Objective: To evaluate the function and impact of a highly specialist psychologist working with high risk patients in an acute mental health inpatient setting. The impact was examined on outcomes such as risk related incidents, re-admission, average length of stay, and use of restrictive practice.Method: A mixed methods service evaluation of a pilot project was undertaken to examine the impact of the specialist psychologist role on these outcomes over a 17-month period. Demographic and clinical data was collected for 18 patients who were seen by the psychologist. Routinely collected clinical data examiningrisk incidents, re-admission rates, average length of stay, and use of restrictive practice, were also used to evaluate outcome across the evaluation period (at baseline and six-month follow-up).Results: The specialist psychologist provided input to patients’ care and undertook a variety of direct and indirect work and training. Examination of descriptive routine clinical data indicated a slight reduction in risk related incidents, readmissions, and average length of stay after the introduction of the psychologist role, however these were not statistically significant.Conclusion: These initial findings suggest the potential for outcome improvement, but further, more robust research is required to see if such a role can have a significant impact on outcomes.

Introduction:The efficacy of long-acting injectable antipsychotics in dual schizophrenia patients has been well established.Objectives:To investigate the efficacy of long-acting injectable paliperidone palmitate(PPLAI) in the psychopathology of dual psychotic patients. To examine the tolerability profile of PPLAI in dual psychosis.Method:An open-label, non-interventional, prospective study was conducted in 42 dual psychotic outpatients who received PPLAI in monotherapy. We used the Brief Psychiatric Rating Scale (BPRS) to assess psychotic symptoms and the Udvalg für Kliniske Undersogelser Scale (UKU) to evaluate treatment tolerability, at baseline, and after 3 and 6 months of treatment. Prolactin levels were also determined at the time of the study inclusion and after 6 months.Results:Thirty-five patients were included into the study. After 6 months of treatment, patients receiving PPLAI showed a significant improvement in positive symptoms (disorganisation, suspiciousness), negative symptoms (emotional withdrawal, motor retardation, blunted affect and confusion), affective symptoms (somatic concern, anxiety and depression) and in motor symptoms (unco-operativeness, excitement). When compared to the 3rd month assessment, after 6 months, statistically significant differences were found in items 4,11,14,17 and 18. Patients receiving PPLAI had lower rates of side effects assessed by UKU Scale (asthenia, sedation, failing memory, tension, insomnia, rigidity, tremor, weight gain and sexual dysfunction). Baseline prolactin levels ranged 11–122 (mean:38), at 6 months: 20–136 (mean:38.4).Conclusions:After 6 months, patients receiving PPLAI had lower psychotic symptoms, a decrease in side effects, and a significant improvement in global functioning. No changes in prolactin levels were found.

Introduction:Group psychoeducation is an effective psychotherapy in the treatment of addictive behaviours.Objectives:To evaluate the efficacy of group psychoeducation on quality of life in relatives of dual diagnosed patients.To investigate the impact of group psychoeducation on treatment compliance.Method:A case-control study was conducted between January 2012 and July 2012. Case group: seventy relatives and 53 patients included into an 8 session systematic psychoeducational group designed as follows: 1.5 hours every 3 weeks. The control group was formed by 53 patients who did not participate in psychoeducation during the same period. To assess quality of life in relatives, we used the Health Status Questionnaire (SF-36). Attendance rates for appointments were recorded in patients from both groups.Results:At baseline, relatives had poor outcomes in quality of life (Vitality: 49.8; emotional role: 49.3; mental health: 51.8, and general health perception: 54.9). Psychoeducated, as compared to control group relatives, had significantly better outcomes in quality of life (Vitality 71.0; emotional role 82.6; mental health 72.6, and general health perception 66.5). When compared to the control group, mean psychiatric appointments were higher in patients whose relatives were psychoeducated (8.2 vs.3.6).Conclusions:Our findings suggest that psychoeducation can improve quality of life in relatives of patients with addictive behaviours. Attendance rates for appointments were higher in patients whose relatives were psychoeducated.

Introduction:Long-acting atypical antipsychotics have been widely used in the treatment of substance use disorders and comorbid psychosis.Objectives:To investigate the impact of long-acting injectable paliperidone palmitate (PPLAI) on craving and satisfaction levels in dual psychotic patients.Methods:An open-label, non-interventional, prospective study was conducted in 42 dual psychotic outpatients who received PPLAI in monotherapy. Craving and satisfaction levels in patients and relatives were assessed by using the Visual Analogue Scale (VAS). We used the Clinical Global Impression Scale (CGI) to assess clinical severity and global improvement, and the GAF scale to assess global functioning. 35 patients completed the study and underwent a systematic assessment at baseline and after 3 and 6 months.Results:After 6 months of treatment, mean craving scores decreased in patients treated with PPLAI when compared to baseline scores (4.9 vs 2.3). Mean satisfaction levels in dual psychotic patients increased (6.0 vs 9.1), and satisfaction levels in their relatives improved after 6 months (5.2 vs 9.5). Patients receiving PPLAI showed a statistically significant decrease in consumption relapses, had lower scores in CGI for clinical severity (CGISI), higher scores in global improvement (CGI-GI), and higher scores in global functioning.Conclusions:After 6 months of PPLAI treatment, psychotic patients with substance use had lower craving levels. Satisfaction levels were higher in patients and their relatives. Consumption relapses decrease and patients had higher scores in global functioning.

Introduction:In recent years, special attention has been paid to the quality of life in dual psychotic patients.Objectives:To study quality of life in psychotic patients with co-occurring substance use recently treated with long-acting injectable paliperidone palmitate (PPLAI) in monotherapy.Method:An open-label, non-interventional, observational study was carried out in 42 dual psychotic outpatients who were recently treated with PPLAI in monotherapy. At baseline, main demographic and clinical variables were recorded. The Health Status Questionnaire (SF-36) was assessed at the time of the study inclusion, and after 3 and 6 months. Thirty-five patients completed the study.Results:81% were men, and mean age was 39 years. 31% had an alcohol dependence disorder, 26% opiates, 24% cocaine, 14% cannabis, and 100% nicotine dependence. 95% had co-dependence substance use disorders. 38% per cent were diagnosed as having an unspecified psychosis, 36% schizophrenia, 57% Axis II and 55% III disorders. 29% were previously treated with oral antipsychotics, and 71% received long-acting injectable risperidone (RLAI). 83% were treated with other non-psychopharmacological drugs. After 6 months of treatment, higher scores were found in the following SF-36 items: Vitality (31 vs.77), social functioning (48 vs.85), mental health (49 vs 78), health subjective perception (45 vs.70), and health improvement (65 vs.87). Transaminase levels did not change after treatment. Mean PPLAI dosage at baseline: 111.18 mg; mean dosage at 6 months: 132.86.Conclusions:High psychopathological and organic comorbidity was found. Quality of life improved after 6 months of treatment. PPLAI 100 mg was the most common prescribed dosage.