Mental Health and Wellbeing in England: the Adult Psychiatric Morbidity Survey 2014

This report presents findings of a survey of mental illness and wellbeing among people aged 16 and over living in private households in England. The survey was commissioned by NHS Digital and funded by the Department of Health, and is the fourth in a series of surveys of adult mental health

Automated methods for surveillance of surgical site infections.

Automated data, especially from pharmacy and administrative claims, are available for much of the U.S. population and might substantially improve both inpatient and postdischarge surveillance for surgical site infections complicating selected procedures, while reducing the resources required. Potential improvements include better sensitivity, less susceptibility to interobserver variation, more uniform availability of data, more precise estimates of infection rates, and better adjustment for patients' coexisting illness

Pharmacotherapy in Anorexia Nervosa

There is currently no evidence base for prescribing antidepressants or antipsychotics in young people with eating disorders. There is a need for greater understanding of psychotropic prescribing in individuals with anorexia nervosa (AN) to provide guidance for their use in clinical practice. The aim of this PhD was to explore and describe the drug utilisation and effectiveness of psychopharmacotherapy in individuals with AN. First, a systematic review was conducted to review the current literature. Next, pharmacotherapy in individuals with AN was explored by three means; 1) through self-reported questionnaires by child and adolescent eating disorder (CAED) psychiatrists on their prescribing practices in AN, 2) using The Health Improvement Network (THIN) database by reporting on AN patterns and describing prescribing patterns in AN in primary care, and 3) in multisite specialised child and young people eating disorder services (CYP EDS) within secondary healthcare settings by describing AN population and examining the effects of psychotropic treatment on weight change. Findings from my review fail to provide strong evidence for any increase in weight associated with the use of psychotropic drugs in adolescents with AN and show some evidence of harmful effects associated with their use. Studies in this thesis have shown there is a high use of psychotropics in AN treatment, with around half of individuals in the primary and secondary care study having a record for psychotropic prescriptions, of which olanzapine and fluoxetine are the most common. No serious adverse events were found in any of the studies. After six months of pharmacotherapy, the mean BMI of those individuals on antipsychotics was greater than the mean BMI of those on antidepressants or no medication, despite having a lower starting BMI upon diagnosis. This thesis found that although a lack of strong existing evidence, psychotropic medications are often prescribed for the treatment of young people with AN

ALCOHOL AND MEDICATION USE IN COMMUNITY-DWELLING OLDER ADULTS: UNDERSTANDING THE EFFECT OF ALCOHOL AND CENTRAL NERVOUS SYSTEM-ACTING MEDICATIONS ON THE RISK FOR FALLS

Introduction: Aging, comorbid conditions, and use of medications render older adults more susceptible to alcohol-disease or alcohol-drug interactions that may lead to harmful outcomes. In this dissertation project the risk profile of alcohol and medications use among older adults was investigated. Considering the rise in CNS-acting medication use and the adverse effect profile linked to CNS-acting medications, it was also of interest to find if older adults were at risk of falling due to interactions between alcohol and CNS-acting medication. Objectives: The objectives were as follows: 1) to determine the prevalence, pattern and factors associated with at-risk drinking, 2) to determine the prevalence and pattern of potential concurrent use of CNS-acting medication and alcohol, and to identify factors associated with alcohol use among CNS-acting medication users, 3) to assess the effects of potential concurrent use of CNS-acting medications and alcohol on the risk for falls in older adults. Methods: The study population comprised a nationally representative sample of community-dwelling older adults aged 65 years or older. The 2009 Medicare Current Beneficiary Survey (MCBS) data (n=7163) were employed to determine at-risk drinking based on the Comorbidity Alcohol Risk Evaluation Tool (CARET) and to assess the effects of potential concurrent use of CNS-acting medication and alcohol on the risk for falls. The National Health and Nutrition Examination Survey (NHANES) 2005-2010 data (n=3220) were employed to determine potential concurrent use of alcohol and CNS-acting medications. The effect of combined use of alcohol and CNS-acting medications on risk of falls was assessed using logistic regression modeling and adjusting for confounders. Alcohol consumption was measured by the quantity-frequency method and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) recommended drinking limits were utilized in all analyses. Results: In the MCBS study, 5.6% of the older adults were identified as at-risk drinkers. Adults aged between 65-74 years, being male, non-married, former or current smoker, and having no comorbid conditions were factors associated with at-risk drinking. In the NHANES study, 8.9% reported potential concurrent use of alcohol and CNS-acting medication. Use of at least one CNS-acting medication and drinking excessive alcohol, or binge drinking, was significantly associated with odds of falling. Conclusion: Hazardous alcohol use is common among older adults. A substantial proportion of older adults may concomitantly consume alcohol and CNS-acting medications. Odds of falling are greater in the presence of high alcohol intake and CNS-acting medication use. It is important for health care professionals to warn patients against excessive alcohol consumption. Increasing awareness of this issue among older adults and caregivers may help prevent falls. Contributions from healthcare professionals in the form of screening for potentially harmful alcohol use, prescription monitoring, and initiating counseling may help to reduce older adults’ risk for falls or other adverse effects

The safety of antipsychotic use during pregnancy

Aim: To investigate the patterns of gestational antipsychotics use and whether exposure to antipsychotic medications in pregnancy is associated with gestational diabetes mellitus (GDM) in mothers and seizure, attention deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), preterm birth (PTB) and small for gestational age (SFGA) in subsequent children. Methods: Firstly, a methodological review was conducted to review the methodological characteristics of existing observational studies that investigate the association between prenatal central nervous system (CNS) drugs use and CNS disorders. Secondly, a systematic review and meta-analysis was conducted to evaluate the evidence-based association between gestational antipsychotic use and GDM. Thirdly, a cross-sectional study was conducted to investigate the patterns and trends of antipsychotics use during pregnancy in the United Kingdom (UK) and Hong Kong (HK). Lastly, seven cohort studies were conducted to investigate the association between antipsychotics use in pregnancy and the risk of above-mentioned outcomes, respectively. Results: 4.64% and 0.34% of pregnancies were prescribed at least one prescription of antipsychotic during pregnancy in the UK and HK, respectively. When women who continued using antipsychotics during pregnancy were compared with those who had stopped, there was no evidence to demonstrate an increased risk of GDM. No evidence supported prenatal exposure to antipsychotics can increase the risk of ADHD/ASD/SFGA. Children with prenatal antipsychotics exposure was associated with an increased risk of seizure (HR 1.49, 95% CI 1.11-1.99) and PTB (OR 1.40, 95%CI 1.13-1.75), comparing to those without. However, further sibling-matched analyses and negative control analyses indicated no evidence supported the above-mentioned associations. Conclusion: This PhD project did not suggest an increased risk of GDM in mothers or seizure/ADHD/ASD/PTB/SFGA in children regarding antipsychotics use during pregnancy. Women are not recommended to stop their regular antipsychotic prescription during pregnancy due to the risk of developing GDM or delivering an offspring with seizure/ADHD/ASD/PTB/SFGA

Psychiatry in the Digital Age: A Blessing or a Curse?

Social distancing and the shortage of healthcare professionals during the COVID-19 pandemic, the impact of population aging on the healthcare system, as well as the rapid pace of digital innovation are catalyzing the development and implementation of new technologies and digital services in psychiatry. Is this transformation a blessing or a curse for psychiatry? To answer this question, we conducted a literature review covering a broad range of new technologies and eHealth services, including telepsychiatry; computer-, internet-, and app-based cognitive behavioral therapy; virtual reality; digital applied games; a digital medicine system; omics; neuroimaging; machine learning; precision psychiatry; clinical decision support; electronic health records; physician charting; digital language translators; and online mental health resources for patients. We found that eHealth services provide effective, scalable, and cost-efficient options for the treatment of people with limited or no access to mental health care. This review highlights innovative technologies spearheading the way to more effective and safer treatments. We identified artificially intelligent tools that relieve physicians from routine tasks, allowing them to focus on collaborative doctor-patient relationships. The transformation of traditional clinics into digital ones is outlined, and the challenges associated with the successful deployment of digitalization in psychiatry are highlighted