Psychotropic treatment in patients undergoing gynaecological procedures

Background: Around 27% of the adult population in Europe has at some point suffered from a mental disorder in the past year. Patients with psychiatric illness have different needs and require specific medication review prior to surgery in view of the risks from anesthesia, the direct and indirect effects of psychotropics, risk of withdrawal symptoms, and risk of psychiatric recurrence or relapse. Gynaecological patients, particularly those going through the menopausal transition phase have an associated risk of psychiatric conditions especially mood disorders. This audit is set to determine the link between psychotropic drug use and patients seen at gynaecological pre-operative assessment clinic, the most encountered diagnosis, how this relates to age together with analysis of most common drugs used to treat these patients. -- Methods: Data of 123 patients from 24 weekly pre-operative assessment clinics was collected. The number of patients listed in each clinic was documented together with the patient’s age. Patients on psychotropic medication were analysed to note diagnoses of each case and treatment used. -- Results: 21.1% of patients suffered from a mental health illness requiring psychotropic medication. Their average age was that of 51 years. The most common diagnosis was depression, summing up to 9.8% of all patients, followed by anxiety at 6.5%. -- Conclusion: Depression and anxiety are leading mental health illnesses both in this cohort and the general population. Such patients have lower pain threshold which affects their recovery. Some psychotropics have severe interactions with anaesthetic thus need to be stopped prior to surgery after evaluation of risks such as drug withdrawal and deterioration in mental health.peer-reviewe

A prospective audit examining non-attendance at a surgical outpatients clinic in Mater Dei, Hospital, Malta, after the introduction of a text-messaging reminder system

Non-attendance rates at hospital outpatients clinics has always proved to be a serious problem. Missed appointments cause delays in patient management, impacting patient outcomes. Mater Dei Hospital introduced a text-messaging reminder system in July 2017 in an attempt to reduce non-attendance rates and this study assesses the efficacy of this system. Four surgical outpatients clinics were observed over a period of one month and the total number of appointments documented. Non-attenders were contacted via a telephone call and asked to explain their non-attendance as well as asked if they had received a text-message reminding them of their appointment. Out of a total of 227 appointments (205 females, 22 males), 49 patients did not turn up, representing a 22% non-attendance rate. Out of these 49 patients, 41 answered their phone and were interviewed for this study. The rest were not reached because a contact number was not in their physical and electronic records (2 patients) or they did not answer their phone at all (6 patients). Out of the 41 contacted, 39% claimed they did not receive a text message reminding them about their appointment whilst acknowledging that they all have a functional mobile phone and they know how to receive and read a text message. This study shows that non-attendance rates of 30% decreased by 27% to 22% after the introduction of text-messaging. It is hoped that this system will further decrease not attendance rates if more patients have a registered mobile phone number in the hospital electronic records system.peer-reviewe

Psychiatric admissions in Malta : demographics and diagnoses

Background: The decision to hospitalize a patient exhibiting signs of psychiatric distress is made as a last resort after outpatient management has failed. The rising number of admissions also has an effect on costs burden within the national health system. This audit is set to determine the main psychiatric reasons for admission to hospital in Malta and analyze demographics, source of referrals and mental health act status whilst comparing such result to those abroad. --- Methods: Data from admissions between the 15th October 2018 till the 1st March 2019 was collected, using a recently established electronic database system. Details including; age, sex, nationality, type of admission (new case versus readmission), mental health act status and reason for admission were collected. --- Results: 300 patients admitted to Mount Carmel hospital during the stated period. Roughly 2 male patient were admitted for every female. 75.3% of the cohort were of Maltese nationality. The majority of foreign patient were European, 14%, followed by African, 8.3%, Asian and American. The most common sources of referrals were casualty at 40%, followed by those from general practitioners at 26.7%. --- Conclusion: Reasons for admission were most commonly, substance abuse(15.3%), depression (15%) and acute psychosis (13.3%), following similar trends across Europe. Methods to decrease unnecessary referrals include better training of emergency doctors and general practitioners. Additionally, recent implementation of a 24 hour on call crisis service should provide better acute management of patients and help to prevent saturation of inpatients with cases that can handled in the community.peer-reviewe