Reduction in antipsychotic drug dosage in mentally handicapped patients: a hospital study

Article Abstract:

Not all inmates of mental institutions suffer from psychiatric illness, yet many more of the patients are given antipsychotic drugs (neuroleptics) than need them. Some research has shown that up to 50 percent of patients in these hospitals are given psychotropic drugs, which in addition to possessing serious side effects produce profound changes in behavior. To investigate the use of these medications, a study was conducted at a hospital for the mentally ill in England. In January 1986, 983 patients were evaluated according to the medication(s) they were receiving. Age, sex, length of stay in the hospital, and psychiatric diagnosis were also noted, and for patients who had been in the hospital four years previously, their admission medication pattern was also recorded. The average patient was 40 years old, and had been in the hospital 24.3 years; 63 percent were males. Statistical analysis revealed that 243 patients (24 percent) were receiving neuroleptic medications, most commonly chlorpromazine and thioridazine. The most common diagnosis was behavior disorder, which is not a psychotic condition, suggesting that the drugs were being given to control problem patients. Patients over age 70 were given lower daily doses. Although the proportion of women receiving such drugs was lower, on average, women and girls received higher daily doses than men. These findings indicate that the use of antipsychotic medication among the mentally ill is not always justifiable by the patient's diagnosis. The tendency to use such drugs to control nonpsychotic patients seems to be reduced among junior house staff. Neuroleptics are effective when they are accurately prescribed. Other methods of behavior control should be examined for patients who are not psychotic. (Consumer Summary produced by Reliance Medical Information, Inc.)

Mentally ill persons, Drug therapy, Ethical aspects, Mentally ill, Mental illness, Mental disorders, Dosage and administration, Antipsychotic drugs, Antipsychotic agents, Psychiatric hospital patients

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A profile of long-stay psychogeriatric patients

Article Abstract:

Long-term elderly psychiatric patients residing in hospitals in one London borough between January and March 1987 (106 patients, with an average age of 80 years) were surveyed to assess their medical, placement, and psychiatric needs. The patients were given a medical assessment and a battery of tests to evaluate behavior according to various subscales to measure physical disability, functioning, dependency, and cognitive function. A comparison (control) group, matched for age and sex, were similarly assessed. The control group consisted of 51 residents of a local nursing home that was known to accept disabled and dependent patients. The ratio of females to males in both patient groups was approximately three to one. Most inpatients (86 percent) were diagnosed with dementia: 86 percent were confused; 85 percent suffered loss of bladder or bowel control; 96 percent could not dress themselves; and 83 percent were unable to socialize. Analysis of test data revealed that the psychogeriatric ward inpatients had a significantly higher level of dependency needs, were more disabled, and more socially disturbed than controls. Since it is likely that the profiles of the inpatients in this survey are similar to other London psychogeriatric inpatients, plans to close long-term psychiatric wards and to provide community care may be inappropriate and in need of extensive re-evaluation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Surveys, Community psychiatric services, Community mental health services, Geriatric psychiatry, Mentally ill aged, Mentally ill elderly, Great Britain

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Physical health of the long-term mentally ill in the community: is there unmet need?

Article Abstract:

A survey was carried out to assess the extent of physical illness and unmet medical needs of long-term users of outpatient psychiatric services in an English catchment area. One hundred forty-five adult male and female patients were studied. Close relatives and psychiatric staff were interviewed regarding the patient's psychological, behavioral, and physical problems and medical treatment. About half the patients were overweight, and approximately 25 percent were heavy smokers. Twenty-eight percent had dental problems or gum disease. More than 50 percent of patients over 50 years had physical health problems, compared with 28 percent of those under 50. Physical problems included high blood pressure (eight patients); hypothyroidism, underactive thyroid (five patients), and diabetes (six patients). There were four cases of lung disorders, four cases of hearing impairments, and three cases of epilepsy. Five patients each had neurological, cardiovascular, or motor disorders. Patients also suffered from urinary tract problems, dermatological, and other disorders. Overall, 41 percent of the patients had physical problems requiring medical care, and 15 percent had unmet medical needs. Thyroid and liver function tests were particularly useful for diagnosis. These results suggest that mentally ill community-care patients require extensive medical supervision. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Mentally disabled persons

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