Aims and methodMental illness is associated with increased physical morbidity. We aimed to assess and improve the routine blood testing of prescribed antipsychotics in out-patients from a busy London inner city area. Audit findings were presented locally to prescribers, together with educational suggestions to improve physical health assessment.ResultsInitially, the numbers monitored were low in the overall number of 126 patients included in the first audit. Following the intervention, this improved significantly in the second audit (of 106 patients).Clinical implicationsA simple one-page monitoring prompt and an educational intervention could significantly increase the adherence to routine blood-testing guidelines. Better physical screening may help reduce physical morbidity and mortality, and improve the quality of life of individuals with mental illness.
Introduction: It is difficult to distinguish between posttraumatic and idiopathic psychotic disorders. After a traumatic brain injury, the incidence of psychotic symptoms is between 5-20%, with an average duration of 4 years. Delusions and auditory hallucinations are more frequent than negative and catathoniform symptoms. Despite the lack of strong scientific evidence, antipsychotic treatment seems the best choice, although there is a bigger risk of adverse effects. The prognosis does not seem to be related to the severity of the injury. Objectives and aims: We intend to illustrate the daily clinical practice, in which we find patients with important comorbidities, difficult differential diagnosis and therapeutic challenges. Methods: Using a case-report format, we describe a 26 year old patient with the following diagnostics: traumatic brain injury with secondary psychotic symptoms versus schizophrenia; alcohol abuse; cannabis dependence; pathologic gambling. We summarize complementary explorations, therapeutic management and evolution. Results: Along three years of follow up there is a preponderance of negative symptoms. Positive symptom exacerbations also occur, in coincidence with an increase of cannabis consumption. Due to lack of compliance, long acting antipsychotics are prescribed. Motivational Interview is used for the drug use disorders and the treatment compliance, achieving the goal of reducing cannabis consumption. Conclusions: Daily clinical practice brings us highly complex cases in which a multidisciplinary approach is very important. This particular case shows the differential diagnose difficulties between posttraumatic and idiopathic psychosis, and the troubles of clinical and therapeutical management in the dual pathology field.
BackgroundSome studies of first psychotic episodes have suggested the association between childhood trauma, such as sexual abuse, and the risk of hallucinations.1 Furthermore, other studies indicated that environment can alter the phenomenological presentation of first psychotic episodes.2However, there are no studies about the association between hallucinations in first psychotic episodes and the prognosis of the disease. This is the main objective of this study. We also compared the phenomenological differences between hallucinations in first episode psychosis and persistent hallucinations in patients with chronic psychosis.MethodsNaturalistic, longitudinal follow-up study in a sample of 173 patients of first psychotic episode attending public mental health service in Area 5 of Valencia region (Spain) in a period between 2010–2017.We compared first-episode patients with hallucinations (N=38) with two samples: A) First-episode patients without hallucinations (N=137). B) Chronic patients with persistent hallucinations (N=45) from a previous study.3In the first comparison we used the following variables: sociodemographic data, risk factors (such as cannabis consume and immigration), psychiatric pathology (CIE-10), psicopathology (including clinical scales GAF, CGI and PANSS), number of emercengy visits and number of hospitalization after the first psychotic episode.In the second one, we use the PSYRATS scale to compare both groups.ResultsIn the first comparison, First Episode Psychotic patients with and without hallucinations,we only found significant differences in the number of hospital income, with more hospitalizations in the non hallucinating group (P= 0.001).In the second comparison, First Episode Hallucinations versus Chronic Persistent Hallucinations, significant differences were only found in the duration of the hallucinations, which was much higher in chronic persistent hallucinations group (P= 0.001)DiscussionConsequently, it seems that first psychotic episode patients without hallucinations have more hospitalizations than first-episode patients with hallucinations. Moreover, we can conclude that the duration of voices is higher in chronic patients with persistent hallucinations than in first psychotic episode hallucinations.Both results have practical implications in the prognostic importance of hallucinations in first psychotic episodes.References1. Misiak, B. et al “Childhood traumatic events and types of auditory verbal hallucinations in first-episode schizophrenia patients”, Comprehensive Psychiatry 66 (2016) 17–22.2. Oher, F.J. et al “The effect of the environment on symptom dimensions in the first episode of psychosis: a multilevel study”, Psychological Medicine 44 (2014) 2419–2430.3. González, J.C. et al J., “Persistent Auditory Hallucinations”, Psychopathology 39 (2006) 120–125.
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