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Pakistan Journal of Medical Sciences 2023Many people with Schizophrenia lack the resources and access to mental health services especially in low and middle income countries. Integration of mental health into... (Review)
Review
Many people with Schizophrenia lack the resources and access to mental health services especially in low and middle income countries. Integration of mental health into primary care services can be a cost effective way of reducing the disability associated with Schizophrenia. Our aim was to review the studies conducted on role of Primary care physicians in management of Schizophrenia in low and middle income countries. PRISMA guidelines were followed and we registered the study protocol at PROSPERO. Four Electronic Databases (Medline, Psycinfo, CINAHL and Embase) were searched in May 2022. Relevant articles after search were 504 of which 61 full text were examined. A total of 20 studies were included in the final review comprising of observational, experimental and qualitative studies. Most studies reported on abilities of Primary care physicians including their knowledge, perceptions, skills and competencies in identifying and management of Schizophrenia and related Psychosis. Findings suggest that there is considerable amount of stigma, lack of awareness and social support about people diagnosed with Schizophrenia. Significant improvement was observed in diagnosis and management of schizophrenia by Primary care physicians who received appropriate training by experts in the field. This review suggests that appropriate training of General practitioners in diagnosing and treating schizophrenia can help in reduction of huge Treatment Gap in Schizophrenia. They can also be utilised in delivering psycho social interventions to improve overall quality of patient care.
PubMed: 37492315
DOI: 10.12669/pjms.39.4.7286 -
The Primary Care Companion For CNS... Nov 2023To investigate the effectiveness of acute short-stay hospital admissions in psychiatric observation units for improving the flow of patients with mental health...
To investigate the effectiveness of acute short-stay hospital admissions in psychiatric observation units for improving the flow of patients with mental health presentations through the emergency department (ED). CINAHL, MEDLINE, OVID, PsycINFO, PubMed, Web of Science, and Google Scholar were systematically searched for English-language studies from 1990 onward. Descriptors used to describe psychiatric observation units were identified, and in databases with MESH term availability, the terms "mental disorder" and "emergency services, psychiatric" were also utilized to further enhance the search. A total of 6,571 studies were screened. The PICOS framework was used to determine the inclusion and exclusion criteria, and the process of study selection followed PRISMA guidelines. Articles were included if the unit studied had a length of stay (LOS) < 72 hours and if patients suffered from a mental health condition and were treated as hospital inpatients. Reviewers performed data extraction and quality assessment of the included studies following the review protocol. A total of 14 psychiatric observation unit studies were included in the review: 5 in North America and 9 in Australia. Most of these units were in large urban general hospitals. There appears to be some improvement in ED LOS for patients with mainly crisis mental health presentations. Seven of the 14 studies specifically discussed ED LOS, and 6 of these studies showed mild to moderate improvement in ED LOS, ranging from 17 minutes to > 11 hours. Psychiatric observation units were mainly located in North American and Australian settings. These units may reduce ED LOS based on limited, poor-quality evidence. Further research is required to determine whether psychiatric observation units have ongoing effects on ED LOS and alleviate access block. .
Topics: Humans; Clinical Observation Units; Australia; Hospitalization; Length of Stay; Emergency Service, Hospital; Retrospective Studies
PubMed: 37976230
DOI: 10.4088/PCC.22r03468 -
The Australian and New Zealand Journal... Sep 2023Engagement with secondary mental health services after an emergency department presentation with suicidal behaviours may be an important strategy for reducing the risk... (Review)
Review
OBJECTIVE
Engagement with secondary mental health services after an emergency department presentation with suicidal behaviours may be an important strategy for reducing the risk of repeat attempts. Our aim was to examine secondary mental health service contact following a presentation to emergency department with suicidal behaviours.
METHODS
A systematic review of papers published between 2000 and 2020 was undertaken. This identified 56 papers relating to 47 primary studies. Data were extracted and summarised separately by age group: (1) young people, (2) older adults and (3) adults and studies with participants of 'all ages'.
RESULTS
Studies in young people ( = 13) showed, on average, 44.8% were referred and 33.7% had contact with secondary mental health services within 4 weeks of emergency department discharge. In comparison, in adult/all ages studies ( = 34), on average, 27.1% were referred to and 26.2% had mental health service contact within 4 weeks. Only three studies presented data on contact with mental health services for older adults, and proportions ranged from 49.0% to 86.0%.
CONCLUSION
This review highlights poor utilisation of secondary mental health service following emergency department presentation for suicidal behaviours, and further research is needed to identify the reasons for this. Crucially, this information could assist in the allocation of resources to facilitate the timely implementation of suicide prevention services.
Topics: Humans; Aged; Adolescent; Suicidal Ideation; Suicide; Suicide Prevention; Mental Health Services; Emergency Service, Hospital
PubMed: 37161341
DOI: 10.1177/00048674231172116 -
Clinical Child Psychology and Psychiatry Jul 2024Before the COVID-19 pandemic, the prevalence and severity of psychiatric disorders among sexual and gender diverse (SGD) young people was greater than in their... (Review)
Review
Before the COVID-19 pandemic, the prevalence and severity of psychiatric disorders among sexual and gender diverse (SGD) young people was greater than in their heterosexual/cisgender peers. We systematically reviewed literature examining the prevalence, severity, and risk factors for psychiatric disorders among SGD young people aged 25 and under during the pandemic. Four databases (MEDLINE, PsycInfo, Scopus and Web of Science) were searched. Eligibility criteria were studies assessing prevalence rates, mean symptomology scores and risk factors of psychiatric disorders using contemporaneous screening measures or diagnosis. Thirteen studies of mixed quality were identified. Most studies indicated SGD young people were at high risk of experiencing several psychiatric disorders including depressive and generalised anxiety disorder compared to the general population. This group also experienced more severe symptomology of various psychiatric disorders compared to their heterosexual/cisgender peers. Risk factors included those specific to the pandemic along with factors that led to greater risk before the pandemic. This systematic review has indicated evidence of heightened risk of psychiatric disorders among SGD young people during the COVID-19 pandemic. It is important for clinicians to acknowledge the needs of SGD young people, working with them to co-develop more inclusive care as they deal with the pandemic's fallout.
Topics: Humans; COVID-19; Risk Factors; Mental Disorders; Prevalence; Adolescent; Sexual and Gender Minorities; Young Adult; Severity of Illness Index; Female; Male; Adult
PubMed: 38290723
DOI: 10.1177/13591045241229751 -
Sante Mentale Au Quebec 2023Context In the exercise of his practice, the psychiatrist is commonly called upon to assess the suicidal risk of a patient and may, under the circumstances, engage his...
Context In the exercise of his practice, the psychiatrist is commonly called upon to assess the suicidal risk of a patient and may, under the circumstances, engage his professional liability and become the subject of a civil suit in the event of the death of the patient. Despite the existence of guidelines and tools for the assessment and management of suicide risk, the practice often remains unstandardized. Few studies have focused on the assessment and management of this risk from a legal perspective. Some knowledge of case law could be useful to psychiatrists in making future decisions, both from a medico-legal point of view and to improve the care offered. Objectives This article aims to study the civil liability of the psychiatrist following the suicide of a patient by analyzing Canadian case law from a perspective of continuous improvement of practice with particular attention to the assessment and management of suicide risk. Method A systematic review of the judgments was carried out on CanLII.org, a virtual library of Canadian legal information allowing access to the judgments rendered by the courts of first instance, the Courts of Appeal as well as those of the Supreme Court of Canada. The search strategy consisted in using the key words "suicide," "psychiatrie," "faute" and "responsabilité" as well as their English translation to retain the recourses where a judgment was rendered by the court and where at least one psychiatrist acted as a defendant or co-defendant following the suicide of a patient. Results Nine judgments met our inclusion criteria. Since elements were of interest for our research question, it seemed wise to us to also include three decisions where the patient did not die of his suicidal attempt but kept significant sequelae. The analysis of the judgments made it possible to identify the alleged faults most often reproached to the psychiatrist by the plaintiff and to present the usual position of the courts, and the arguments which underlie them. The alleged faults can be grouped into three categories: an assessment of the suicide risk deemed faulty, a management of the suicide risk by supervisory measures deemed faulty and an omission to have used legal custody measures when they should have been applied. In nearly all cases, Canadian courts render a decision in favor of the psychiatrist, demonstrating sensitivity to the reality of psychiatrists' practice. The recommendations resulting from our analysis of Canadian case law support the guidelines of the American Psychiatric Association and the Ontario Hospital Association practice guidelines for suicide risk assessment and management, particularly in terms of the content of evaluation, specific moments of re-evaluation and documentation. Conclusion Knowledge of Canadian case law on civil liability for the suicide of a patient represents an additional asset for the practice of responsible and quality psychiatry.
Topics: Humans; United States; Psychiatrists; Suicide; Psychiatry; Liability, Legal; Ontario
PubMed: 38578190
DOI: No ID Found -
Scandinavian Journal of Public Health Mar 2024This systematic review aims to identify and describe how children of parents with mental illness, substance dependence, or severe physical illness/injury, experience... (Review)
Review
This systematic review aims to identify and describe how children of parents with mental illness, substance dependence, or severe physical illness/injury, experience and practise their everyday life. The review followed the four stepwise recommendations of Harden and colleagues when including quantitative and qualitative studies on peoples' experiences and views. In all, 23 studies with data from Norway (2010-2022) have been included. Brown and Clark's thematic analysis was applied. Three themes were constructed from the reviewed articles: (a) Children practice their relational agency by actively doing practical tasks, occasionally jobs to maintain family economy, and organising fun activities with the ill parent. (b) Emotional ambivalence when their own needs were set aside in favour of the parents. They loved their parents but also felt guilt, anger, disappointment, shame, fear of inheriting the illness and longed for a 'normal' everyday life. (c) Supportive contextual factors were, for example, at least one significant adult recognising them, participating in leisure activities, socialising with friends, and talking with other peers who shared similar experiences as next of kin. Obstructive factors were lack of information and recognition as well as silence and lack of dialogue within the family and/or health professional.
PubMed: 38506846
DOI: 10.1177/14034948241232040 -
International Journal of Environmental... Mar 2024Grief after suicide or patient-perpetrated homicide can be complex for those involved in the patient's care. Mental health practitioners with patients who die...
What Are the Experiences of Mental Health Practitioners Involved in a Coroner's Inquest and Other Inquiry Processes after an Unexpected Death of a Patient? A Systematic Review and Thematic Synthesis of the Literature.
Grief after suicide or patient-perpetrated homicide can be complex for those involved in the patient's care. Mental health practitioners with patients who die unexpectedly may be called to assist in the formal investigation processes that follow. The aim of this study was to examine the experience of mental health practitioners called to attend a coroner's inquest or other forms of formal inquiry. A protocol for a systematic review was prospectively registered on PROSPERO (CRD42023400310). A thematic synthesis of existing literature was conducted. We identified six articles for inclusion and constructed three themes from our analysis: Blame and enduring hostility, In the dark, and Limited learning. We found mental health practitioners may construct narratives of self-blame. These can be reinforced by the investigatory processes that follow. Feedback from inquiries is often delivered haphazardly and may not reflect the realities of clinical work. The support given to assist practitioners through inquiry processes varied-both in amount and how helpful it was. The research conducted on this topic is limited. More qualitative research should be conducted to understand the factors that make this experience more or less difficult as well as well as what support is needed for whom.
Topics: Humans; Bereavement; Coroners and Medical Examiners; Grief; Mental Health
PubMed: 38541356
DOI: 10.3390/ijerph21030357 -
The Cochrane Database of Systematic... May 2024Because of wars, conflicts, persecutions, human rights violations, and humanitarian crises, about 84 million people are forcibly displaced around the world; the great... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Because of wars, conflicts, persecutions, human rights violations, and humanitarian crises, about 84 million people are forcibly displaced around the world; the great majority of them live in low- and middle-income countries (LMICs). People living in humanitarian settings are affected by a constellation of stressors that threaten their mental health. Psychosocial interventions for people affected by humanitarian crises may be helpful to promote positive aspects of mental health, such as mental well-being, psychosocial functioning, coping, and quality of life. Previous reviews have focused on treatment and mixed promotion and prevention interventions. In this review, we focused on promotion of positive aspects of mental health.
OBJECTIVES
To assess the effects of psychosocial interventions aimed at promoting mental health versus control conditions (no intervention, intervention as usual, or waiting list) in people living in LMICs affected by humanitarian crises.
SEARCH METHODS
We searched CENTRAL, MEDLINE, Embase, and seven other databases to January 2023. We also searched the World Health Organization's (WHO) International Clinical Trials Registry Platform and ClinicalTrials.gov to identify unpublished or ongoing studies, and checked the reference lists of relevant studies and reviews.
SELECTION CRITERIA
Randomised controlled trials (RCTs) comparing psychosocial interventions versus control conditions (no intervention, intervention as usual, or waiting list) to promote positive aspects of mental health in adults and children living in LMICs affected by humanitarian crises. We excluded studies that enrolled participants based on a positive diagnosis of mental disorder (or based on a proxy of scoring above a cut-off score on a screening measure).
DATA COLLECTION AND ANALYSIS
We used standard Cochrane methods. Our primary outcomes were mental well-being, functioning, quality of life, resilience, coping, hope, and prosocial behaviour. The secondary outcome was acceptability, defined as the number of participants who dropped out of the trial for any reason. We used GRADE to assess the certainty of evidence for the outcomes of mental well-being, functioning, and prosocial behaviour.
MAIN RESULTS
We included 13 RCTs with 7917 participants. Nine RCTs were conducted on children/adolescents, and four on adults. All included interventions were delivered to groups of participants, mainly by paraprofessionals. Paraprofessional is defined as an individual who is not a mental or behavioural health service professional, but works at the first stage of contact with people who are seeking mental health care. Four RCTs were carried out in Lebanon; two in India; and single RCTs in the Democratic Republic of the Congo, Jordan, Haiti, Bosnia and Herzegovina, the occupied Palestinian Territories (oPT), Nepal, and Tanzania. The mean study duration was 18 weeks (minimum 10, maximum 32 weeks). Trials were generally funded by grants from academic institutions or non-governmental organisations. For children and adolescents, there was no clear difference between psychosocial interventions and control conditions in improving mental well-being and prosocial behaviour at study endpoint (mental well-being: standardised mean difference (SMD) 0.06, 95% confidence interval (CI) -0.17 to 0.29; 3 RCTs, 3378 participants; very low-certainty evidence; prosocial behaviour: SMD -0.25, 95% CI -0.60 to 0.10; 5 RCTs, 1633 participants; low-certainty evidence), or at medium-term follow-up (mental well-being: mean difference (MD) -0.70, 95% CI -2.39 to 0.99; 1 RCT, 258 participants; prosocial behaviour: SMD -0.48, 95% CI -1.80 to 0.83; 2 RCT, 483 participants; both very low-certainty evidence). Interventions may improve functioning (MD -2.18, 95% CI -3.86 to -0.50; 1 RCT, 183 participants), with sustained effects at follow-up (MD -3.33, 95% CI -5.03 to -1.63; 1 RCT, 183 participants), but evidence is very uncertain as the data came from one RCT (both very low-certainty evidence). Psychosocial interventions may improve mental well-being slightly in adults at study endpoint (SMD -0.29, 95% CI -0.44 to -0.14; 3 RCTs, 674 participants; low-certainty evidence), but they may have little to no effect at follow-up, as the evidence is uncertain and future RCTs might either confirm or disprove this finding. No RCTs measured the outcomes of functioning and prosocial behaviour in adults.
AUTHORS' CONCLUSIONS
To date, there is scant and inconclusive randomised evidence on the potential benefits of psychological and social interventions to promote mental health in people living in LMICs affected by humanitarian crises. Confidence in the findings is hampered by the scarcity of studies included in the review, the small number of participants analysed, the risk of bias in the studies, and the substantial level of heterogeneity. Evidence on the efficacy of interventions on positive mental health outcomes is too scant to determine firm practice and policy implications. This review has identified a large gap between what is known and what still needs to be addressed in the research area of mental health promotion in humanitarian settings.
Topics: Humans; Randomized Controlled Trials as Topic; Mental Health; Developing Countries; Quality of Life; Adult; Child; Psychosocial Intervention; Adaptation, Psychological; Altruism; Adolescent; Refugees; Bias; Health Promotion; Psychosocial Functioning; Female; Stress Disorders, Post-Traumatic; Mental Disorders
PubMed: 38770799
DOI: 10.1002/14651858.CD014300.pub2 -
Frontiers in Neurology 2024Tardive dyskinesia (TD) is a movement disorder that can arise as a side effect of treatment with dopamine receptor-blocking agents (DRBAs), including antipsychotic drugs...
Tardive dyskinesia (TD) is a movement disorder that can arise as a side effect of treatment with dopamine receptor-blocking agents (DRBAs), including antipsychotic drugs (APDs) used to manage psychotic illnesses. Second-generation APDs (SGAs) are often preferred to first-generation drugs due to their lower propensity to cause TD, however many SGAs-treated patients still develop the condition. Although TD is a global health concern, evidence regarding the occurrence of TD and how it is managed in Asian countries is currently limited. This article reports the results of a systematic review of the published literature on TD focusing on its prevalence, types of patients, knowledge of the condition, causative factors, and usual treatment pathways in clinical practice in Asian countries. Epidemiological data suggest that the prevalence of TD is increasing globally due to an overall rise in APD use, contributing factors being polypharmacy with multiple APDs, the use of higher than necessary doses, and off-label use for non-psychotic indications. Although exact prevalence figures for TD in Asian countries are difficult to define, there is a similar pattern of rising APD use which will result in increasing numbers of TD patients in this region. These issues need to be addressed and strategies developed to minimize TD risk and manage this disabling condition which impacts patients' quality of life and daily functioning. To date, both research into TD has been predominantly psychiatry focused and the perspectives from neurologists regarding the clinical management of this challenging condition are scarce. However, neurologists have an essential role in managing the movement disorders manifestations that characterize TD. Optimum management of TD, therefore, should ideally involve collaboration between psychiatrists and neurologists in joint care pathways, wherever practical. Collaborative pathways are proposed in this article, and the challenges that will need to be addressed in Asian countries to improve the care of people with TD are highlighted, with a focus on the neurologist's viewpoint and the implications for the management of TD globally.
PubMed: 38419696
DOI: 10.3389/fneur.2024.1356761 -
Psychiatry, Psychology, and Law : An... 2024Police negotiators respond to crisis and high-risk situations including mental health crises, but little is known about the nature, frequency and characteristics of...
Police negotiators respond to crisis and high-risk situations including mental health crises, but little is known about the nature, frequency and characteristics of these events. This systematic review examined literature about mental disorder and suicidality prevalence in negotiation events from peer-reviewed articles published within the last 20 years. Of 1455 articles identified, 11 met study inclusion criteria. Most contributed only indirect evidence using data on fatal police encounters, case reviews and analysis of communication techniques. Reliable prevalence estimates were not found, though findings suggest suicidality was a precipitating factor in more than half of events and was present during most events. Mental disorder (primarily substance use, mood and psychotic disorders) was also identified as a significant factor prior to and during events. Few articles described frequency or characteristics of these critical events. Further research is needed to inform frontline responses, resourcing and support pathways for police providing this crucial service.
PubMed: 38455272
DOI: 10.1080/13218719.2023.2175066