RESUMO
People who complete suicide are in contact with general medical services frequently in the year before their death. The high rate of medical contacts in the year before suicide and evidence that psychiatric conditions are under-diagnosed suggests that a significant opportunity for suicide prevention exists in the general medical setting. This article makes several recommendations to seize this opportunity with the aim of reaching as many patients as possible, ensuring early diagnosis and treatment of mental health problems and providing compassionate care to those who most need it.
Assuntos
Transtornos Mentais/terapia , Aceitação pelo Paciente de Cuidados de Saúde , Atenção Primária à Saúde , Prevenção do Suicídio , Humanos , Serviços de Saúde Mental , Psiquiatria , Reino UnidoRESUMO
OBJECTIVE: Lithium users are offered routine renal monitoring but few studies have quantified the risk to renal health. The aim of this study was to assess the association between use of lithium carbonate and incidence of renal failure in patients with bipolar disorder. METHODS: This was a retrospective cohort study using the General Practice Research Database (GPRD) and a nested validation study of lithium exposure and renal failure. A cohort of 6360 participants aged over 18 years had a first recorded diagnosis of bipolar disorder between January 1, 1990 and December 31, 2007. Data were examined from electronic primary care records from 418 general practices across the UK. The primary outcome was the hazard ratio for renal failure in participants exposed to lithium carbonate as compared with non-users of lithium, adjusting for age, gender, co-morbidities, and poly-pharmacy. RESULTS: Ever use of lithium was associated with a hazard ratio for renal failure of 2.5 (95% confidence interval 1.6 to 4.0) adjusted for known renal risk factors. Absolute risk was age dependent, with patients of 50 years or older at particular risk of renal failure: Number Needed to Harm (NNH) was 44 (21 to 150). CONCLUSIONS: Lithium is associated with an increased risk of renal failure, particularly among the older age group. The absolute risk of renal failure associated with lithium use remains small.
Assuntos
Transtorno Bipolar/tratamento farmacológico , Lítio/efeitos adversos , Lítio/uso terapêutico , Insuficiência Renal/induzido quimicamente , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Biológicos , Modelos de Riscos Proporcionais , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Resultado do Tratamento , Suspensão de Tratamento , Adulto JovemRESUMO
BACKGROUND: Balancing pressures of the 4-h wait in Accident and Emergency (A&E) and the National Institute for Clinical Excellence (NICE) requirement for a psychosocial assessment (PSA) before leaving hospital for patients presenting with self-harm is a challenge. This paper suggests a new method for coping with this demand. METHODS: A score of 5 or above on the Modified Sad Persons Scale (MSPS), rated by general hospital staff, would result in an automatic admission to the general hospital for detailed PSA by the dedicated liaison psychiatry team the following day. RESULTS: Most patients are usually admitted due to medical concerns. Only a small number of patients needed further psychiatric inpatient admission. CONCLUSIONS: This integrated care pathway (ICP) is evidence of true multidisciplinary working resulting in mutually beneficial outcomes for both the acute and mental health trusts.