Mania occurring for the first time in later life is uncommon; however, it can rarely occur as a consequence of stroke. Here, the authors present the case of an elderly man who developed secondary mania shortly following a haemorrhagic stroke, and who responded well to treatment with olanzapine. Copyright © 2014 John Wiley & Sons

No abstract

illness, because there may be varying periods of duration of untreated psychosis and this can have its own treatment implications. Despite these shortcomings, findings of the study suggest that even with a national healthcare system in place and the wider dissemination of treatment guidelines, there is still only a modest impact of these on real clinical practice. The possible effect of treatment guidelines is reflected by the fact that today patients receive fewer trials of other antipsychotics (2.8 v. 4 trials) before being started on clozapine compared with earlier studies.

AimsTo improve practice of Hospital Anticipatory Care Planning for inpatients of Organic Old Age Psychiatry wards in NHS Lanarkshire.BackgroundHospital Anticipatory Care Plans (HACPs) are important components of care for inpatients with progressive and life-limiting conditions. HACPs provide guidance on treatment escalation and limitation for individual patients, in the event that they become acutely unwell. In the Old Age Psychiatry Department at NHS Lanarkshire, HACP standards are as follows: HACP forms should be completed within 2 weeks of admissionHACP information leaflets should be provided to relatives/carersHACPs should be discussed with relatives/carersIf a patient without an HACP becomes acutely unwell, an HACP should be made, and the responsible Consultant informedHACP should be discussed within the multi-disciplinary team (MDT)HACPs should be regularly reviewedHACP and DNACPR forms should be kept at the front of the notesSuperseded HACPs should be marked as obsoleteMethodInpatient notes were reviewed in October 2019 and compared against the above standards.The findings were presented at the Clinical Governance Meeting and Old Age Psychiatry Teaching Group in December 2019.An ‘HACP Checklist’ was also created to prompt good practice.Inpatient notes were reviewed again in July 2020.Data from both time periods were compared.ResultThere was an improvement in:The proportion of patients who had an HACP - from 59% to 96%The proportion of patients who had an HACP made within 2 weeks of admission - from 35% to 78%Documentation of HACP discussions with relatives/carers - documented for 77% of patients (from 47%)Timing of HACP discussions with relatives/carers - took place within 2 weeks for 52% of patients (from 29%)Documentation of HACP discussion by MDT - documented for 73% of patients (from 29%)HACP Information Leaflets were only distributed to one patient's relatives/carers across both time pointsMedical emergencies for patients with no HACP were infrequent and so comparison could not be madeHACPs were reviewed less frequently in July 2020 than in October 2019HACP forms and DNACPR forms were always filed appropriatelySuperseded HACP forms were always appropriately marked as obsoleteConclusionHACP practice mostly improved from October 2019 to July 2020. This may have been due to increased awareness of HACP Standards, following the presentation of initial data to inpatient teams.A much larger influence, however, was likely to be the COVID-19 pandemic and associated efforts to improve HACP practice throughout the Health Board.

No abstract