How do individuals in the UK experience recovery from prescribed benzodiazepine dependence and what helped?

Background: Benzodiazepines are a class of drug prescribed mainly for anxiety and insomnia. Since 1988, UK guidelines have warned not to prescribe benzodiazepines for longer than 2-4 weeks, because they cause dependence and withdrawal symptoms that can last months to years. Despite this, an estimated 72% of prescriptions between 2015-18 in England exceeded 4 weeks. There is a lack of services available in the UK to support individuals struggling with dependence and withdrawal, and limited scientific literature available on the experience of, and how to support individuals with, recovery from benzodiazepine dependence. Aims: This study aims to explore the experience of recovery from prescribed benzodiazepine dependence, what individuals found helpful during the recovery process, and their views on what future services should look like. Methods: Qualitative data was collected through semi structured interviews with seven participants who were prescribed benzodiazepines for at least 4 weeks, struggled with stopping or withdrawal symptoms, and stopped taking benzodiazepines at least one year ago. Interview transcripts were analysed using Reflexive Thematic Analysis within a phenomenological framework. Results: Four themes were developed, which cover: (1) facing disbelief and failures in the healthcare system and consequent calls for improved education; (2) receiving and providing peer support; (3) the changing relationship to withdrawal symptoms during recovery, strategies used to cope with symptoms, and the persistence of post-withdrawal symptoms long after stopping; (4) severe suffering that can impact many different areas of life, can lead to enduring trauma, and requires holistic support. Conclusion: This study demonstrates how some benzodiazepine patients endure severe suffering that can be unnecessarily exacerbated by disbelief and failures in the healthcare system, resulting in trauma and distrust of healthcare professionals. This situation could be improved by believing and validating patient experiences, so appropriate care can be received and further harm avoided. Counselling Psychologists may particularly need to focus on establishing trust, providing validation, and advocating for this client group. The findings further point to a need for improved education, commissioning of specialist services and a national helpline, updated NICE guidance, and improved monitoring of prescribing behaviour

Experiencing discrimination mediates the relationship between victimization and social withdrawal in patients suffering from a severe mental illness:A cross-sectional study

Psychiatric patients are often victims of crime and discrimination and are often socially withdrawn. This has negative consequences for their health and recovery. We examined whether such discrimination mediates the association between victimization and social withdrawal, and whether these associations differ between men and women. We also determined the prevalence of social withdrawal and the discrimination experienced by patients suffering from a severe mental illness. This study is embedded in the Victimization in Psychiatric Patients study. Information on discrimination, social withdrawal and victimization was obtained using structured self-report questionnaires (N = 949). We reported the 12-month prevalence of these phenomena and used path analysis to estimate the direct path between personal and property victimization and social withdrawal, and the indirect path through the discrimination experienced. The impact of gender was assessed by testing interaction terms. Social withdrawal was reported by 20.6% (95%CI 18.1–23.2) of participants, and being discriminated against in the past 12 months by 75.3% (95%CI: 72.6–78.0%). While crime victimization had no direct effects on social withdrawal, personal crime victimization (B = 0.47; 95%CI 0.25-0.72; p < 0.001) and property crime victimization (B = 0.65; 95%CI 0.42-0.93; p < 0.001) had significant indirect effects on social withdrawal, which were mediated by the discrimination experienced. In men we found a direct negative effect of property crime on social withdrawal (B = -0.68; 95%CI: −1.21to −0.11, p = 0.014). We conclude that personal and property victimization, for both men and women, was associated with higher levels of social withdrawal, and this was fully mediated by the discrimination experienced

Recovery from psychosis : physical health, antipsychotic medication and the daily dilemmas for mental health nurses

This paper considers some of the dilemmas experienced by Mental Health Nurses everyday when faced with the seemingly conflicting relationships that exist between recovery, antipsychotics and the physical health of people experiencing psychosis. We examine the role of antipsychotics in the process of recovery from psychosis and argue that Mental Health Nursing’s laudable shift away from the medical model towards the concept of self-defined personal recovery should not result in overlooking the importance of physical health and medication management. Mental Health Nurses have a responsibility to help services users make an informed choice about treatment; this exchange of information should be based on the best available evidence rather than philosophical values or personal opinion

Peripartum cardiomyopathy: diagnosis and management

No abstract available

Problematisation and regulation: bodies, risk, and recovery within the context of Neonatal Abstinence Syndrome

Background Neonatal Abstinence Syndrome (NAS) is an anticipated effect of maternal drug use during pregnancy. Yet it remains a contested area of policy and practice. In this paper, we contribute to ongoing debates about the way NAS is understood and responded to, through different treatment regimes, or logics of care. Our analysis examines the role of risk and recovery discourses, and the way in which the bodies of women and babies are conceptualised within these. Methods Qualitative interviews with 16 parents (9 mothers, 7 fathers) and four focus groups with 27 health and social care professionals based in Scotland. All the mothers were prescribed opioid replacement therapy and parents were interviewed after their baby was born. Data collection explored understandings about the causes and consequences of NAS and experiences of preparing for, and caring for, a baby with NAS. Data were analysed using a narrative and discursive approach. Results Parent and professional accounts simultaneously upheld and subverted logics of care which govern maternal drug use and the assessment and care of mother and baby. Despite acknowledging the unpredictability of NAS symptoms and the inability of the women who are opioid-dependent to prevent NAS, logics of care centred on ‘proving’ risk and recovery. Strategies appealed to the need for caution, intervening and control, and obscured alternative logics of care that focus on improving support for mother-infant dyads and the family as a whole. Conclusion Differing notions of risk and recovery that govern maternal drug use, child welfare and family life both compel and trouble all logics of care. The contentious nature of NAS reflects wider socio-political and moral agendas that ultimately have little to do with meeting the needs of mothers and babies. Fundamental changes in the principles, quality and delivery of care could improve outcomes for families affected by NAS

Evaluating Drought Vulnerability of Small Community Surface Water Supply Systems in the Midwest

This report presents approaches and data availability for evaluating the drought vulnerability of small community water supply systems in the Midwest that obtain water from surface water bodies, such as rivers, streams, natural lakes, and man-made reservoirs. A description is provided of the various types of surface water sources from which 320 small community systems in the Midwest, each serving 10,000 or fewer people, obtain their water. The small community surface water system most commonly obtains its supply from one or two small impounding reservoirs. However, a substantial number of communities instead obtain their water from either direct river withdrawals or off-channel storage of water withdrawn from streams and rivers. Sixty of these 320 small community surface water systems were interviewed to gather information on the availability of data to determine the drought vulnerability of these systems. Although hydrologic and physical data exist for evaluating many of these systems, relatively few of the interviewed system managers could provide such pertinent information. A summary of selected hydrologic data is provided that can be used to determine the relative severity of major historical drought periods for various portions of the Midwest. Focus is given to historical droughts and available data for the southern portion of the Midwest where most surface water supply systems are located, comprising parts of Kansas, Missouri, Iowa, Illinois, Indiana, and Ohio. Geographic differences in drought severity are described, as is the influence of the physical characteristics of a water supply on the “critical” drought duration that a community must consider. Basic water budget analyses of water supplies and data needs are presented. Reservoir capacity measurements and estimates of inflow are the most critical data in reliable assessment of water supply adequacy. Depending on data availability, estimation of inflows may be straightforward to highly uncertain. For water supply systems that withdraw directly from a stream or river, the existence of long-term stream gage data on that river is particularly crucial to evaluate supply adequacy, and such data for larger streams and rivers are often available. With impounding reservoirs, which are typically located on smaller streams, data for that stream may often not exist; however, data from a “surrogate” gage that is considered to be hydrologically similar are often sufficient to estimate water supply yield. Systems that use off-channel reservoirs often withdraw water from smaller streams that do not have data for accurate depiction of their yield, and these systems also appear to be the most vulnerable to severe drought conditions. Case studies are presented to provide examples of yield calculations and innovative approaches that selected small communities have undertaken for addressing drought vulnerability. The role of demand management (drought response and water conservation) in evaluating drought vulnerability is also presented. If hydrologic data and basic physical data such as storage capacity are lacking, it may be difficult for either system managers or experienced professionals to estimate a community system’s yield and potential drought impacts, particularly for off-channel reservoir and low channel dam systems. However, managers should attempt to understand the type of drought period likely to test the adequacy of the available supply and can begin recording basic system observations, such as daily withdrawal records and reservoir drawdown, in a readily-accessible form that will be useful for future evaluations.published or submitted for publicationis peer reviewe

Management of perceived devastating brain injury after hospital admission: a consensus statement from stakeholder professional organizations.

Patients with severe grades of life-threatening brain injury are commonly characterized as having devastating brain injury (DBI), which we have defined as: 'any neurological condition that is assessed at the time of hospital admission as an immediate threat to life or incompatible with good functional recovery AND where early limitation or withdrawal of therapy is being considered'. The outcome in patients with DBI is often death or severe disability, and as a consequence rapid withdrawal of life sustaining therapies is commonly contemplated or undertaken. However, accurate prognostication in life-threatening brain injury is difficult, particularly at an early stage. Evidence from controlled studies to guide decision-making is limited, and there is a risk of a 'self-fulfilling prophecy', with early prognostication leading to early withdrawal of life sustaining therapies and death. The Joint Professional Standards committee of the Faculty of Intensive Care Medicine and the Intensive Care Society convened a consensus group with representation from stakeholder professional organizations to develop clear professional guidance in this area. It recognized that the weak evidence base makes GRADE guidelines difficult to justify. We have made 12 practical, pragmatic recommendations to help clinicians deliver safe, effective, equitable, and justifiable care within resource constrained healthcare systems. In the situation where patient-centred outcomes are recognized to be unacceptable, regardless of the extent of neurological improvement, then early transition to palliative care is appropriate. These recommendations are intended to apply where the primary pathology is DBI, rather than where DBI has compounded a progressive and irreversible deterioration in other life-threatening comorbidities