Asunto(s)
Ataxia/complicaciones , Disfunción Cognitiva/complicaciones , Síndrome del Cromosoma X Frágil/complicaciones , Pedúnculo Cerebeloso Medio/diagnóstico por imagen , Temblor/complicaciones , Ataxia/diagnóstico por imagen , Ataxia/psicología , Disfunción Cognitiva/diagnóstico por imagen , Disfunción Cognitiva/psicología , Síndrome del Cromosoma X Frágil/diagnóstico por imagen , Síndrome del Cromosoma X Frágil/psicología , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Temblor/diagnóstico por imagen , Temblor/psicologíaRESUMEN
OBJECTIVES: To develop indicators of safe psychotropic prescribing practices for people with dementia and to test them in a convenience sample of six aged mental health services in Victoria, Australia. METHOD: The clinical records of 115 acute inpatients were checked by four trained auditors against indicators derived from three Australian health care quality and safety standards or guidelines. Indicators addressed psychotropic medication history taking; the prescribing of regular and 'as needed' psychotropics; the documentation of psychotropic adverse reactions, and discharge medication plans. RESULTS: The most problematic areas concerned the gathering of information about patients' psychotropic prescribing histories at the point of entry to the ward and, later, the handing over on discharge of information concerning newly prescribed treatments and the reasons for ceasing medications, including adverse reactions. There were wide variations between services. CONCLUSION: The indicators, while drawn from current Australian guidelines, were entirely consistent with current prescribing frameworks and provide useful measures of prescribing practice for use in benchmarking and other quality improvement activities.
Asunto(s)
Demencia/tratamiento farmacológico , Prescripciones de Medicamentos/normas , Psiquiatría Geriátrica/normas , Pacientes Internos , Pautas de la Práctica en Medicina/normas , Servicio de Psiquiatría en Hospital/normas , Psicotrópicos/uso terapéutico , Indicadores de Calidad de la Atención de Salud , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Psicotrópicos/efectos adversos , VictoriaRESUMEN
OBJECTIVE: The aim of the study was to determine whether depressed aged inpatients treated with brief pulse unilateral electroconvulsive therapy (ECT) differed from those treated with bilateral (bitemporal or bifrontal) ECT with respect to numbers of treatments, length of hospital admission, changes in scores on depression and cognitive scales, and serious adverse effects. METHODS: An audit of routinely collected data regarding 221 acute ECT courses in 7 public aged psychiatry services in Victoria, Australia. RESULTS: Patients given unilateral, bifrontal, and bitemporal treatments were similar with respect to personal, clinical, and treatment characteristics. Most treatments were administered in line with local clinical guidelines and were rated as effective. Psychiatrists preferred unilateral ECT in the first instance with stimulus dosing based on patients' seizure thresholds. Approximately a quarter of unilateral courses were switched later to bitemporal placement, most probably because of insufficient progress. Bilateral treatments were associated with a larger number of treatments, less improvement in scores on mood and cognitive scales, and more refusals to continue treatment than unilateral-only ECT. DISCUSSION: Brief pulse unilateral ECT proved more effective than bitemporal and bifrontal ECT for most aged patients, especially when coupled with stimulus dosing based on seizure threshold.
Asunto(s)
Trastorno Depresivo Mayor/terapia , Terapia Electroconvulsiva/métodos , Afecto , Anciano , Anciano de 80 o más Años , Cognición , Trastorno Depresivo Mayor/psicología , Terapia Electroconvulsiva/efectos adversos , Electrodos , Lateralidad Funcional , Humanos , Longevidad , Auditoría Médica , Servicio de Psiquiatría en Hospital , Resultado del Tratamiento , Negativa del Paciente al Tratamiento , VictoriaRESUMEN
AIM: The Alcohol-Related Problems Survey (ARPS) reliably classifies drinking as non-hazardous, hazardous or harmful using scoring algorithms that consider quantity and frequency of alcohol use alone and in combination with health conditions, medication-use and functional status. Because it has been developed using a 14-g US standard drink, it is not valid in Australia where a standard drink contains 10 g of ethanol. METHOD: We recalibrated the ARPS scoring algorithms for a 10-g Australian standard drink and updated the list of medications. The Australian ARPS (A-ARPS) was then administered to 50 non-treatment-seeking participants in waves of five. RESULTS: The A-ARPS recalibrated scoring algorithms reliably classified all 50 individuals. Sixty-six per cent were classified as hazardous or harmful drinkers. Many were taking medications that interact with alcohol or had medical conditions that can be exacerbated by alcohol consumption. CONCLUSION: The A-ARPS is available for use in Australia. Its utilisation could reduce the incidence of alcohol-related harms.
Asunto(s)
Consumo de Bebidas Alcohólicas/efectos adversos , Trastornos Relacionados con Alcohol/diagnóstico , Etanol/efectos adversos , Indicadores de Salud , Encuestas y Cuestionarios , Anciano , Consumo de Bebidas Alcohólicas/epidemiología , Trastornos Relacionados con Alcohol/epidemiología , Trastornos Relacionados con Alcohol/prevención & control , Algoritmos , Australia/epidemiología , Interacciones Farmacológicas , Estudios de Factibilidad , Femenino , Evaluación Geriátrica , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Medición de Riesgo , Factores de RiesgoAsunto(s)
Antipsicóticos/administración & dosificación , Isoxazoles/administración & dosificación , Palmitatos/administración & dosificación , Risperidona/administración & dosificación , Esquizofrenia/tratamiento farmacológico , Anciano , Femenino , Humanos , Palmitato de Paliperidona , Recurrencia , Insuficiencia del TratamientoRESUMEN
OBJECTIVES: A clinical file review was conducted of clozapine use in three aged psychiatry services in Melbourne, Australia, to compare its safety and tolerability with findings reported in the literature. METHODS: The review period spanned the intervals from 2008 to the services' origins between 11 and 15 years earlier. The files of all patients treated with clozapine during this period were checked with respect to adverse effects and the reasons for ceasing treatment. RESULTS: Clozapine was prescribed to 75 patients (mean age 74.2 years, range 65-89) with doses ranging from 25-800 mg daily (mean 296 mg). Treatment was stopped within the review period in 37 (49%) cases. Reasons for discontinuation included death (n=14), non-fatal adverse events (n=12), patient choice (n=8) and other factors (n=3). While none of the 14 deaths could be linked directly to treatment, orthostatic hypotension might have contributed to a single fatal cerebrovascular accident. There were three cases of "red alert" leukopenia, none of which progressed to agranulocytosis. In general, side effects were more frequent than in a previous report concerning aged patients, most probably because clozapine doses were higher. CONCLUSIONS; Most of the adverse events leading to treatment cessation occurred within the first month, emphasising the need for slow titration. Strict monitoring procedures ensured that there were no fatal haematological adverse events.
Asunto(s)
Antipsicóticos/efectos adversos , Clozapina/efectos adversos , Evaluación Geriátrica/métodos , Anciano , Anciano de 80 o más Años , Australia , Femenino , Evaluación Geriátrica/estadística & datos numéricos , Humanos , Leucopenia/inducido químicamente , Masculino , Satisfacción del Paciente , Estudios Retrospectivos , Análisis de SupervivenciaRESUMEN
BACKGROUND: We report on the outcomes in aged patients with severe, treatment-resistant depression or psychosis who were given ongoing outpatient continuation-maintenance ECT of varying duration to prevent remission and relapse following a successful course of acute ECT. METHODS: A retrospective chart review of 58 consecutive patients of three Australian aged psychiatry services comparing the number and length of psychiatric admissions before and after the start of continuation-maintenance ECT. RESULTS: Four patients had only one treatment and two received over 50 (mean 14.7). Five were still enrolled in a maintenance program two years later. In the two years after continuation-maintenance ECT started, admissions fell by 53% in number and 79% in duration compared with the previous two years. Within the actual treatment period which varied from one patient to another, admissions fell by 90% in number and 97% in duration compared with the same period beforehand. CONCLUSION: A treatment effect cannot be proven but the severity and chronicity of patients' conditions make placebo effects and spontaneous remission unlikely. Randomised, controlled trials are almost impossible in this setting and so carefully conducted reviews and case-control studies are still of value. Our findings suggest that continuation-maintenance ECT is effective in carefully selected patients at high risk of relapse.
Asunto(s)
Trastorno Depresivo Mayor/terapia , Terapia Electroconvulsiva/métodos , Terapia Electroconvulsiva/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Servicios de Salud Mental/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Anciano , Australia/epidemiología , Áreas de Influencia de Salud , Trastorno Depresivo Mayor/epidemiología , Trastorno Depresivo Mayor/rehabilitación , Femenino , Humanos , Acontecimientos que Cambian la Vida , Masculino , Registros Médicos , Estudios Retrospectivos , Factores de TiempoRESUMEN
OBJECTIVE: To check if experienced psychiatrists in Victoria, Australia, observed the standards outlined by the American Psychiatric Association and the Royal College of Psychiatrists regarding the administration and monitoring of continuation-maintenance electroconvulsive therapy (ECT). METHODS: A retrospective chart review of 60 consecutive patients given continuation-maintenance ECT in 3 Victorian public aged psychiatry services. RESULTS: Practice guidelines were often not observed concerning documentation of treatment plans, mental state reviews and patients' and carers' viewpoints. CONCLUSIONS: Continuation-maintenance ECT proved highly effective in this clinical sample. Our audit identifies areas for improvement in clinical practice. It will be helpful to have a simple checklist of treatment plans, rating scale scores, and discussions with patients and carers that clinicians can complete at regular intervals.
Asunto(s)
Terapia Electroconvulsiva/normas , Escalas de Valoración Psiquiátrica/normas , Psiquiatría/normas , Australia , Terapia Electroconvulsiva/métodos , Femenino , Humanos , Masculino , Estudios RetrospectivosRESUMEN
Antipsychotic medication is the mainstay of treatment in elderly patients with psychosis. In recent years, second generation antipsychotics have come to be preferred. Long-acting risperidone is the first such antipsychotic available for use in this vulnerable group of patients and offers an attractive alternative to traditional medications. The available literature revealed that long-acting risperidone is generally well tolerated and is effective in treating both the positive and negative symptoms of schizophrenia. Despite a lack of randomized trials and head-to-head studies, it appears to be a useful addition to the treatment armory for patients with chronic psychosis who require a depot preparation. Further research into its endocrine and metabolic side effects is needed.