SUMMARY The strong, life-long association between epilepsy and intellectual disability means that psychiatric teams, and the services they exist in, have a need for significant competencies in the field of epilepsy. This article addresses these competencies through the pathway of care. It will focus on those areas most relevant to psychiatric care and, when possible, explore where technology has begun to influence practice. The pathway leads from diagnosis through, in some cases, to mortality and support of the bereaved in psychiatric care. We will approach the topic through showing how the intertwining themes of information, empowerment, access to care, assessment of risk and psychological support are important. Technological advances are supporting changes in most of these areas, and psychological support, a knowledge of the needs of people with epilepsy and intellectual disability and epilepsy skills remain the foundation in the application of these advances.
{"title":"Epilepsy, intellectual disability and the epilepsy care pathway: improving outcomes","authors":"M. Kerr, G. Goodwin, J. Hanna","doi":"10.1192/bja.2022.64","DOIUrl":"https://doi.org/10.1192/bja.2022.64","url":null,"abstract":"SUMMARY The strong, life-long association between epilepsy and intellectual disability means that psychiatric teams, and the services they exist in, have a need for significant competencies in the field of epilepsy. This article addresses these competencies through the pathway of care. It will focus on those areas most relevant to psychiatric care and, when possible, explore where technology has begun to influence practice. The pathway leads from diagnosis through, in some cases, to mortality and support of the bereaved in psychiatric care. We will approach the topic through showing how the intertwining themes of information, empowerment, access to care, assessment of risk and psychological support are important. Technological advances are supporting changes in most of these areas, and psychological support, a knowledge of the needs of people with epilepsy and intellectual disability and epilepsy skills remain the foundation in the application of these advances.","PeriodicalId":9336,"journal":{"name":"BJPsych Advances","volume":"26 1","pages":"295 - 304"},"PeriodicalIF":1.3,"publicationDate":"2022-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78237041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
SUMMARY Partial agonists such as aripiprazole are often used in addition to a full antagonist such as amisulpride, risperidone or olanzapine in an attempt to mitigate side-effects such as sedation, hyperprolactinaemia and weight gain. However, there can be unintended consequences, including worsening of psychosis. Moreover, previous exposure to a partial agonist may impair the subsequent response to a potent antipsychotic such as haloperidol used to control symptoms of relapse. To understand the mechanisms involved, a method is needed to compare potency in the pharmacological effects of different drugs used in combinations. This article is intended to explore and explain the theoretical principles based on the dopamine hypothesis of schizophrenia. We apply the method to analyse a recently described trial in which two full antagonists (olanzapine and amisulpride) are compared individually and in combination.
{"title":"Partial agonists of dopamine receptors: theoretical principles of combining antipsychotics including partial agonists to treat schizophrenia","authors":"J. Cookson, J. Pimm, Andrew S. Brentnall","doi":"10.1192/bja.2022.66","DOIUrl":"https://doi.org/10.1192/bja.2022.66","url":null,"abstract":"SUMMARY Partial agonists such as aripiprazole are often used in addition to a full antagonist such as amisulpride, risperidone or olanzapine in an attempt to mitigate side-effects such as sedation, hyperprolactinaemia and weight gain. However, there can be unintended consequences, including worsening of psychosis. Moreover, previous exposure to a partial agonist may impair the subsequent response to a potent antipsychotic such as haloperidol used to control symptoms of relapse. To understand the mechanisms involved, a method is needed to compare potency in the pharmacological effects of different drugs used in combinations. This article is intended to explore and explain the theoretical principles based on the dopamine hypothesis of schizophrenia. We apply the method to analyse a recently described trial in which two full antagonists (olanzapine and amisulpride) are compared individually and in combination.","PeriodicalId":9336,"journal":{"name":"BJPsych Advances","volume":"25 1","pages":"151 - 157"},"PeriodicalIF":1.3,"publicationDate":"2022-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72701061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Tracy, R. Gadelrab, A. Rahim, Gabrielle Pendlebury, Hashim Reza, R. Bhattacharya, Asif M. Bachlani, K. Worlley, David Rigby, Jonathan Scott, S. Dave
Digital psychiatry has become increasingly important and understanding of certain aspects is essential for practising clinicians. This article discusses electronic patient records (EPRs), from their origins to current and future use, the growth and embedding of outcome measurements, the use of social media, and learning and research in virtual arenas.
{"title":"Digital literacy in contemporary mental healthcare: electronic patient records, outcome measurements and social media","authors":"D. Tracy, R. Gadelrab, A. Rahim, Gabrielle Pendlebury, Hashim Reza, R. Bhattacharya, Asif M. Bachlani, K. Worlley, David Rigby, Jonathan Scott, S. Dave","doi":"10.1192/bja.2022.74","DOIUrl":"https://doi.org/10.1192/bja.2022.74","url":null,"abstract":"\u0000 Digital psychiatry has become increasingly important and understanding of certain aspects is essential for practising clinicians. This article discusses electronic patient records (EPRs), from their origins to current and future use, the growth and embedding of outcome measurements, the use of social media, and learning and research in virtual arenas.","PeriodicalId":9336,"journal":{"name":"BJPsych Advances","volume":"12 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2022-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74611987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
SUMMARY Genomic medicine is an evolving medical specialty that uses genomic information about an individual as part of their clinical care (e.g. for diagnostic or therapeutic decision-making). It has rapidly grown since the completion of the Human Genome Project in 2003. In England, the National Health Service's Genomic Medicine Service is considered to be the first national healthcare system to offer whole-genome sequencing as part of routine clinical care. Already, genomic medicine is making an impact in the fields of oncology, pharmacology, rare and undiagnosed diseases, infectious disease and neurology. In this article, we present a useful tool kit for clinicians working with individuals with intellectual disability, autism spectrum disorder and epilepsy. This article provides evidence for the importance of genetic testing, conveys an understanding of the range of genetic tests available and their diagnostic yields and how these apply to intellectual disability, autism spectrum disorder and epilepsy. Our simple tool kit gives information on when to refer to a clinical geneticist and where to find resources for clinicians and parents on genetic testing.
{"title":"Genetic investigations pathway for people with intellectual disability, autism and/or epilepsy","authors":"Elaine Clark, Maria Koutsogianni","doi":"10.1192/bja.2022.44","DOIUrl":"https://doi.org/10.1192/bja.2022.44","url":null,"abstract":"SUMMARY Genomic medicine is an evolving medical specialty that uses genomic information about an individual as part of their clinical care (e.g. for diagnostic or therapeutic decision-making). It has rapidly grown since the completion of the Human Genome Project in 2003. In England, the National Health Service's Genomic Medicine Service is considered to be the first national healthcare system to offer whole-genome sequencing as part of routine clinical care. Already, genomic medicine is making an impact in the fields of oncology, pharmacology, rare and undiagnosed diseases, infectious disease and neurology. In this article, we present a useful tool kit for clinicians working with individuals with intellectual disability, autism spectrum disorder and epilepsy. This article provides evidence for the importance of genetic testing, conveys an understanding of the range of genetic tests available and their diagnostic yields and how these apply to intellectual disability, autism spectrum disorder and epilepsy. Our simple tool kit gives information on when to refer to a clinical geneticist and where to find resources for clinicians and parents on genetic testing.","PeriodicalId":9336,"journal":{"name":"BJPsych Advances","volume":"20 1","pages":"353 - 362"},"PeriodicalIF":1.3,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78634953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
For more information, visit CPD eLearning on the eLearning Hub: https://elearninghub.rcpsych.ac.uk BJPsych Advances and CPD eLearning work together to produce regular joint commissions to enhance learning for mental health professionals. CPD credits: 0.5 Module: Planning ahead: end-of-life care, treatment escalation and advance care planning Planning ahead, including advance care and treatment escalation planning, increases the likelihood that care and treatment is consistent with the individual's preferences and minimises invasive treatment of limited clinical benefit. The psychology behind mathematical modelling of epidemics Managing alcohol withdrawal in acute in-patient psychiatry Coping with the ‘pointless suffering’ of COVID-19 Re-reading Camus's ‘The Plague’ in pandemic times Obedience to authority – lessons from Milgram applied to COVID-19 Mental Health Tribunals: response to the COVID-19 emergency How do we lead effectively through the COVID-19 pandemic?
{"title":"New from CPD eLearning","authors":"","doi":"10.1192/bja.2022.70","DOIUrl":"https://doi.org/10.1192/bja.2022.70","url":null,"abstract":"For more information, visit CPD eLearning on the eLearning Hub: https://elearninghub.rcpsych.ac.uk BJPsych Advances and CPD eLearning work together to produce regular joint commissions to enhance learning for mental health professionals. CPD credits: 0.5 Module: Planning ahead: end-of-life care, treatment escalation and advance care planning Planning ahead, including advance care and treatment escalation planning, increases the likelihood that care and treatment is consistent with the individual's preferences and minimises invasive treatment of limited clinical benefit. The psychology behind mathematical modelling of epidemics Managing alcohol withdrawal in acute in-patient psychiatry Coping with the ‘pointless suffering’ of COVID-19 Re-reading Camus's ‘The Plague’ in pandemic times Obedience to authority – lessons from Milgram applied to COVID-19 Mental Health Tribunals: response to the COVID-19 emergency How do we lead effectively through the COVID-19 pandemic?","PeriodicalId":9336,"journal":{"name":"BJPsych Advances","volume":"1 1","pages":"343 - 343"},"PeriodicalIF":1.3,"publicationDate":"2022-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90300931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
SUMMARY This editorial introduces the first of two special issues of BJPsych Advances on neurodevelopmental disorders, including intellectual disability, autism spectrum disorder, attention-deficit hyperactivity disorder and epilepsy. This issue is intended to offer a clinical tool kit for mental health professionals giving guidance on assessment and management of these disorders and associated conditions, such as behaviours that challenge.
{"title":"Neurodevelopmental disorders including intellectual disability: a clinical tool kit for mental health professionals","authors":"A. Biswas, P. Casey","doi":"10.1192/bja.2022.65","DOIUrl":"https://doi.org/10.1192/bja.2022.65","url":null,"abstract":"SUMMARY This editorial introduces the first of two special issues of BJPsych Advances on neurodevelopmental disorders, including intellectual disability, autism spectrum disorder, attention-deficit hyperactivity disorder and epilepsy. This issue is intended to offer a clinical tool kit for mental health professionals giving guidance on assessment and management of these disorders and associated conditions, such as behaviours that challenge.","PeriodicalId":9336,"journal":{"name":"BJPsych Advances","volume":"136 1","pages":"350 - 352"},"PeriodicalIF":1.3,"publicationDate":"2022-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78178452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
SUMMARY In this reflection we summarise the various obstacles to accessing healthcare encountered by people with neurodevelopmental disorders (intellectual disability, autism and attention-deficit hyperactivity disorder) with and without mental health problems. We outline different service models from around the world, ranging from the person centred to the institutional. Finally, we suggest ways of addressing some of the problems identified, including a model of integrated care involving intellectual disability, neurodevelopmental and mental health services that would better serve this population.
{"title":"Future clinical priorities in neurodevelopmental disorders: an international perspective","authors":"A. Roy, M. Roy, H. Shah","doi":"10.1192/bja.2022.69","DOIUrl":"https://doi.org/10.1192/bja.2022.69","url":null,"abstract":"SUMMARY In this reflection we summarise the various obstacles to accessing healthcare encountered by people with neurodevelopmental disorders (intellectual disability, autism and attention-deficit hyperactivity disorder) with and without mental health problems. We outline different service models from around the world, ranging from the person centred to the institutional. Finally, we suggest ways of addressing some of the problems identified, including a model of integrated care involving intellectual disability, neurodevelopmental and mental health services that would better serve this population.","PeriodicalId":9336,"journal":{"name":"BJPsych Advances","volume":"2006 1","pages":"318 - 321"},"PeriodicalIF":1.3,"publicationDate":"2022-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86980108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The use of hypnotherapy in psychiatry has been controversial. However, evidence presented by Chan and colleagues shows that it is beneficial to the promotion of good mental health and well-being, specifically being applicable in the management of mental disorders. But what does this mean for practice? This commentary looks at what we agree and disagree with, what we opine is missing from the article and what now needs to happen. Patients should be able to access hypnotherapy or hypnosis routinely on the National Health Service. Since it works, who may it work for and how may we make this available to those who could benefit from it?
{"title":"Hypnotherapy and therapeutic suggestion: bridging the gap between evidence and utility","authors":"Henry Orewa, I. Udo","doi":"10.1192/bja.2022.68","DOIUrl":"https://doi.org/10.1192/bja.2022.68","url":null,"abstract":"\u0000 The use of hypnotherapy in psychiatry has been controversial. However, evidence presented by Chan and colleagues shows that it is beneficial to the promotion of good mental health and well-being, specifically being applicable in the management of mental disorders. But what does this mean for practice? This commentary looks at what we agree and disagree with, what we opine is missing from the article and what now needs to happen. Patients should be able to access hypnotherapy or hypnosis routinely on the National Health Service. Since it works, who may it work for and how may we make this available to those who could benefit from it?","PeriodicalId":9336,"journal":{"name":"BJPsych Advances","volume":"779 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2022-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91129433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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