ABSTRACT
Priapism is a urological emergency defined as persistent penile erection that is unrelated to sexual stimulation and typically involving only the corporal cavernosa. It can occur as a rare side effect of antipsychotic medications and is mediated via their α-adrenergic antagonist effect. In this paper we describe a case of priapism in a patient started on risperidone and sodium valproate. We also review the South London and Maudsley Case Register Interactive Search database to assess how many other cases of priapism were reported in patients taking risperidone. We add this information to a literature review of cases of priapism associated with risperidone.
ABSTRACT
Progress in personalised psychiatry is dependent on researchers having access to systematic and accurately acquired symptom data across clinical diagnoses. We have developed a structured psychiatric assessment tool, OPCRIT+, that is being introduced into the electronic medical records system of the South London and Maudsley NHS Foundation Trust which can help to achieve this. In this report we examine the utility of the symptom data being collected with the tool. Cross-sectional mental state data from a mixed-diagnostic cohort of 876 inpatients was subjected to a principal components analysis (PCA). Six components, explaining 46% of the variance in recorded symptoms, were extracted. The components represented dimensions of mania, depression, positive symptoms, anxiety, negative symptoms and disorganization. As indicated by component scores, different clinical diagnoses demonstrated distinct symptom profiles characterized by wide-ranging levels of severity. When comparing the predictive value of symptoms against diagnosis for a variety of clinical outcome measures (e.g. 'Overactive, aggressive behaviour'), symptoms proved superior in five instances (R(2) range: 0.06-0.28) whereas diagnosis was best just once (R(2):0.25). This report demonstrates that symptom data being routinely gathered in an NHS trust, when documented on the appropriate tool, have considerable potential for onward use in a variety of clinical and research applications via representation as dimensions of psychopathology.
Subject(s)
Electronic Health Records/instrumentation , Mental Disorders , Adult , Cohort Studies , Cross-Sectional Studies , Female , Humans , Male , Mental Disorders/diagnosis , Mental Disorders/physiopathology , Mental Disorders/psychology , Middle AgedABSTRACT
BACKGROUND: To investigate the feasibility and effectiveness of a needs-led, community-based intervention for treating individuals from black minority ethnic (BME) groups with common mental disorders. METHOD: Forty eligible individuals from BME groups were randomised to a needs-led package of care (therapy based on the principles of cognitive behaviour therapy and ethnically matched therapists, advocacy and mentoring; 'rapid access') or to a 3-month waiting list control with information on local mental health services ('standard access'). RESULTS: At 3-month follow-up, individuals in the rapid access group showed significantly improved levels of depression (GHQ-28 adjusted p<0.05) although there was no evidence for difference in general functioning (GAF, p=0.87). The intervention was found to be culturally appropriate and acceptable among users and did not result in significantly increased costs. LIMITATIONS: The exploratory study sample was small with low power and therefore the statistical certainty may be limited. CONCLUSIONS: Effective and culturally acceptable psychosocial interventions can be delivered in the community to individuals from BME groups with anxiety and depression with no significant cost implications.
Subject(s)
Anxiety Disorders/ethnology , Anxiety Disorders/therapy , Black People/psychology , Cognitive Behavioral Therapy , Community Mental Health Services , Depressive Disorder/ethnology , Depressive Disorder/therapy , Health Services Accessibility , Health Services Needs and Demand , Somatoform Disorders/ethnology , Somatoform Disorders/therapy , Adult , Anxiety Disorders/diagnosis , Cultural Competency , Depressive Disorder/diagnosis , Early Diagnosis , England , Female , Follow-Up Studies , Humans , Male , Middle Aged , Patient Satisfaction , Personality Inventory , Somatoform Disorders/diagnosis , Young AdultABSTRACT
Objetivo y Método: Este estudio examina las razones que subyacen a la prescripción farmacológica en psiquiatría. Se pidió a varios psiquiatras de diferentes niveles clínicos de un dispositivo de salud mental que completaran una encuesta que examinaba especialmente sus selecciones de fármacos y el uso de polifarmacia en pacientes diagnosticados de esquizofrenia, manía y depresión. Resultados: entre los que respondieron, se encontró que la "experiencia personal" era la razón más importante al prescribir. Entre los pre-residentes ("Senior House Officers", SHO) era significativamente más probable que recetaran como resultado de la "influencia de sus colegas". Implicaciones Clínicas: Aunque los hábitos prescriptivos se atribuían a la "experiencia personal", la elección del medicamento y el uso de polifarmacia, eran acordes con la evidencia disponible
