Liaison or general hospital psychiatry is experiencing unprecedented expansion in the UK. A liaison psychiatry team in a typical general hospital may deliver savings of up to £5 million a year. However, liaison psychiatry faces challenges associated with this pace of change, with consequences for its long-term sustainability.
SummaryThis is a complex case of post-traumatic stress disorder (PTSD) with comorbid panic disorder occurring in a woman in her mid-60s, with a family history of neurotic illness. PTSD arose in the context of treatment for terminal lung cancer. This patient who had been close to her father watched him die of cancer, when he was about her age. Her diagnosis and treatment prompted traumatic recollections of her father's illness and death that resulted in her voluntary withdrawal from cancer treatment. The goals of treatment were to promptly reduce anxiety, minimise use of sedating pharmacotherapy, promote lucidity and prolong anxiety-free state thereby allowing time for important family interactions. Prompt, sustained relief of severe anxiety was necessary to achieve comfort at the end of life. Skilled additions of psychological therapies (eye movement desensitisation reprocessing, clinical hypnosis and breathing exercises) with combined pharmacotherapy (mirtazepine and quetiapine) led to control of anxiety and reduction of post-traumatic stress. BACKGROUND
SUMMARY Eye movement desensitisation and reprocessing (EMDR) is an established psychotherapy developed in the late 1980s to treat post-traumatic stress disorder (PTSD). It involves the use of repetitive eye movements or other bilateral stimulation to aid in the reprocessing of traumatic memories. It is unique in that it does not require extended exposure to or discussion of distressing memories and may result in symptom resolution in fewer sessions than other psychotherapies. In the decades since its initial development, a wealth of high-quality evidence has suggested that EMDR is a safe and effective treatment for trauma- and stress-based conditions, resulting in its inclusion in various treatment guidelines. This article reviews the theory behind how EMDR works, how it is conducted, the evidence supporting its use in the treatment of PTSD and its approved indications and contraindications.
IntroductionPersons receiving care in forensic settings face unique challenges. Long hospital stay combined with other factors such as reduced physical activity, unhealthy diets, smoking, serious mental illness, antipsychotic medications, all add up to increase their risk of acquiring metabolic syndrome, thereby increasing morbidity and mortality.AimPractice of monitoring for metabolic effects of an atypical antipsychotic- Clozapine was audited with the Maudsley Guideline as standard in 2 medium secure wards with 25 patients. It was conducted in 2011.ObjectivesWe checked whether blood lipids and body weight were monitored at baseline, at 3 months and then yearly; whether blood glucose and blood pressure were checked at baseline, at 4–6 months and then yearly.MethodsVarious sources of information were used including: paper medical records, electronic clinical entries, physical observation charts, medication prescription charts, Clozapine charts and acute hospital laboratory resultsResults24 patients (96%) were on antipsychotic medication. Of these, 23 patients were on atypicals. Of the latter, 8 persons were on Clozapine. No patient on Clozapine achieved a 100% monitoring on indices. Baseline monitoring for cholesterol, weight, blood glucose and blood pressure were 88%, 50%, 75% and 88% respectively. At midterm they were 50%, 100%, 38%, and 25% respectively. There were variable compliance with other indices at stipulated times. Lack of supporting infrastructure to facilitate compliance was identified.ConclusionThere was a need to adhere to existing guidelines which were also embodied in Trust policy to help manage metabolic syndrome.
SUMMARY Eye Movement Desensitisation and Reprocessing (EMDR) is an established psychotherapy that utilises repetitive, bilateral stimulation, such as saccadic eye movements, to treat the symptoms associated with traumatic experiences. Much of the attention EMDR has received has focused on its use in treating post-traumatic stress disorder (PTSD), which has resulted in its inclusion in several treatment guidelines. There is, however, emerging evidence that suggests a promising role for EMDR in managing a wide range of other mental and physical health conditions. High-quality studies demonstrate the efficacy of EMDR in managing conditions such as anxiety disorders, obsessive–compulsive disorder, major depressive disorder and chronic pain. Preliminary studies have also investigated its use in conditions such as bipolar disorder, eating disorders, substance misuse, psychotic disorders and sleep disturbances. The major studies exploring these applications of EMDR, outside of PTSD, are reviewed in this article.
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