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Biomedical subjects

Camilla Haw

Publications and source records attributed to Camilla Haw.

16 recordsLinked to original sources
PubMed2006

Benzodiazepines--a necessary evil? A survey of prescribing at a specialist UK psychiatric hospital.

Guidelines on the prescription of benzodiazepines recommend their use be limited to the short-term relief of severe anxiety or insomnia. However, clinical experience suggests that in psychiatry these drugs may be being prescribed more widely. The aim of this survey was to investigate benzodiazepine prescribing in a specialist UK psychiatric hospital using a structured interview with consultant psychiatrists. Prescribers were also asked their views on the UK CSM guidance on benzodiazepines (1988). Of 412 inpatients, 77 (18.7%) were receiving 90 benzodiazepine prescriptions for psychiatric indications. Most prescriptions were for anxiety (45/90; 50.0%), aggression (23/90; 25.6%) and agitation (13/90; 14.4%). Use was commonest for acquired brain injury, schizophrenia and personality disorders. Much usage was chronic (only 4/90 (4.4%) prescriptions had been initiated within the previous 4 weeks) and off-label (85/90; 94.4%). Prescribers were concerned about the addictive nature of benzodiazepines for these patients and to a lesser extent about their abuse potential. Most consultants believed the UK CSM guidance was too restrictive in relation to their clinical practice and needed modification to encompass new indications, for example rapid tranquillization, and specialist prescribing. In psychiatry benzodiazepines are quite frequently used in the management of a number of groups of difficult-to-treat patients. Although largely not evidence based, some psychiatrists report a favourable risk-benefit ratio for benzodiazepines in the treatment of certain patients.

Adolescent↗
PubMed2006

Deliberate self-harm patients of no fixed abode: a study of characteristics and subsequent deaths in patients presenting to a general hospital.

BACKGROUND: International studies report high rates of deliberate self-harm (DSH) and suicide in the homeless. Little is known about DSH among homeless people in the UK and their subsequent risk of death from suicide and non-suicidal causes. METHOD: We have carried out a study of no fixed abode (NFA) patients using data collected through the Oxford Monitoring System for Attempted Suicide. We describe the demographic and clinical characteristics of NFA DSH patients and the findings of a mortality follow-up study of a cohort of these patients. RESULTS: Between July 1988 and December 2002, 10,346 persons presented following 17,352 DSH episodes. Of these persons, 374 (3.6%) were of NFA. Compared with domiciled DSH patients, NFA patients were more likely to be male, single, unemployed, to have been a recent victim of violence and violent towards others, to have a criminal record and to have a personality disorder. More NFA patients faced problems with drugs and alcohol, social isolation, finances, the law and housing and had received psychiatric treatment within the previous 12 months. Substantially more NFA patients had a past history of DSH and re-presented with a further episode of DSH within 12 months. In the cohort of DSH patients who presented between January 1978 and December 1997 and who were followed up until December 2000, mortality from probable suicide and from all causes was approximately double that of domiciled patients. CONCLUSIONS: NFA DSH patients are a vulnerable group of patients at high risk of DSH repetition and with increased mortality from all causes. Good liaison between medical and psychiatric services is important. Specialist services may need to be developed to meet the particular needs of this patient group.

Adolescent↗
PubMed2006

Prescription errors in psychiatry - a multi-centre study.

Medication errors are an important cause of patient morbidity and mortality, of which there have been few reports in psychiatry, especially in the UK. Our aim was to examine the nature, frequency and potential severity of prescribing errors in UK mental health units in a prospective, 1 week survey of errors detected by pharmacy staff in nine NHS trusts. Pharmacists checked 22036 prescription items. In total, 523 errors meeting the study definition were detected (2.4% of prescription items checked). Prescription writing errors (77.4%) were most common, while decision-making errors accounted for 22.6% of errors. In 280 (53.5%) cases the prescribed drug had been administered before the error was detected. Most errors were of doubtful or minor importance but 22 (4.3%) were deemed likely to result in serious adverse effects or death. The error detection rate varied fourfold between trusts. Prescribing errors are fairly common in psychiatry. A small proportion of errors have the potential for serious harm. Pharmacy staff have an important role to play in their management.

Drug Prescriptions↗
PubMed2005

Alcohol dependence, excessive drinking and deliberate self-harm: trends and patterns in Oxford, 1989-2002.

BACKGROUND: Problems relating to alcohol use are very common among deliberate self-harm (DSH) patients, and alcohol abuse increases the risk of both DSH and suicide. In the UK, per capita consumption of alcohol has risen by 50% since 1970. The proportion of women (but not men) drinking in excess of government-recommended limits has also increased. We investigate trends, by gender and age group, in alcohol problems and usage among DSH patients. METHOD: Data collected by the Oxford Monitoring System for Attempted Suicide were used to examine trends in alcohol disorders and alcohol consumption shortly before, or at, the time of self-harm by patients aged 15 years or over between 1989 and 2002. RESULTS: Data were available on 10,414 patients who were involved in 17,511 episodes of DSH. The annual numbers of both male and female DSH patients rose progressively over the study period. Although rates of alcohol disorders and consumption remained higher in males than females, substantial increases were seen in females of all ages in rates of alcohol problems, excessive drinking and consumption of alcohol within 6 h of DSH and as part of the act of DSH. Rates for males largely remained unchanged. CONCLUSIONS: There has been a significant increase in excessive drinking and consumption of alcohol around the time of DSH by females but not males. These changes may relate to increases in the affordability and availability of alcohol and to social changes in drinking patterns. They have implications for services for DSH patients and may have an impact on future patterns of suicidal behaviour.

Adolescent↗
PubMed2005

A survey of the off-label use of mood stabilizers in a large psychiatric hospital.

The term 'off-label' prescribing refers to the use of a drug outside the terms of its Marketing Authorization, including prescribing for an unlicensed indication. The aims of the study were to determine the frequency of off-label prescriptions for mood stabilizers (lithium and antiepileptics) among inpatients of a large psychiatric hospital, the nature of the off-label clinical indications in use and whether patients had been informed about the off-label usage.A cross-sectional survey of inpatients aged 18-65 years at St Andrew's Hospital, Northampton, UK and interviews with consultant psychiatrists about off-label usage of mood stabilizers were carried out. Of the 249 patients studied, 75 (30.1%) were receiving one or more mood stabilizers, of which 71 (94.7%) were off-label. The most frequently cited off-label indications for mood stabilizers were: prophylaxis of mood swings (48 cases), treatment of aggression (31), manic symptoms (10), antipsychotic augmentation in treatment-resistant schizophrenia (7) and post-traumatic stress disorder (6). Lithium was prescribed infrequently. The reasons for this are discussed. Although in most instances the psychiatrist was aware the drug was being used off-label, in less than one-third of cases had the patient been informed of this, partly because of anticipated difficulties in their understanding the off-label concept, but also because of concerns that this information could adversely affect compliance. The off-label prescription of mood stabilizers is very common in psychiatry and such usage benefits patients. When prescribing off-label, psychiatrists should consider the evidence that the drug is likely to be effective for the unlicensed indication. Where there is limited evidence of benefit, a trial of the drug, with clinical monitoring, may be indicated. Patients should be fully informed about their medication, and this includes information that the prescription is off-label. Pharmacists can assist this process. The off-label concept may be difficult for some patients to understand.

Adolescent↗
PubMed2005

Old and mad in Victorian Oxford: a study of patients aged 60 and over admitted to the Warneford and Littlemore Asylums in the nineteenth century.

This is a historical case note analysis of older patients admitted to the Warneford and Littlemore Asylums in nineteenth-century Oxford. Of 1044 admissions to the Warneford, 93 patients were aged over 60 (8.9%). At Littlemore, 998 of a total of 5464 admissions were aged over 60 (18.3%). High levels of psychopathology were found, as in other studies examining patients of all ages, and were similar for the two institutions. The largest difference was in the death rate, which was much higher for Littlemore Asylum. This resulted from the preponderance of patients with organic diagnoses who were admitted to Littlemore, many of whom died shortly afterwards.

Aged↗
PubMed2005

Schizophrenia and suicide: systematic review of risk factors.

BACKGROUND: Suicide risk is greatly increased in schizophrenia. Detection of those at risk is clinically important. AIMS: To identify risk factors for suicide in schizophrenia. METHOD: The international literature on case-control and cohort studies of patients with schizophrenia or related conditions in which suicide was reported as an outcome was systematically reviewed. Studies were identified through searching electronic databases and reference lists, and by consulting experts. RESULTS: Twenty-nine eligible studies were identified. Factors with robust evidence of increased risk of suicide were previous depressive disorders (OR=3.03, 95% CI 2.06-4.46), previous suicide attempts (OR=4.09, 95% CI 2.79-6.01), drug misuse (OR=3.21, 95% CI 1.99-5.17), agitation or motor restlessness (OR=2.61, 95% CI 1.54-4.41), fear of mental disintegration (OR=12.1, 95% CI 1.89-81.3), poor adherence to treatment (OR=3.75, 95% CI 2.20-6.37) and recent loss (OR=4.03, 95% CI 1.37-11.8). Reduced risk was associated with hallucinations (OR=0.50, 95% CI 0.35-0.71). CONCLUSIONS: Prevention of suicide in schizophrenia is likely to result from treatment of affective symptoms, improving adherence to treatment, and maintaining special vigilance in patients with risk factors, especially after losses.

Depressive Disorder↗
PubMed2005

Schizophrenia and deliberate self-harm: a systematic review of risk factors.

Deliberate self-harm (DSH) is a strong predictor of suicide in schizophrenia. The aim of this review was to identify risk factors for DSH in schizophrenia. This systematic review of the international literature examined cohort and case-control studies of patients with schizophrenia or related diagnoses that reported DSH as an outcome. Studies were identified by searching electronic databases and reference lists, and by consulting international experts. Fourteen studies met the eligibility criteria. Of the 29 variables examined by two or more studies, five (past or recent suicidal ideation, previous DSH, past depressive episode, drug abuse or dependence, and higher mean number of psychiatric admissions) were associated with an increased risk of DSH, and one (unemployment) was associated with a reduced risk. Schizophrenic patients with these risk factors need careful follow-up and monitoring, with treatment of any associated comorbid depression or drug abuse. Large, prospective studies of DSH in schizophrenia are needed to further define risk factors and to build on the findings of this review.

Adult↗
PubMed2005

Suicide and attempted suicide in bipolar disorder: a systematic review of risk factors.

OBJECTIVE: To determine the main risk factors for suicide and nonfatal suicidal behavior in patients with bipolar disorder through a systematic review of the international literature. DATA SOURCES: Studies were identified through electronic searches of MEDLINE (1966-December 2003), EMBASE (1980-December 2003), PsycINFO (1872-November 2003), and Biological Abstracts (1985-December 2003) using index and free-text search terms for bipolar disorder, bipolar depression, manic depression, mania, and affective disorders; combined with terms for self-harm, self-injury, suicide, attempted suicide, automutilation, self-mutilation, self-poisoning, and self-cutting; and combined with terms for risk, case control, cohort, comparative, longitudinal, and follow-up studies. No language restrictions were applied to the search. STUDY SELECTION: Included studies were cohort, case-control, and cross-sectional investigations of patients with bipolar disorder in which suicide (13 studies) or attempted suicide (23 studies) was reported as an outcome. The selected studies also used diagnostic tools including the DSM, International Classification of Diseases, and Research Diagnostic Criteria. DATA SYNTHESIS: Meta-analysis of factors reported in more than 1 study identified the main risk factors for suicide as a previous suicide attempt and hopelessness. The main risk factors for nonfatal suicidal behavior included family history of suicide, early onset of bipolar disorder, extent of depressive symptoms, increasing severity of affective episodes, the presence of mixed affective states, rapid cycling, comorbid Axis I disorders, and abuse of alcohol or drugs. CONCLUSIONS: Prevention of suicidal behavior in patients with bipolar disorder should include attention to these risk factors in assessment and treatment, including when deciding whether to initiate treatment aimed specifically at reducing suicide risk.

Bipolar Disorder↗
PubMed2004

Suicide by gunshot in the United Kingdom: a review of the literature.

This paper reviews the research literature on gunshot suicide in the United Kingdom and the international literature with reference to strategies aimed at preventing gunshot suicides. Trends in gun ownership and changes in firearm legislation in the UK over the past 20 years are described. Most UK gunshot suicides are male, middle-aged and living with a partner and involve the use of shotguns. They are less likely to have current or past mental health problems, or a previous act of self-harm, than people who commit suicide by other methods, and their suicide is more likely to have been precipitated by a relationship dispute. Where alcohol is consumed the amount tends to be large. The international literature provides evidence of a strong association between rates of gun ownership and gunshot suicide, and some evidence of a reduction in firearm suicide rates following the introduction of restrictive firearm legislation. Over the past 20 years the number of gunshot suicides in the UK has declined by over 50% to a little over a hundred deaths per annum. At the same time, firearm legislation has become progressively more restrictive and rates of gun ownership have declined. Measures, which might further reduce the prevalence of gunshot suicides in the UK, are discussed.

Death Certificates↗
PubMed2003

Assessment and aftercare for deliberate self-harm patients provided by a general hospital psychiatric service.

We report on a sample of 135 deliberate self-harm (DSH) patients who were assessed by a general hospital DSH service, and on those who were offered aftercare by, or telephone open access to, the service. Patients' satisfaction with assessment and treatment, and their outcome were investigated at follow-up 12-20 months later. Four-fifths of patients reported the assessment following DSH to have been helpful and the assessor sympathetic. Thirty-three (24%) of the 135 patients assessed were offered treatment by the DSH service but 13 declined or failed to attend. Of the 20 who engaged in treatment, 17 (94%) were satisfied with their care. Open access to the DSH service by telephone was offered to 53 (39%) patients, nine (22%) of whom reported at follow-up that they had used this facility. A specialist DSH service can effectively assess and treat patients following DSH. It is important that the service is accessible and acceptable to patients.

Adolescent↗
PubMed2003

Comorbidity of axis I and axis II disorders in patients who attempted suicide.

OBJECTIVE: The authors compared the characteristics of suicide attempters with and without comorbid psychiatric and personality disorders to identify factors that explain the high suicide risk associated with psychiatric comorbidity. METHOD: A representative group of 111 patients who had attempted suicide (72 female and 39 male) was assessed for psychiatric and personality disorders according to ICD-10 criteria. The characteristics of patients with both types of disorder were compared with those of patients without comorbid disorders. A semistructured interview schedule and standardized questionnaires were used to investigate patients' background characteristics, the circumstances of the suicide attempts, psychological characteristics, and outcome after 12-20 months. RESULTS: Comorbidity of psychiatric and personality disorders was present in 49 patients (44%). More patients with comorbid disorders had made previous suicide attempts (N=41 [84%] versus N=28 [45%]) and repeated attempts during the follow-up period (N=25 [51%] versus N=9 [15%]). Differences in precipitants and motives for the index episode were also found: patients with comorbid disorders were more depressed and hopeless, reported more episodes of aggression, were more impulsive, and had lower self-esteem and poorer problem-solving skills. Differences in self-esteem and problem-solving skills distinguished between the groups in a stepwise discriminant function analysis. More of the patients with comorbid disorders reported not being loved by their parents and parental suicidal behavior. CONCLUSIONS: Suicide attempters with comorbid psychiatric and personality disorders show marked differences from those without both of these disorders. Comorbidity may contribute to greater suicide risk. Some of the characteristics of patients with comorbid disorders pose major clinical challenges that should be addressed in an effort to reduce suicide risk.

Adolescent↗
PubMed2003

Correlates of relative lethality and suicidal intent among deliberate self-harm patients.

Conflicting findings have been reported regarding the relationship between the potential lethality of acts of deliberate self-harm (DSH) and suicidal intent, and how each relates to patient characteristics. This study examines the relationship of suicidal intent of DSH to lethality, the relationship of both to patient characteristics, and determines if intent or lethality are risk factors for repetition of DSH. Potential lethality and Suicide Intent Scale (SIS) scores for DSH episodes were examined in a representative sample of 150 patients presenting to a general hospital. Follow-up interviews were completed 12 to 20 months later. Lethality was strongly associated with high intent. Both lethality and intent were associated with male gender. Suicidal intent but not lethality was associated with the presence of psychiatric disorder and depression. Intent was significantly correlated with hopelessness scale score. Although intent was correlated with both depression and self-esteem scale scores, these correlations became nonsignificant when the effect of hopelessness was removed. Repetition of DSH during the follow-up period was related to neither lethality nor intent scores for the original episodes. Lethality and suicidal intent, although related, have somewhat different correlates. Both should be considered when assessing DSH patients, but their relationship to further suicidal behavior does not appear to be straightforward.

Adolescent↗
PubMed2002

Deliberate self harm patients with depressive disorders: treatment and outcome.

BACKGROUND: Depression is the most common psychiatric disorder in deliberate self-harm (DSH) patients and in those who commit suicide. The aim of this study was to examine the treatment received by DSH patients with depression and their progress following DSH. METHODS: A representative sample of 106 patients with an ICD-10 depressive episode who presented to a general hospital following an episode of DSH were investigated in terms of their treatment before and after the episode and their outcome at follow-up. RESULTS: Prior to the index episode of DSH, 39 patients (36.8%) were receiving treatment from the psychiatric services and a further 35 (33.0%) were receiving treatment for mental health problems from their general practitioner. Fifty-two patients (49.1%) were receiving antidepressants (in therapeutic dosages in 93.6%). After the episode of DSH 94 patients (88.7%) were offered treatment with the psychiatric services, either as a new referral or continuation of treatment they were receiving prior to DSH. Of the patients who were followed-up, 36.3% remained in contact with the psychiatric services, 52.3% showed poor compliance with recommended treatment and 60.2% no longer fulfilled the diagnostic criteria for depression. Almost one-third reported a further episode of DSH during the follow-up period. LIMITATIONS: The nature and quality of non-physical treatments provided by the psychiatric services was not investigated. Reports of the treatment provided by general practitioners, the timing of improvement in symptoms and compliance with treatment largely relied on patients' self report. CONCLUSIONS: All patients presenting following DSH need to be carefully screened for depressive illness. Randomised controlled studies need to be conducted on DSH patients with depression to determine which treatments are effective.

Adult↗
PubMed2002

Family history of suicidal behaviour: prevalence and significance in deliberate self-harm patients.

OBJECTIVE: To investigate whether there are differences between the characteristics of deliberate self-harm (DSH) patients with and without a family history of suicidal behaviour. METHOD: In 146 DSH patients, those with and without a positive family history were compared with regard to the nature and repetition of their DSH episodes, and psychological and psychiatric characteristics. RESULTS: Fifty-two (35.6%) patients had a family history of suicidal behaviour. DSH was more frequent in patients' mothers (17.1%) than fathers (2.7%). Patients with a family history of suicidal behaviour, especially females, had higher state anger scores. CONCLUSION: Family history of suicidal behaviour appears to be associated with greater anger. Absence of other associations suggests that family history probably has less implication for individuals who have already engaged in DSH than in contributing to its initiation. Future studies should include patients with violent or life-threatening DSH acts.

Adolescent↗