RESUMEN
Despite high reported rates of antipsychotic non-adherence, little is known about consumer experiences during discontinuation. This study was designed to increase understanding of antipsychotic discontinuation from consumer perspectives. In 2011-2012, 98 Australian consumers involved with participating organizations completed an anonymous survey detailing past antipsychotic discontinuation attempts. Of the 88 participants who reported at least one discontinuation attempt, over half (n = 47, 54.7%) reported stopping without clinician knowledge or support. This group was 35% (confidence interval 15.4-54.6%) more likely to stop abruptly than those (n = 41, 45.3%) stopping with clinician support (P = 0.002). Only 10 participants (23.3%) recalled being given information about discontinuation symptoms other than relapse; however, 68 participants (78.2%) reported experiencing a range of discontinuation symptoms including physical, cognitive, emotional, psychotic or sleep-related disturbances. Findings cannot be readily generalized because of sampling constraints. However, the significant number of participants who reported discontinuation symptoms, in addition to psychosis, is consistent with previous research. This study provides new insight into consumer motivations for discontinuation and possible problems in clinical communication that may contribute to frequent non-collaborative discontinuation attempts. Mental health nurses, who play a pivotal role in medication communication events, may benefit from increased awareness of consumer perspectives on this topic.
Asunto(s)
Antipsicóticos/administración & dosificación , Cumplimiento de la Medicación/psicología , Trastornos Psicóticos/tratamiento farmacológico , Síndrome de Abstinencia a Sustancias/psicología , Adulto , Australia , Humanos , Trastornos Psicóticos/psicologíaRESUMEN
Mental health clinicians working in emergency crisis assessment teams or mental health triage roles are required to make rapid and accurate risk assessments. The assessment of violence risk at triage is particularly pertinent to the early identification and prevention of patient violence, and to enhancing the safety of clinical staff and the general public. To date, the evidence base for mental health triage violence risk assessment has been minimal. This study aimed to address this evidence gap by identifying best available evidence for mental health-related risk factors for patient-initiated violence. We conducted a systematic review based on the National Health and Medical Research Council of Australia's methodology for systematic reviews. A total of 6847 studies were retrieved, of which 326 studies met the study inclusion criteria. Of these studies, 277 met inclusion criteria but failed the quality appraisal process, thus a total of 49 studies were included in the final review. The risk factors that achieved the highest evidence grading were predominantly related to dynamic clinical factors immediately observable in the patient's general appearance, behaviour and speech. These factors included hostility/anger, agitation, thought disturbance, positive symptoms of schizophrenia, suspiciousness and irritability.
Asunto(s)
Servicios de Urgencia Psiquiátrica/métodos , Trastornos Mentales/psicología , Triaje/métodos , Violencia/psicología , Actividades Cotidianas/psicología , Edad de Inicio , Ira , Trastorno de Personalidad Antisocial/complicaciones , Trastorno de Personalidad Antisocial/psicología , Australia , Trastornos del Conocimiento/complicaciones , Trastornos del Conocimiento/psicología , Toma de Decisiones , Hostilidad , Humanos , Genio Irritable , Trastornos Mentales/complicaciones , Salud Mental/estadística & datos numéricos , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Agitación Psicomotora/complicaciones , Agitación Psicomotora/psicología , Medición de Riesgo/métodos , Factores de Riesgo , Esquizofrenia/complicaciones , Psicología del Esquizofrénico , Índice de Severidad de la Enfermedad , Distribución por Sexo , Conducta Social , Violencia/prevención & control , Violencia/estadística & datos numéricosRESUMEN
Childbirth involves many psychological and emotional changes for women. The recent Commonwealth Government of Australia, National Perinatal Mental Health Action Plan (in 2008) recommends all pregnant and postnatal women have a psychosocial assessment including completion of the Edinburgh Postnatal Depression Scale. Midwives will assess all women at antenatal 'booking in' to maternity services. Currently, midwives receive little education regarding mental health assessment of women. This study explored the perceptions of midwives of their own mental health skills, knowledge and experiences, when working with women with mental illness in the perinatal period. An exploratory descriptive design was utilized to survey midwives across 19 maternity sites in Victoria, Australia. Clearly, midwives lack mental health skills and knowledge, describing their lack of confidence and feeling uncomfortable and unsafe when providing care for women with mental illness. They also report little knowledge of resources available to provide appropriate services for these women. The future direction for improving maternity care will require midwives to assess mental health needs of women, and refer them on, for timely intervention. It is critical midwives are prepared and able to make this kind of assessment.
Asunto(s)
Trastornos Mentales/diagnóstico , Partería , Complicaciones del Embarazo/psicología , Adulto , Femenino , Humanos , Masculino , Trastornos Mentales/enfermería , Persona de Mediana Edad , Partería/educación , Partería/normas , Embarazo , Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/enfermería , Encuestas y Cuestionarios , Adulto JovenRESUMEN
Women who are pregnant and who have a history of psychosis are commonly managed with antipsychotic medications. The evidence regarding the use of antipsychotics in pregnancy has been insufficient to provide adequate support for this practice and is a concern for clinicians and women alike. This review presents literature surrounding the use of antipsychotic medications in pregnancy, providing an overview of the historical and contemporary perspectives which influence clinicians prescribing practices. Data were sourced from Medline, CINAHL, PsycINFo, using the terms antipsychotics with pregnancy and psychosis or schizophrenia. This was expanded to include the most common atypical antipsychotics: olanzapine, risperidone, clozapine, quetiapine, ziprasidone and aripiprazole. Literature was found reporting the use of antipsychotic medications in pregnancy since the introduction of antipsychotics in the 1950s, comprising mainly of authors' reviews of the literature, case studies, retrospective reports, drug company registries and more recently a prospective comparative study. This review identifies that the literature provides no clear answer for clinicians as to the risk associated with the use of antipsychotics in pregnancy. To this effect, recently in Australia, the National Register of Antipsychotic Medications in Pregnancy was established to prospectively collect information regarding outcomes for mother and baby, when antipsychotic medications have been used during pregnancy.
Asunto(s)
Anomalías Inducidas por Medicamentos/etiología , Antipsicóticos/toxicidad , Complicaciones del Embarazo/tratamiento farmacológico , Complicaciones del Embarazo/enfermería , Trastornos Psicóticos/tratamiento farmacológico , Trastornos Psicóticos/enfermería , Antipsicóticos/uso terapéutico , Aripiprazol , Benzodiazepinas/uso terapéutico , Benzodiazepinas/toxicidad , Clozapina/uso terapéutico , Clozapina/toxicidad , Diabetes Gestacional/inducido químicamente , Diabetes Gestacional/enfermería , Dibenzotiazepinas/uso terapéutico , Dibenzotiazepinas/toxicidad , Femenino , Humanos , Recién Nacido , Olanzapina , Piperazinas/uso terapéutico , Piperazinas/toxicidad , Embarazo , Fumarato de Quetiapina , Quinolonas/uso terapéutico , Quinolonas/toxicidad , Risperidona/uso terapéutico , Risperidona/toxicidad , Tiazoles/uso terapéutico , Tiazoles/toxicidadRESUMEN
Presented with the concerns of emergency department nurses about providing appropriate and co-ordinated care for patients seeking mental health services, a Monash University School of Nursing, Victoria, Australia, research team chose a participatory action research strategy. Jointly executed with staff from the Peninsula Health Care Network, the research process brought together in a number of fora multiple disciplines involved in the care and management of psychiatric patients. The participatory action research process itself was the first step in remedial action. Through it, participants and management gained a firmer view of the issues facing Frankston Hospital Emergency Department staff in dealing with psychiatric patients, and in securing their access to suitable pathways of care. Other research outcomes included: a compilation of summary statistics showing patterns of use by psychiatric patients of Frankston Hospital's Emergency Department; beginning discussions about pathways of care for these patients; and the development of a screening tool to be used by the triage nurse for at-risk psychiatric patients presenting to the Emergency Department.