Differences in the quality of life of two groups of drug users.

The aims of this study was to assess aspects of the quality of life of drug users on a methadone maintenance programme compared to drug users on a harm minimisation programme. 36 clients attending the harm minimisation programme in the National Drug Treatment Centre, Dublin, were matched for age and sex to 36 clients on the methadone maintenance programme. All were interviewed with the SF-36 Health Survey Questionnaire to measure health related quality of life and with the Hospital Anxiety and Depression Scale [HADs] to measure psychological morbidity. More clients from the harm minimisation programme had previous psychiatric problems than clients on the methadone maintenance programme, with an odds ratio of 4.3 CI (1.2,15.2). On the HADs clients on the methadone maintenance programme had significantly lower depression scores than clients on the harm minimisation programme. In addition more clients on the harm minimisation programme were severely depressed than clients on the methadone maintenance programme. On the UK SF-36 Scale, clients on the harm minimisation programme perceived a significantly greater deterioration in "change in health" over the previous year than clients on the methadone maintenance programme. Although clients on a methadone maintenance programme had an improved perception of their quality of life in relation to psychological and overall health function from the previous year, compared to clients on a harm minimisation programme, there still existed varying degrees of psychopathology in both groups which needs to be considered when providing future services for drug users

Psychiatric morbidity in sentenced segregated HIV positive prisoners.

In this comparative study with a control group of prisoners, psychiatric morbidity was measured in two groups of sentenced prisoners, each group completing the GHQ-30 and 21-item Beck Depression Inventory (BDI). Group 1 consisted of 40 segregated HIV-positive prisoners and group 2 a matched control group in the main prison who had no history of HIV seropositivity. All members of group 1 had a history of intravenous drug abuse. The mean GHQ-30 and BDI scores were significantly higher in group 1, and 90% of group 1 were psychiatric 'cases' compared with just over 42% of group 2. Levels of psychiatric morbidity present in a third group, consisting of HIV-positive prisoners who had not been segregated (prison authorities were unaware of their seropositivity) are an interesting pointer for further research

Psychotropic prescribing in the oldest old attending a geriatric psychiatry service: a retrospective, cross-sectional study.

Objective: More people are living beyond their 90s, yet this group has not been much studied. This study aimed to describe a sample of non-agenarians and centerians attending an old age psychiatry service with a focus on pharmacotherapy. Methods: Retrospective, cross-sectional survey of patients aged >90 in contact with the Department of Old Age Psychiatry in a university hospital over a 1-year period. Results were compared with the Beers, the Canadian and Screening Tool of Older Persons’ potentially inappropriate Prescriptions (STOPP) criteria. Results: A total of 65 nonagenarians or centerians were identified (mean age 93, 82% female). The majority (65%) resided in a nursing home; dementia was the most common diagnosis (77%), followed by depression (29%). The most commonly prescribed psychotropics were antidepressants (58%), followed by antipsychotics (45%), hypnotics (42%), anti-dementia agents (31%) and anxiolytics (26%). Overall, patients were on a mean of 2.1 (S.D. 1.3, range 0–5) psychotropics and 4.99 (S.D. 2.7, range 0–11) non-psychotropics. Mean Mini Mental State Examination (MMSE) score was 15 (S.D. 8.1). Increasing anticholinergic burden was negatively associated with MMSE scores (B = −1.72, p = 0.013). Residing in a nursing home was associated with a higher rate of antidepressant [OR 5.71 (95% CI 1.9–17.4)], anxiolytic [OR 13.5 (95% CI 1.7–110.4)] and antipsychotic [OR 3.4 (95% CI 1.1–10.4)] use. Potentially inappropriate prescribing included long-term benzodiazepine use (26%) and long-term antipsychotic use (25%). Conclusions: Our sample had a high psychiatric morbidity burden with high levels of psychotropic use. Ongoing review and audit of psychotropic use in elderly patients can identify potentially inappropriate prescribing in a group vulnerable to high levels of polypharmacy and extended psychotropic use