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Poverty, substandard medical care, social neglect or withdrawal, unhealthy lifestyle -- these are just some of the contributors to the substantial morbidity of patients with severe mental illness. Medical deteriorations are often unexpected and severe, and particularly difficult to evaluate in the context of psychotic disorders. For this new edition, the Handbook of Medicine in Psychiatry has been updated and streamlined to provide a realistic approach to the medical issues encountered in psychiatric practice by helping clinicians answer whether their patient: • Is at risk of dying or becoming severely disabled.• Requires an immediate therapeutic intervention for a potentially life-threatening condition.• Needs to be transferred to an emergency medicine setting.• Requires urgent investigations.• Must have changes made in the current medication regimen. Clinical vignettes for each chapter illustrate the complexity of the presentation of abnormal vital signs and somatic disorders in psychiatric settings, including fever, hypertension, seizures, and nausea and vomiting. The guide also provides risk stratification for major complications -- from abnormal thyroid function and acute kidney injury to myocarditis and venous thromboembolism -- enabling readers to determine the need for a transfer of the patient to an emergency medicine setting. A brand-new section features thorough discussions of topics requiring interdisciplinary collaboration with geriatricians, neurologists, anesthesiologists, addiction medicine, and adolescent medicine specialists. Clinicians working in today's busy inpatient and outpatient psychiatric settings will find in these pages a cognitive framework and knowledge base that will aid them in accurate decision making in the conditions of uncertainty created by potentially major medical deteriorations of the vulnerable populations under their care.

ObjectivesThis study considers whether, in an easy access single-payer health care system, patients placed on outpatient commitment—community treatment orders (CTOs) in Victoria Australia—are more likely to access acute medical care addressing physical illness than voluntary patients with and without severe mental illness.MethodFor years 2000 to 2010, the study compared acute medical care access of 27,585 severely mentally ill psychiatrically hospitalized patients (11,424 with and 16,161 without CTO exposure) and 12,229 never psychiatrically hospitalized outpatients (individuals with less morbidity risk as they were not considered to have severe mental illness). Logistic regression was used to determine the influence of the CTO on the likelihood of receiving a diagnosis of physical illness requiring acute care.ResultsValidating their shared and elevated morbidity risk, 53% of each hospitalized cohort accessed acute care compared to 32% of outpatients during the decade. While not under mental health system supervision, however, the likelihood that a CTO patient would receive a physical illness diagnosis was 31% lower than for non-CTO patients, and no different from lower morbidity-risk outpatients without severe mental illness. While, under mental health system supervision, the likelihood that CTO patients would receive a physical illness diagnosis was 40% greater than non-CTO patients and 5.02 times more likely than outpatients were. Each CTO episode was associated with a 4.6% increase in the likelihood of a member of the CTO group receiving a diagnosis.ConclusionMental health system involvement and CTO supervision appeared to facilitate access to physical health care in acute care settings for patients with severe mental illness, a group that has, in the past, been subject to excess morbidity and mortality.

The loss of reason, a sense of alienation from the commonsense world we all like to imagine we inhabit, the shattering emotional turmoil that seizes hold and won't let go-these are some of the traits we associate with madness. Today, mental disturbance is most commonly viewed through a medical lens, but societies have also sought to make sense of it through religion or the supernatural, or by constructing psychological or social explanations in an effort to tame the demons of unreason.Madness in Civilizationtraces the long and complex history of this affliction and our attempts to treat it. Beautifully illustrated throughout,Madness in Civilizationtakes readers from antiquity to today, painting a vivid and often harrowing portrait of the different ways that cultures around the world have interpreted and responded to the seemingly irrational, psychotic, and insane. From the Bible to Sigmund Freud, from exorcism to mesmerism, from Bedlam to Victorian asylums, from the theory of humors to modern pharmacology, the book explores the manifestations and meanings of madness, its challenges and consequences, and our varied responses to it. It also looks at how insanity has haunted the imaginations of artists and writers and describes the profound influence it has had on the arts, from drama, opera, and the novel to drawing, painting, and sculpture. Written by one of the world's preeminent historians of psychiatry,Madness in Civilizationis a panoramic history of the human encounter with unreason.

The history of psychiatric institutions and the psychiatric profession is by now familiar: asylums multiplied in nineteenth-century England and psychiatry established itself as a medical specialty around the same time. We are, however, largely ignorant about madness at home in this key period: what were the family's attitudes toward its insane member, what were patient's lives like when they remained at home? Until now, most accounts have suggested that the family and community gradually abdicated responsibility for taking care of mentally ill members to the doctors who ran the asylums. However, this provocatively argued study, painting a fascinating picture of how families viewed and managed madness, suggests that the family actually played a critical role in caring for the insane and in the development of psychiatry itself. Akihito Suzuki's richly detailed social history includes several fascinating case histories, looks closely at little studied source material including press reports of formal legal declarations of insanity, or Commissions of Lunacy, and also provides an illuminating historical perspective on our own day and age, when the mentally ill are mainly treated in home and community.

Supporting Troubled Young People provides a vital and much-needed resource for anyone involved with children and young people who are suffering from or at risk of developing, mental health problems. Problems such as self-harm, eating disorders, and anxiety and depression are increasing, while young men, in particular, are at increasing risk of suicide. This is against a backdrop of NHS CAMH services unable to cope with demand and resources in the voluntary sector being stretched beyond their capacity. This means parents, teachers, social workers and nurses are often the first and only help available. This book gives them a jargon-free, accessible guide to help them assess situations, provide skills and guidance to support children and young people, and know how and where to get more help for them. Full of practical tips, advice, exercises and case studies. Articulates gender, multi-cultural, spirituality and sexuality issues. Tackles contemporary issues such as cyber bullying, eating disorders and self-harm. Uses research and established theory in an engaging way enabling the reader to translate ideas into modern multi-cultural practice. Supporting Troubled Young People provides any worker involved in supporting, helping and caring for young people with a practical resource to use in their work as teachers, social workers, nurses, youth workers, doctors, foster carers, residential staff, psychologists and psychiatrists. Parents and young people will also find much of value here. This book makes a rich contribution to the understanding and treatment of children's mental health at a time when this is desperately needed. It is well-informed, full of case illustrations to guide the reader, and is written by a compassionate therapist and researcher with a solid grasp of the complex social environment in which children live today. Dr Chris Nicholson - Head of the Department of Psychosocial and Psychoanalytic Studies, University of Essex

Zones of social abandonment are emerging everywhere in Brazil’s big cities—places like Vita, where the unwanted, the mentally ill, the sick, and the homeless are left to die. This haunting, unforgettable story centers on a young woman named Catarina, increasingly paralyzed and said to be mad, living out her time at Vita. Anthropologist João Biehl leads a detective-like journey to know Catarina; to unravel the cryptic, poetic words that are part of the “dictionary” she is compiling; and to trace the complex network of family, medicine, state, and economy in which her abandonment and pathology took form. An instant classic, Vita has been widely acclaimed for its bold fieldwork, theoretical innovation, and literary force. Reflecting on how Catarina’s life story continues, this updated edition offers the reader a powerful new afterword and gripping new photographs following Biehl and Eskerod’s return to Vita. Anthropology at its finest, Vita is essential reading for anyone who is grappling with how to understand the conditions of life, thought, and ethics in the contemporary world.

People with serious mental illness get sick and die 10--20 years earlier than their same age cohort. The social determinants are many: stigma associated with mental illness, poverty, ethnicity-based discrimination, higher rates of smoking and alcohol and drug use, and poor diet and exercise patterns, to name a few. Although multiple interventions have emerged as ways to combat these health challenges, additional research is necessary for the continued development and evaluation of strategies. This context serves as the springboard for Health and Wellness in People Living With Serious Mental Illness. Through multiple case vignettes, the book delves into the challenges of health and wellness for people with mental illness -- including those listed above -- summarizing the research on mortality and morbidity in this group as well as information about the status quo on wellness. It also provides a thorough description of community-based participatory research (CBPR), an approach that includes people in a community as partners in all facets of research, rather than just the subjects of that research. CBPR acts as the lens through which this guide considers solutions to these health problems, including integrated services and patient-centered medical homes; medical practices that diminish the iatrogenic effects of psychiatry; psychoeducation; interpersonal supports; and shared decision-making. Co-edited by Patrick Corrigan, with a 30-year history in services research, and Sonya Ballentine, a community-based member of a CBPR team, this volume offers a grounded, real-world illustration of CBPR in practice. Students of psychiatry, practicing clinicians, primary care providers, allied health professionals, policy makers -- all will find, in the pages of this book, a nuanced portrait of the health challenges patients with mental illness face, possible treatment options, and future directions for the field.

Alzheimer's Disease and Other Related Dementias (AD/ADRD) leads to frequent emergency department (ED) and inpatient use. Mental health symptoms among persons with AD/ADRD increases cognitive and functional disabilities and could contribute to these high rates of intensive health care use. The objective of this paper is to assess the relationship of mental illness on 12-month patterns in hospitalization and ED use among Veterans aged 65 and over with a new AD/ADRD diagnosis. We used an existing dataset of administrative electronic health record data of Veterans with AD/ADRD from the US Veterans Health Administration linked with Medicare claims data from 2011-2015. We use multivariable logistic regression to examine the association between no pre-existing mental illness, pre-existing mental illness (e.g., major depressive disorder, generalized anxiety disorder, or post-traumatic stress disorder), and pre-existing severe mental illness-or SMI-(e.g., bipolar disorder, major depressive disorder with psychosis, or schizophrenia) and 12- month ED and hospitalization use and readmissions among Veterans who had an initial hospitalization visit. We estimated predicted probabilities, differential effect, and associated 95% confidence intervals. In our sample, 1.4% had SMI and 11% had non-SMI mental illness. The unadjusted percentage with inpatient and ED use was higher among Veterans with SMI (34% and 26%, respectively) and Veterans with non-SMI mental illness (20%, 16%) compared with Veterans without pre-existing mental illness (12%, 9%). Compared to individuals with no pre-existing mental illness, having a pre-existing mental illness (1.27 percentage points, 95% CI: 0.76, 1.78) and a pre-existing SMI (7.17 percentage points, 95% CI: 5.66, 8.69) were both associated with an increased likelihood of ED use. The same pattern was observed for any inpatient use (mental illness 2.18, 95% CI: 1.59, 2.77; SMI 9.91, 95% CI: 8.21, 11.61). Only pre-existing SMI was associated higher hospitalization readmission. Pre-existing mental illness increases use of high cost, intensive health care and this association is higher of more severe mental health conditions. We also show that pre-existing mental illness exerts a unique influence, above and beyond other comorbidities, such as diabetes, on ED and inpatient visits. More needs to be done to increase recognition of the unique risks of this combination of health conditions and encourage strategies to address them. Developing, testing, and implementing comprehensive strategies that address the intersection of ADRD and mental illness is promising approach that requires more focused attention.

In the late 1970s, South African mental institutions were plagued with scandals about human rights abuse, and psychiatric practitioners were accused of being agents of the apartheid state. Between 1939 and 1994, some psychiatric practitioners supported the mandate of the racist and heteropatriarchal government and most mental patients were treated abysmally. However, unlike studies worldwide that show that women, homosexuals and minorities were institutionalized in far higher numbers than heterosexual men, Psychiatry, Mental Institutions and the Mad in Apartheid South Africa reveals how in South Africa, per capita, white heterosexual males made up the majority of patients in state institutions. The book therefore challenges the monolithic and omnipotent view of the apartheid government and its mental health policy. While not contesting the belief that human rights abuses occurred within South Africa's mental health system, Tiffany Fawn Jones argues that the disparity among practitioners and the fluidity of their beliefs, along with the disjointed mental health infrastructure, diffused state control. More importantly, the book shows how patients were also, to a limited extent, able to challenge the constraints of their institutionalization. This volume places the discussions of South Africa's mental institutions in an international context, highlighting the role that international organizations, such as the Church of Scientology, and political events such as the gay rights movement and the Cold War also played in shaping mental health policy in South Africa.

Alzheimer's Disease and Other Related Dementias (AD/ADRD) leads to frequent emergency department (ED) and inpatient use. Mental health symptoms among persons with AD/ADRD increases cognitive and functional disabilities and could contribute to these high rates of intensive health care use. The objective of this paper is to assess the relationship of mental illness on 12-month patterns in hospitalization and ED use among Veterans aged 65 and over with a new AD/ADRD diagnosis. We used an existing dataset of administrative electronic health record data of Veterans with AD/ADRD from the US Veterans Health Administration linked with Medicare claims data from 2011-2015. We use multivariable logistic regression to examine the association between no pre-existing mental illness, pre-existing mental illness (e.g., major depressive disorder, generalized anxiety disorder, or post-traumatic stress disorder), and pre-existing severe mental illness-or SMI-(e.g., bipolar disorder, major depressive disorder with psychosis, or schizophrenia) and 12- month ED and hospitalization use and readmissions among Veterans who had an initial hospitalization visit. We estimated predicted probabilities, differential effect, and associated 95% confidence intervals. In our sample, 1.4% had SMI and 11% had non-SMI mental illness. The unadjusted percentage with inpatient and ED use was higher among Veterans with SMI (34% and 26%, respectively) and Veterans with non-SMI mental illness (20%, 16%) compared with Veterans without pre-existing mental illness (12%, 9%). Compared to individuals with no pre-existing mental illness, having a pre-existing mental illness (1.27 percentage points, 95% CI: 0.76, 1.78) and a pre-existing SMI (7.17 percentage points, 95% CI: 5.66, 8.69) were both associated with an increased likelihood of ED use. The same pattern was observed for any inpatient use (mental illness 2.18, 95% CI: 1.59, 2.77; SMI 9.91, 95% CI: 8.21, 11.61). Only pre-existing SMI was associated higher hospitalization readmission. Pre-existing mental illness increases use of high cost, intensive health care and this association is higher of more severe mental health conditions. We also show that pre-existing mental illness exerts a unique influence, above and beyond other comorbidities, such as diabetes, on ED and inpatient visits. More needs to be done to increase recognition of the unique risks of this combination of health conditions and encourage strategies to address them. Developing, testing, and implementing comprehensive strategies that address the intersection of ADRD and mental illness is promising approach that requires more focused attention.