Hospital Length of Stay and Readmission for Individuals Diagnosed With Schizophrenia: Are They Related? Summary Pan-Canadian data show relatively high rates of readmission and declining
More informationSuicide Risk and Melancholic Features of Major Depressive Disorder: A Diagnostic Imperative
Suicide Risk and Melancholic Features of Major Depressive Disorder: A Diagnostic Imperative Robert I. Simon, M.D.* Suicide risk is increased in patients with Major Depressive Disorder with Melancholic
More informationThe New Clinical Science of ECT
The New Clinical Science of ECT C. Edward Coffey, MD Professor of Psychiatry & Behavioral Sciences, and of Neurology Baylor College of Medicine Houston, Texas Fellow and Past President, International Society
More informationPertanika J. Sci. & Technol. 23 (1): (2015)
Pertanika J. Sci. & Technol. 23 (1): 29-35 (2015) SCIENCE & TECHNOLOGY Journal homepage: http://www.pertanika.upm.edu.my/ Prevalence of Psychological Stress among Undergraduate Students Attending a Health
More informationA study of clinico-demographic profile of patients with dissociative disorder
Journal of College of Medical Sciences-Nepal, 2012, Vol-8, No-3, 30-35 Original Article A study of clinico-demographic profile of patients with dissociative disorder SK Shah Lecturer, Department of Psychiatry,
More informationAging with Bipolar Disorder. Neha Jain, MD, FAPA Assistant Professor of Psychiatry, UConn Health
Aging with Bipolar Disorder Neha Jain, MD, FAPA Assistant Professor of Psychiatry, UConn Health Objectives Define bipolar disorder in the elderly Review comorbidities How does it differ from bipolar in
More informationKeith G. Rasmussen, MD Mayo Clinic Department of Psychiatry Rochester, Minnesota, USA
Keith G. Rasmussen, MD Mayo Clinic Department of Psychiatry Rochester, Minnesota, USA rasmussen.keith@mayo.edu Why is lithium important? Effective for all stages of bipolar disorder acute treatment as
More informationHow To Treat Resistant Bipolar Patients
Transcript Details This is a transcript of an educational program accessible on the ReachMD network. Details about the program and additional media formats for the program are accessible by visiting: https://reachmd.com/programs/clinicians-roundtable/how-to-treat-resistant-bipolar-patients/3560/
More informationSocial Factors and Psychopathology in Epilepsy
ORIGINAL ARTICLE Social Factors and Psychopathology in Epilepsy N. Cyriac, P.N. Sureshkumar, A.M. Kunhikoyamu, A.S. Girija* Departments of Psychiatry and Neurology* Medical College Calicut, Kerala, India.
More informationIEHP UM Subcommittee Approved Authorization Guidelines Electroconvulsive Therapy- ECT
Electroconvulsive Therapy- ECT Policy: IEHP considers ECT medically necessary for members with the following disorders: 1. Unipolar and bipolar depression. 2. Bipolar mania. 3. Psychotic disorders including
More informationCHAPTER 3 SCHIZOPHRENIA. Highlights
CHAPTER 3 SCHIZOPHRENIA Highlights Schizophrenia affects 1% of the Canadian population. Onset is usually in early adulthood. Schizophrenia can be treated effectively with a combination of medication, education,
More informationCohort Profile. 16 th October Dr. Tania Islam Department of Surgery Faculty of Medicine
Cohort Profile 16 th October 2017 Dr. Tania Islam Department of Surgery Faculty of Medicine Why was the cohort set up? In Malaysia, there is marked ethnic differences in breast cancer incidence, disease
More informationExpectations Of Patients Using Mental Health Services
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 16, Issue 8 Ver. I (Aug. 2017), PP 33-37 www.iosrjournals.org Expectations Of Patients Using Mental Health
More informationA descriptive analysis of admissions to Amanuel Psychiatric Hospital in Ethiopia
Original article A descriptive analysis of admissions to Amanuel Psychiatric Hospital in Ethiopia Abebaw Fekadu 1, Menelik Desta 2, Atalay Alem 3, Martin Prince 1 Abstract Background: The care of patients
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE. Single Technology Appraisal
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE Single Technology Appraisal Aripiprazole for the treatment and prevention of acute manic and mixed episodes in bipolar disorder in children and adolescents
More informationBEST in MH clinical question-answering service
1 BEST.awp.nhs.uk Best Evidence Summaries of Topics in Mental Healthcare BEST in MH clinical question-answering service Question In adult patients experiencing a mental health crisis, which service model
More informationSupplementary Online Content
Supplementary Online Content Subotnik KL, Casaus LR, Ventura J, et al. Long-acting injectable risperidone for relapse prevention and control of breakthrough symptoms after a recent first episode of schizophrenia:
More informationMODEL PSYCHOPHARMACOLOGY CURRICULUM
Third Edition MODEL PSYCHOPHARMACOLOGY CURRICULUM For Psychiatric Residency Programs, Training Directors and Teachers of Psychopharmacology VOLUME I By A Committee of the American Society of Clinical Psychopharmacology
More informationrtms Versus ECT The Future of Neuromodulation & Brain Stimulation Therapies
rtms Versus ECT The Future of Neuromodulation & Brain Stimulation Therapies rtms Treatment Equipment rtms Equipment Positioning of coil ECT & rtms Innovative Treatment Options for Patients Only a fraction
More informationThe mortality and outcome of delirium, dementia and other organic disorders: a two-year study
ASEAN Journal of Psychiatry 2007;8 (1):3-8. ORIGINAL ARTICLE The mortality and outcome of delirium, dementia and other organic disorders: a two-year study PREM KUMAR CHANDRASEKARAN, STEPHEN THEVANATHAN
More informationMJP Online Early
ORIGINAL PAPER Psychiatric Disorders Among New Child and Adolescent Attendees in an Outpatient Setting of a Sungai Petani Hospital: A Registry from January 2014 to December 2014 Nazariah Harun, Ravivarma
More informationHistory of psychiatry & psychology.
History of psychiatry & psychology Assoc. Prof. Kultegin Ogel ogelk@ogelk.net A case C.G. 17 years old, male. He killed his girl friend, amputated her body, put it in a suitcase and threw it to a litter.
More informationELECTROCONVULSIVE THERAPY EFFECTS ON COGNITION AND MEMORY AND NURSE S ROLE
PERIOPERATIVE NURSING (2016), VOLUME 5, ISSUE 2 REVIEW ARTICLE ELECTROCONVULSIVE THERAPY EFFECTS ON COGNITION AND MEMORY AND NURSE S ROLE Antonia Stergiopoulou RN, Msc, Phd National and Kapodistrian University
More informationJohnson D 1, Badi ah Y 2. Abstract
ORIGINAL PAPER A Comparison Between the UK and a Malaysian Setting of Antipsychotic Prescribing on Forensic Wards Using Prescribing Observatory for Mental Health-UK Standards Johnson D 1, Badi ah Y 2 1
More informationAUDIT OF THE ECT SERVICE IN WALSALL UK EXCELLENCE (NICE) GUIDELINES
JPPS 2008; 5(2): 112-117 AUDIT AUDIT OF THE ECT SERVICE IN WALSALL UK AGAINST THE NATIONAL INSTITUTE OF CLINICAL EXCELLENCE (NICE) GUIDELINES Rashda Tabassum, Syed Hassan Jawed, Usman Khalid, Sarabjeet
More informationMental Health Reform Position Statement on Electroconvulsive Therapy (ECT)
Mental Health Reform Position Statement on Electroconvulsive Therapy (ECT) Mental Health Reform (MHR) is a coalition of organisations that together promote improved mental health services in line with
More informationPsychopharmacology 1: ECT
Psychopharmacology 1: ECT Paul Glue paul.glue@otago.ac.nz August 2017 How do antidepressants work? Early theories neurotransmitter deficiency - Unable to demonstrate; doesn t account for diversity of antidepressant
More informationC U R R I C U L U M V I T A E. ADDRESS: 101 The City Dr S, Bld 3, Orange, CA,
C U R R I C U L U M V I T A E 1. PERSONAL DATA NAME: Nisha Warikoo, MD ADDRESS: 101 The City Dr S, Bld 3, Orange, CA, 92868 nwarikoo@uci.edu 2. EDUCATION 07/98-12/03: Byramjee Jeejeebhoy Medical College
More informationLithium in bipolar disorders.
Lithium in bipolar disorders. S. Mehdi Samimi Ardestani M.D. Department of Psychiatry, Shahid Beheshti University of Medical Science, Behavioral science research center Iranian psychiatric association,
More informationPredictors of Severity of Alcohol Withdrawal in Hospitalized Patients
Elmer Original Article ress Predictors of Severity of Alcohol Withdrawal in Hospitalized Patients Radhames Ramos a, Thierry Mallet b, Anthony DiVittis c b, d, e, Ronny Cohen Abstract Background: Alcohol
More informationThe pattern of psychiatric admissions in a referral hospital, Bhutan
Original research The pattern of psychiatric admissions in a referral hospital, Bhutan Rinchen Pelzang a Background: Mental illnesses are becoming a public health issue in all countries. However, data
More informationECT in children and adolescents
ECT in children and adolescents Adi Sharma MD MRCPsych PhD Clinical Senior Lecturer & Hon Consultant in Child & Adolescent Psychiatry National Adolescent Bipolar Service 1 Conflicts None relevant to this
More informationAmerican Board of Psychiatry and Neurology, Inc. Geriatric Psychiatry Core Competencies Outline
American Board of Psychiatry and Neurology, Inc. Geriatric Psychiatry Core Competencies Outline I. Geriatric Psychiatry Patient Care and Procedural Skills Core Competencies A. Geriatric psychiatrists shall
More informationMood Disorders for Care Coordinators
Mood Disorders for Care Coordinators David A Harrison, MD, PhD Assistant Professor, Dept of Psychiatry & Behavioral Sciences University of Washington School of Medicine Introduction 1 of 3 Mood disorders
More informationTHE PREVALENCE OF DEPRESSIVE SYMPTOMS AND POTENTIAL RISK FACTORS THAT MAY CAUSE DEPRESSION AMONG ADULT WOMEN IN SELANGOR
ORIGINAL PAPER THE PREVALENCE OF DEPRESSIVE SYMPTOMS AND POTENTIAL RISK FACTORS THAT MAY CAUSE DEPRESSION AMONG ADULT WOMEN IN SELANGOR Sherina MS*, Rampal L*, Azhar MZ** *Department of Community Health,
More informationCircumstances Surrounding Accidental Poisoning in Children
ORIGINAL ARTICLE Circumstances Surrounding Accidental Poisoning in Children B H 0 Azizi, MRCP* H I Zulkifli, M Med* M S Kassim, FRCP** * Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan
More informationResource impact report: Eating disorders: recognition and treatment (NG69)
Resource impact report: Eating disorders: recognition and treatment (NG69) Published: May 2017 Summary This report looks at the resource impact of implementing NICE s guideline on eating disorders: recognition
More informationProfile of in-patient suicides in two hospitals Malaysia
Med. J. Malaysia Vol. 4.No. June 1991 Profile of in-patient suicides in two hospitals Malaysia In Azhar M Zain, M.D., M.P.M. Lecturer Department of Psychiatry, Hospital University. Universiti Sains Malaysia.
More informationEffect of Instructional Module on Drug Adherence in Terms of Attitude among Patients with Schizophrenia
Original Article NUJHS Vol. 6, No.1, March 2016, ISSN 2249-7110 Effect of Instructional Module on Drug Adherence in Terms of Attitude among Patients with Schizophrenia 1 S. Mary Metilda, S. Santhi² & G.
More informationPREDICTORS OF PROLONGED HOSPITAL STAY
PREDICTORS OF PROLONGED HOSPITAL STAY IN CARDIAC SURGERY Zuraida Khairudin Faculty of Science Computer and Mathematics, Universiti Teknologi MARA, Malaysia zurai405@salam.uitm.edu.my ABSTRACT quality of
More informationGuidelines for the Utilization of Psychotropic Medications for Children in Foster Care. Illinois Department of Children and Family Services
Guidelines for the Utilization of Psychotropic Medications for Children in Foster Care Illinois Department of Children and Family Services Introduction With few exceptions, children and adolescents in
More informationClinical Fellowship for TMS/Inpatient Services/ Mood Disorders Program/ ECT -Electroconvulsive Therapy (TIME)
Clinical Fellowship for TMS/Inpatient Services/ Mood Disorders Program/ ECT -Electroconvulsive Therapy (TIME) Name of Institution: Location: Number of positions: McGill University Health Centre Montreal
More informationInpatient psychiatric care in Medicare: Trends and issues
C h a p t e r6 Inpatient psychiatric care in Medicare: Trends and issues C H A P T E R 6 Inpatient psychiatric care in Medicare: Trends and issues Chapter summary In this chapter Medicare beneficiaries
More informationPrescribing for people with a personality disorder. POMH-UK QIP 12b
Prescribing for people with a personality disorder POMH-UK QIP 12b Personality disorder Personality disorders are a heterogeneous group of conditions which vary greatly in their severity Characterised
More informationPreferred Practice Guidelines Bipolar Disorder in Children and Adolescents
BadgerCare Plus Preferred Practice Guidelines Bipolar Disorder in Children and Adolescents These Guidelines are based in part on the following: American Academy of Child and Adolescent Psychiatry s Practice
More informationClozapine-induced concordant agranulocytosis
Ó 2001 Martin Dunitz Ltd International Journal of Psychiatry in Clinical Practice 2001 Volume 5 Pages 71 ± 73 71 Clozapine-induced concordant agranulocytosis in monozygotic twins J HORAÂ C Ï EK, J LIBIGER,
More informationAdherence in A Schizophrenia:
Understanding and Diagnosing Bipolar Disorder Treatment Promoting for Bipolar Treatment Disorder Adherence in A Schizophrenia: Resource for Providers Engagement Strategies for Health Care Providers, Case
More informationReview: Psychosocial assessment and theories of development from N141 and Psych 101
Unit III Theory and Practice of Psychiatric Nursing REQUIRED READINGS AND ACTIVITIES Related Activities Assignments Review: Psychosocial assessment and theories of development from N141 and Psych 101 Anxiety,
More informationA Study of Anxiety among Hospitalized Patients of Orthopedics Ward of a Tertiary Care Hospital
The International Journal of Indian Psychology ISSN 2348-5396 (e) ISSN: 2349-3429 (p) Volume 5, Issue 1, DIP: 18.01.005/20170501 DOI: 10.25215/0501.005 http://www.ijip.in October-December, 2017 Original
More informationElectro-Convulsive Therapy Goals. Electro-Convulsive Therapy: Update Ambulatory Surgery Center at UCSF. Outline
: Update 2008 Descartes Li, M.D. Associate Clinical Professor Department of Psychiatry University of California, San Francisco Goals By the end of the seminar, a participant should be able to: Describe
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE 1 Guideline title SCOPE Psychosis and schizophrenia in children and young people: recognition and management 1.1 Short title Psychosis and schizophrenia
More informationRegional Affective Disorders Service (RADS)
Regional Affective Disorders Service (RADS) The Regional Affective Disorders Service (RADS) is a tertiary level specialist service that has been in existence for over 30 years. The service continues to
More informationSickness absence after inguinal herniorrhaphy
Journal of Epidemiology and Community Health, 1979, 33, 121-126 Sickness absence after inguinal herniorrhaphy M. GRIFFITHS, W. E. WATERS, AND E. D. ACHESON From the Department of Community Medicine, University
More informationEarly Intervention Teams services for early psychosis
Early Intervention Teams services for early psychosis Early intervention services work with people who are usually between 14 and 35, and are either at risk of or are currently experiencing a first episode
More informationAiming for recovery for patients with severe or persistent depression a view from secondary care. Chrisvan Koen
Aiming for recovery for patients with severe or persistent depression a view from secondary care Chrisvan Koen Kent and Medway NHS and Social care Partnership trust Persistent depressive disorder F34 Persistent
More informationMood Disorders and Addictions: A shared biology?
Mood Disorders and Addictions: A shared biology? Dr. Paul Stokes Clinical Senior Lecturer, Centre for Affective Disorders, Department of Psychological Medicine Disclosures No relevant disclosures: No paid
More informationCatatonia a forgotten but not extinct condition
NACT meeting 2016 Catatonia a forgotten but not extinct condition Tom G. Bolwig Professor emeritus, dr.med University of Copenhagen What is Catatonia? Catatonia is a motor dysregulation syndrome among
More informationA lmost all patients admitted to hospital receive prescribed
4 ORIGINAL ARTICLE The use of prescribing indicators to measure the quality of care in psychiatric inpatients C Paton, P Lelliott... See editorial commentary, p 9 See end of article for authors affiliations...
More informationMental Health Disorders Civil Commitment UNC School of Government
Mental Health Disorders 2017 Civil Commitment UNC School of Government Edward Poa, MD, FAPA Chief of Inpatient Services, The Menninger Clinic Associate Professor, Baylor College of Medicine NC statutes
More informationInadequacy of Antidepressant Treatment for Patients With Major Depression Who Are at Risk for Suicidal Behavior
Inadequacy of Antidepressant Treatment for Patients With Major Depression Who Are at Risk for Suicidal Behavior Maria A. Oquendo, M.D., Kevin M. Malone, M.D., Steven P. Ellis, Ph.D., Harold A. Sackeim,
More informationDepartment of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
Depression Research and Treatment Volume 2011, Article ID 470985, 7 pages doi:10.1155/2011/470985 Research Article Predictors of Time to Relapse/Recurrence after Electroconvulsive Therapy in Patients with
More informationBock Associates 221 West 2 nd Street, Suite 607 Little Rock, AR 72201
Bock Associates 221 West 2 nd Street, Suite 607 Little Rock, AR 72201 State Project Director- Bliss Beeman, RN Clinical Associate- Shelley Smith, RN Administrative Assistant- Viki DeClerk bockarkansas@gmail.com
More informationMedication Management. Dr Ajith Weeraman MBBS, MD (Psychiatry), FRANZCP Consultant Psychiatrist Epworth Clinic Camberwell 14 th March 2015
Medication Management Dr Ajith Weeraman MBBS, MD (Psychiatry), FRANZCP Consultant Psychiatrist Epworth Clinic Camberwell 14 th March 2015 1 Medication Management Objectives: 1. Principles of psycho-pharmacology
More informationStigma in Patients Using Mental Health Services
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861Volume 17, Issue 12 Ver 2 (December 2018), PP 16-23 wwwiosrjournalsorg Stigma in Patients Using Mental Health
More informationOf those with dementia have a formal diagnosis or are in contact with specialist services. Dementia prevalence for those aged 80+
Dementia Ref HSCW 18 Why is it important? Dementia presents a significant and urgent challenge to health and social care in County Durham, in terms of both numbers of people affected and the costs associated
More informationCharles H. Kellner, MD
ECT: Learning From Recent Trials Charles H. Kellner, MD Professor, Department of Psychiatry Icahn School of Medicine at Mount Sinai ISCTM Philadelphia, PA 27 September, 2016 Charles H. Kellner, MD Disclosures
More informationMending the Mind: treatment of the severely mentally ill
Mending the Mind: treatment of the severely mentally ill First, the bad news Mental Illness Prevalence: putting things in perspective --More than 54 million Americans have a mental disorder in any given
More informationUnit 6: Psychopathology and Psychotherapy (chapters 11-12)
Unit 6: Psychopathology and Psychotherapy (chapters 11-12) Learning Objective 1 (pp. 381-382): Conceptions of Mental Illness Biological Dysfunction 1. What is psychopathology? 2. What criteria are used
More informationStrathprints Institutional Repository
Strathprints Institutional Repository Akram, Gazala (2015) Profiling psychotropic discharge medication from a children s psychiatric ward. International Journal of Clinical Pharmacy, 37 (5). pp. 753-757.
More informationA cross sectional study on prevalence and pattern of personality disorders in psychiatric inpatients of a tertiary care hospital
Original Research Article A cross sectional study on prevalence and pattern of personality disorders in psychiatric inpatients of a tertiary care hospital Maanasa T J 1*, Sivabackiya C 1, Srinivasan B
More informationHelp and Healing: Section 2: Treatment Planning. Treatment and Timelines. Depression Treatment Reference. Care Team Communication
Help and Healing: Resources for Depression Care and Recovery Section 2: Treatment Planning Treatment and Timelines Depression Treatment Reference Care Team Communication Provider Education Tool - Questions
More information8. DEPRESSION 1. Eve A. Kerr, M.D., M.P.H. and Kenneth A. Clark, M.D., M.P.H.
8. DEPRESSION 1 Eve A. Kerr, M.D., M.P.H. and Kenneth A. Clark, M.D., M.P.H. We relied on the following sources to construct quality indicators for depression: the AHCPR Clinical Practice Guideline in
More informationEffectiveness of Cognitive Behaviour Therapy on Patients Suffering From Depression
The International Journal of Indian Psychology ISSN 2348-5396 (e) ISSN: 2349-3429 (p) Volume 3, Issue 4, No. 64, DIP: 18.01.119/20160304 ISBN: 978-1-365-32519-9 http://www.ijip.in July-September, 2016
More informationUnitedHealthcare Community (UHCCP) Louisiana Clinical Program Guidelines Record Supplemental Tool
December-18 UnitedHealthcare Community (UHCCP) Louisiana Clinical Program Guidelines Record Supplemental Tool Facility Name: Primary Dx: Member Gender: Member Age: Reviewer Name: Date of Facility Review:
More informationTreatment Costs Among Adults With Serious Mental Illness: Influences of Criminal Justice Involvement and Psychiatric Diagnoses
Treatment Costs Among Adults With Serious Mental Illness: Influences of Criminal Justice Involvement and Psychiatric Diagnoses The Promises and Challenges of Administrative Data in Social Policy Research
More information