Lost in documentation: a study of case-formulation documentation in letters after outpatient assessment.

OBJECTIVE: The authors sought to find out how frequently case-formulation is documented by psychiatrists after initial assessment in an outpatient clinic. METHOD: Assessment letters for 150 new referrals/new referrals to a psychiatric clinic in Rotherham, U.K. were examined for the presence or absence of a case-formulation, as well as the different sections of the psychiatric history. RESULTS: A group of 150 assessment letters were selected and examined. An overwhelming majority (94%) of letters did not include any case-formulation; this finding was not affected by the grade of the doctor. CONCLUSIONS: Although case-formulation is considered an important skill by various training bodies, it seems that this is rarely translated into daily clinical practice. The authors discuss the possible reasons for this deficiency and discuss potential solutions.

Predictors and sequelae of fractures in the elderly: the Canadian Study of Health and Aging (CSHA).

The objective of this study was to describe the incidence, type, risk factors, and sequelae of fractures experienced by community-dwelling elderly Canadians. Data are from the Canadian Study of Health and Aging (CSHA), a longitudinal cohort study, collected in three waves: baseline (1991), wave 2 (1996), and wave 3 (2001). In CSHA-2 (1996), fractures were reported by 3.7 per cent of men and 7.5 per cent of women; in CSHA-3 (2001), by 2.9 per cent of men and 7.3 per cent of women. The distribution of fracture types was similar for men and women. Risk factors for women were increased age, history of fracture, and regular alcohol use; for men, stroke, arthritis, and lack of independent bathing. Walkers or wheelchairs were needed by over 30 per cent of those with any lower body fracture. One third of subjects with any fracture and over 50 per cent with femur fractures reported moderate or severe pain. It is concluded that elderly Canadians are at high risk for fractures, and older women are at most risk. Pain and mobility problems were common sequelae. The need for primary and secondary prevention of these age-related events is paramount.

Psychosis related to ephedra-containing herbal supplement use.

Ephedra, a psychoactive substance with stimulant properties, is found in many herbal products. Often perceived by the lay public as benign, the potential health-related dangers of using these products are beginning to be recognized. We review four cases associated with ephedra-containing herbal products and report three additional cases. Unlike the previously reported cases, the patients presented in this report developed persistent psychosis that required psychopharmaceutical management.