Barriers in recognising, diagnosing and managing depressive and anxiety disorders as experienced by Family Physicians; a focus group study

BACKGROUND The recognition and treatment of depressive- and anxiety disorders is not always in line with current standards. The results of programs to improve the quality of care, are not encouraging. Perhaps these programs do not match with the problems experienced in family practice. This study aims to systematically explore how FPs perceive recognition, diagnosis and management of depressive and anxiety disorders. METHODS focus group discussions with FPs, qualitative analysis of transcriptions using thematic coding. RESULTS The FPs considered recognising, diagnosing and managing depressive- and anxiety disorders as an important task. They expressed serious doubts about the validity and usefulness of the DSM IV concept of depressive and anxiety disorders in family practice especially because of the high frequency of swift natural recovery. An important barrier was that many patients have difficulties in accepting the diagnosis and treatment with antidepressant drugs. FPs lacked guidance in the assessment of patients' burden. The FPs experienced they had too little time for patient education and counseling. The under capacity of specialised mental health care and its minimal collaboration with FPs were experienced as problematic. Valuable suggestions for solving the problems encountered were made CONCLUSION Next to serious doubts regarding the diagnostic concept of depressive- and anxiety disorders a number of factors were identified which serve as barriers for suitablemental health care by FPs. These doubts and barriers should be taken into account in future research and in the design of interventions to improve mental health care in family practice.This study was co-funded by the International Health Foundation, Utrecht, the Netherlands

Experiences of Sustainable Abstinence-Based Recovery: an Exploratory Study of Three Recovery Communities (RC) in England

Contemporary recovery-models of treatment for substance misuse prioritise community-based support systems that focus on developing individuals’ strengths and quality of life. The research project aimed to explore the perceived mechanisms and processes that underpinned support in three abstinence-based recovery communities (RCs) across England. Focus groups and telephone interviews were conducted with 44 individuals. This was to identify self-prioritised outcomes for members and other key factors contributing to the delivery of an effective recovery community. Data were thematically analysed. Along with a number of other key outcomes, the achievement and maintenance of abstinence by participants was considered to be a key indicator of an effective RC. RC processes were also viewed as underpinning the development of recovery capital. The study provides an insight into the processes of RCs and highlights that development and support of recovery capital is an important aspect of service provision and delivery for those in abstinence-based recovery. © 2018, The Author(s)

Exploring Charity Worker Perceptions of the Social Value and Sustainability of Solar Lighting in Malawi, Kenya and Zambia: A Scoping Study

Approximately 600 million people in sub-Saharan Africa have no access to electricity and use kerosene as a source of light. Solar lighting is a safer and cost effective alternative allowing families to study, work and live without the harmful effects of kerosene. Qualitative, semi-structured interviews were undertaken with staff from a United Kingdom (UK) based charity to explore the social value of solar lighting (n=7). These staff were based in the UK, Malawi, Kenya and Zambia. Two overarching themes: ‘The Social Value of Solar Lighting’ and ’Improving the Sustainability and Economic Viability of Solar Lighting’ illustrated perceived multi-faceted and wide reaching benefits on the micro-level creating positive social, economic and environmental outcomes. Future studies may look to identify the impact that solar lights may have upon the macro-level, and medium to long-term outcomes; and estimated social return on investment in different developing countries

Dependence on Over the Counter (OTC) Codeine Containing Analgesics: Treatment and Recovery with Buprenorphine Naloxone

Misuse and dependence on prescribed and over the counter (OTC) codeine-combination analgesics is an emerging public health concern. We present a clinical case series of four adult patients dependent on OTC codeine combination analgesics in Ireland. Cases (two males/two females, aged 44–57 years) were consuming between 12 and 72 codeine-containing tablets/day. In three cases, consumption was linked to pain, with on-going misuse reflecting dependence on codeine. Cases were initiated on buprenorphine-naloxone (Suboxone®), stabilised on doses of between 4 mg/1 mg and 14 mg/3.5 mg per day and remain on treatment without additional opioid use, as verified by drug screening reports. Although anecdotal, these cases show the potential of effective opioid assisted treatment (OAT) using buprenorphine-naloxone (Suboxone®) to successfully treat this distinct form of opioid dependence disorder. Optimal service provision should recognise unique patient profiles and needs for this form of opioid dependence and incorporate psycho-social supports

Association of Psychiatric History and Type D Personality with Symptoms of Anxiety, Depression, and Health Status Prior to ICD Implantation

BACKGROUND: Personality factors and psychiatric history may help explain individual differences in risk of psychological morbidity and poor health outcomes in patients with an implantable cardioverter defibrillator (ICD). PURPOSE: We examined associations between previous anxiety and depressive disorder, type D personality, anxiety or depressive symptoms, and health status in ICD patients prior to ICD implantation. METHOD: Patients (N = 278; 83 % men; mean age = 62.2 years ±11) receiving a first ICD from September 2007 through April 2010 at the Medisch Spectrum Twente, The Netherlands completed validated questionnaires before implantation assessing type D personality (14-item Type D Scale), anxiety and depressive symptoms (Hospital Anxiety and Depression Scale), and health status (36-item Short Form Health Survey). History of anxiety or depressive disorder was assessed with the Mini International Neuropsychiatric Interview structural interview. RESULTS: Previous anxiety or depressive disorder was prevalent in 8 and 19 % of patients, respectively. Type D personality was present in 21 %, depressive symptoms in 15 %, and anxiety in 24 %. In adjusted analyses, type D personality was a dominant correlate of previous depressive disorder (odds ratio (OR) 6.2, p < 0.001) and previous anxiety disorder (OR 3.9, p = 0.004). Type D personality (OR 4.0, p < 0.001), age (OR 1.03, p = 0.043), and gender (OR 2.5, p = 0.013) were associated with anxiety symptoms at baseline. Type D personality (OR 5.9. p < 0.001) was also associated with increased depressive symptoms at baseline. Heart failure and type D personality were related to poorer health status. CONCLUSION: In ICD patients, prior to ICD implantation, a previous anxiety or depressive disorder, type D personality, and anxiety and depressive symptoms were associated with poorer health status. Type D personality was also independently associated with increased anxiety and depression symptoms

Rhabdomyolysis in Clozapine Overdose

CONTEXT: Clozapine is used for decennia for the treatment of schizophrenia. Agranulocytosis, diabetic ketoacidosis, gastrointestinal hypomotility, and myocarditis are well-known adverse effects of clozapine, which are sometimes life threatening. Here we report a case of rhabdomyolysis upon an acute overdose of clozapine. CASE: A male patient, 36 years, with elevated creatinine kinase levels (9899 U/l), developed rhabdomyolysis afterafter admission to the emergency department. Approximately 2–4 h earlier he had intoxicated himself with his maintenance oral medication clozapine 125 mg, temazepam 20 mg and lorazepam 1.5 mg. Co-medications, and physical and laboratory examinations did not reveal other risk factors for rhabdomyolysis. According to the Naranjo probability scale there was a probable relation between clozapine dose and symptoms, that developed approximately 2–4 h after the auto-intoxication of 125 mg tablets. At day 5 of hospitalization, clozapine and creatinine kinase levels returned to normal and the patient was discharged with no somatic sequelae. CONCLUSIONS: Elevated creatinine kinase levels in acute clozapine intoxication may be an indicator that rhabdomyolysis may be involved

# Me Too: Global progress in tackling continued custodial violence against women. The 10 year anniversary of the Bangkok Rules.

On any given day, almost 11 million people globally are deprived of their liberty. In 2020, the global female population was estimated to be 741,000, an increase of 105,000 since 2010. In order to investigate progress in the adoption of the Bangkok Rules since 2010, we conducted a legal realist assessment based on a global scoping exercise of empirical research and United Nations reporting, using detailed MESH terms across university and UN databases. We found evidence in 91 documents which directly relate to violations of the Bangkok Rules in 55 countries. By developing a realist account we document the precarious situation of incarcerated women, and continued evidence of systemic failures to protect them from custodial violence and other gender sensitive human rights breaches worldwide. Despite prison violence constituting a complex and multifaceted phenomenon, very little research (from the US, Canada, Brazil, Mexico and Australia) has been conducted on custodial violence against women since 2010. Whilst standards of detention itself is a focus of UN universal periodic review, special procedures (violence against women) and concluding observations by the UN committees, very few explicitly mentioned women, and the implications of violence against them whilst incarcerated. We highlight three central aspects which hinder the full implementation of the Bangkok Rules; the past decade of a continued invisible nature of women as prisoners in the system, the continued legitimization, normalization and trivialization of violence under the pretext of security within their daily lives; and the unawareness and disregard of international (Bangkok and others) rules