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Supporting Colleagues to Respond to Serious Mental Illness
Published in Leanne Rowe, Michael Kidd, Every Doctor, 2018
The use of substances must be assessed within the context of the individual’s life and their readiness for change. A comprehensive psychiatric history is important to identify possible comorbidity including depression, anxiety, psychosis, post-traumatic stress disorder, eating disorders and bipolar disorder. The severity of dependence, the physical health consequences, and any risk-taking behaviour associated with substance use, must be explored by the treating doctor. The treatment and management plan must be adjusted according to the history and the motivation of the individual. While self-management and monitoring are to be encouraged, it is essential that a doctor with a substance use disorder is monitored and reviewed regularly by an independent, experienced treating doctor.
Partial and Total Ear Reconstruction
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
As part of their clinical assessment16 the multidisciplinary team should note the patient’s general medical health and medications. Medical history of cardiorespiratory disease, diabetes, hypertension and immunodeficiency need to be considered in terms of fitness for surgery and the risk of complications afterwards. Use of aspirin, steroids, warfarin, immunosuppressive agents, tobacco and recreational drugs are documented. Previous procedures on the ears and chest, including operations for ear reconstruction, are noted. A history of hypertrophic or keloid scarring is sought. Previous or current psychiatric history may influence the patient’s perception of his or her condition and must be documented.
Confidentiality, privacy and access to medical records
Published in Marc Stauch, Kay Wheat, Text, Cases and Materials on Medical Law and Ethics, 2018
Gurry59 reviews the case law, and concludes that disclosure of a proposed civil wrong would be in the public interest, but doubts whether the disclosure of a past civil wrong would satisfy this, as ‘this would serve only to raise quibbling enmities and thus destroy, rather than advance, the public welfare’, while in the context of commercial confidences it may be the case that proposed civil wrongs may justify a breach. However, it is hard to envisage the circumstances in which past or future civil wrongs would justify a breach of medical confidences. Medical confidentiality would always override the prevention of civil wrongs because of weightier public interest arguments. In any event, what might be an example of a situation where a doctor would consider breaching confidence to prevent a proposed civil wrong? Perhaps a doctor may consider reporting a patient to his employer if, for example, he has failed to disclose a medical condition on a job application form, for example, psychiatric history (see O’Brien v Prudential Assurance Co).60 It is submitted that this sort of medical busy-bodying would be swiftly condemned by the courts and the GMC.
Characterizing Trends in Synthetic Cannabinoid Receptor Agonist Use from Patient Clinical Evaluations during Medical Toxicology Consultation
Published in Journal of Psychoactive Drugs, 2021
Collin Tebo, Maryann Mazer-Amirshahi, Paul Wax, Sharan Campleman, Edward Boyer, Jeffrey Brent, Amit Sheth, Raminta Daniuaityte, Robert Carlson
The current study was successful in demonstrating trends and patterns in the use and use behaviors relating to SCRAs. However, there were a number of limitations in the present study. First, lack of routine laboratory testing for SCRAs prevented biological confirmation in most patients interviewed as well as identification of SCRA type. Additionally, clinical data obtained during consultations were subject to patient recall and clinician documentation bias. The high number of missing values is primarily due to patient refusal to answer which may have been influenced by state of mind at the time of interview. The psychiatric history of patients described in this study were obtained by asking patients about previous mental health diagnoses. These diagnoses were merely reported by the patients and not confirmed by further assessment or chart review.
Toxicity from illegitimate slimming agents – a 10-year case series at a tertiary toxicology laboratory in Hong Kong
Published in Clinical Toxicology, 2021
Nike Kwai Cheung Lau, Magdalene Huen Yin Tang, Sau Wah Ng, Yeow Kuan Chong, Sammy Pak Lam Chen, Hencher Han Chih Lee, Chor Kwan Ching, Tony Wing Lai Mak
Regarding the 153 patients who presented with psychiatric features, 51 patients had a known psychiatric history, while 102 patients did not (Supplementary Table 2). In patients with previous psychiatric history, they most commonly presented with psychosis such as hallucination and delusion, while overdose or other suicidal attempt were most common in patients with no psychiatric history. It was estimated that 37.3% (38/102) of patients with no psychiatric history and 72.5% (37/51) of patients with psychiatric history required further follow up or treatment or both by psychiatrist for at least one year after initial episode. In patients with no previous psychiatric history, the psychiatric symptoms were transient and subsided after cessation of use of the offending sliming agent. We further analyzed the association between sibutramine exposure and presentation with psychiatric symptoms in the subgroup of 262 patients with no known psychiatric history. Amongst these patients, 74 out of 161 patients with sibutramine exposure presented with psychiatric features, compared to 28 out of 101 patients with no sibutramine exposure. The calculated odds ratio was 2.2 (95% confidence interval 1.3 to 3.8, Fisher two-tailed exact probability p = 0.004).
Beliefs of cancer patients in Saudi Arabia
Published in Journal of Psychosocial Oncology, 2020
Rolina Al-Wassia, Faten Al-Zaben, Mohammad Gamal Sehlo, Harold G. Koenig
Questions adapted from the Duke Depression Evaluation Schedule28 were used to assess personal and family history of psychiatric problems. Personal psychiatric history was assessed by asking if they (1) had ever suffered from a previous psychiatric illness, (2) visited a psychiatrist, (3) were admitted to a psychiatric hospital, (4) prescribed psychiatric medication, or (5) had a substance abuse problem. Family psychiatric history was assessed by asking if a family member (1st degree relative) had ever had a mental illness. Response options for each question were either yes (1) or no (0). For personal psychiatric problems (HPP), the five items were summed to create a scale ranging 0–5 (α = 0.72), although was dichotomized into 0 (no) vs. 1–5 (yes) for analyses given the limited response range for this sample (0–3).