ABSTRACT
AIMS AND METHOD: In three localities in a mental health trust in England, an enhanced bed management team was established to improve patient flow and reduce out-of-area placements. Trusted assessments were provided to support risk management and conflict resolution. Two measures of flow were compared before and after the team was established. RESULTS: The trusted assessment recommendation was for discharge in 70% of cases. The number of out-of-area placements was significantly reduced (P < 0.05), saving £616 876 over a 12-month period. Patient flow was significantly improved in one of the three localities as measured by patients/bed/6-month period (P < 0.05). In one of the other localities increased use of trusted assessment input and reduced numbers of patients being transferred in are recommended to improve flow. CLINICAL IMPLICATIONS: Mental health trusts should consider the establishment of an enhanced bed management team, including trusted assessment, as a safe and cost-effective approach to improving patient flow and reducing the need for out-of-area placement.
ABSTRACT
BACKGROUND: Research has clearly established the efficacy of pharmacotherapy and cognitive behaviour therapy (CBT) for depression. There is less literature addressing cessation of treatment, such as relapse during withdrawal from antidepressant medication. AIMS: The current study examines the role of psychological constructs that may influence relapse or fear of relapse and lead to resumption of medication. This hypothesizes that during withdrawal individuals may misinterpret normal variations in mood and dysphoric or other symptoms as reduced levels of medication in their bodies in keeping with a simplistic rationale for antidepressants. METHOD: The study uses an intensive single case AB style design in three cases during the withdrawal process. All participants had been treated with CBT plus antidepressants and had previously attempted to withdraw from antidepressants. The first part of the study naturalistically tracks belief changes as medication decreases; the second examines changes in these if/when a CBT intervention is introduced due to relapse or potential near-relapse. Daily self-monitoring diaries were used to measure target variables, together with standardized questionnaires up to 6 months follow-up. RESULTS: Changes in symptoms, appraisal of symptoms, and beliefs about medication changed throughout the study. All participants remained medication free at 6 months follow-up. Two cases received CBT intervention due to possible relapse; the third underwent an unproblematic withdrawal. CONCLUSIONS: Patterns of change are discussed in terms of current approaches to medication cessation and the role of CBT during withdrawal.
Subject(s)
Antidepressive Agents/adverse effects , Cognitive Behavioral Therapy/methods , Depressive Disorder, Major/therapy , Substance Withdrawal Syndrome/therapy , Adult , Antidepressive Agents/therapeutic use , Combined Modality Therapy , Culture , Depressive Disorder, Major/diagnosis , Depressive Disorder, Major/psychology , Female , Follow-Up Studies , Humans , Long-Term Care , Male , Middle Aged , Secondary Prevention , Substance Withdrawal Syndrome/diagnosis , Substance Withdrawal Syndrome/psychologyABSTRACT
The authors describe 12 patients with antipsychotic-induced hyperprolactinemia. Six patients had erroneous ideas of being pregnant (four delusional and two non-delusional) temporally associated with hyperprolactinemia and resolving as prolactin levels returned to normal. The remaining six patients did not develop such ideas. Contrasting the clinical features of the two groups of patients in the context of existing literature informs on the possible biological and cognitive mechanisms that can be hypothesized to underlie the relationship between hyperprolactinemia due to antipsychotics and the development of inaccurate beliefs and feelings about pregnancy, and the effect of current mental state on the propensity to develop these beliefs.
