Community participation, Health status indicators, Indigenous populations, Reliability and validity, Programme planning,

The recreational use of novel psychoactive substances in the UK has increased markedly within the last decade. The variety of new substances synthesised and sold as ‘legal’, often under the pretence of being ‘plant food’ or ‘bath salts’ is similarly increasing. This presents challenges to clinicians: they may be unaware of these substances or unable to identify them and their potential for complications and drug interactions. This case describes a patient who ingested a novel psychoactive substance and presented with severe agitation following a delay of several days. He experienced renal, hepatic and neurological complications requiring critical care input. Our case adds to the current repertoire of knowledge regarding the effects of ingestion of novel cathinones.

BackgroundA computer assisted interview, the GMHAT/PC has been developed to assist General Practitioners and other Health Professionals to make a quick, convenient and comprehensive standardised mental health assessment. It has proved to be a reliable and valid tool in our previous studies involving General Practitioners and Nurses. Little is known about its use in cardiac rehabilitation settings.AimThe study aims to assess the feasibility of using a computer assisted diagnostic interview by nurses for patients attending Cardiac Rehabilitation Clinics and to examine the level of agreement between the GMHAT/PC diagnosis and a Psychiatrist clinical diagnosis. Prevalence of mental illness was also measured.DesignCross sectional validation and feasibility study.MethodsNurses using GMHAT/PC examined consecutive patients presenting to a cardiac rehabilitation centre. A total of 118 patients were assessed by nurses and consultant psychiatrist in cardiac rehabilitation centres. The kappa coefficient (κ), sensitivity, and specificity of the GMHAT/PC diagnosis were analysed as measures of validity. The time taken for the interview as well as feedback from patients and interviewers were indicators of feasibility. Data on prevalence of mental disorders in an outpatient cardiac rehabilitation setting was collected.ResultsThe mean duration of the interview was 14 minutes. Feedback from patients and interviewers indicated good practical feasibility. The agreement between GMHAT/PC interview-based diagnoses and consultant psychiatrists' ICD-10 criteria-based clinical diagnosis was good or excellent (κ = 0.76, sensitivity = 0.73, specificity = 0.90). The prevalence of mental disorders in this group was 22%, predominantly depression. Very few cases were on treatment.ConclusionGMHAT/PC can assist nurses in making accurate mental health assessments and diagnoses in a cardiac rehabilitation setting and is acceptable to cardiac patients. It can successfully be used to gather epidemiological data and help in managing mental health problems in this group of patients.

Experiences in California suggest that implementation of the 2008 federal parity law should include monitoring health plan performance related to access and quality, in addition to monitoring coverage and costs; examining the breadth of diagnoses covered by health plans; and mounting a campaign to educate consumers about their insurance benefits.