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Physical health of psychiatric patients admitted to a low secure challenging behaviour unit

Published online by Cambridge University Press:  09 June 2006

C Sebastian  and
M D Beer
C Sebastian
Affiliation:
Bracton Centre, Oxleas NHS Trust, Dartford, UK
M D Beer
Affiliation:
Bracton Centre, Oxleas NHS Trust, Dartford, UK
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Abstract

Aims: To determine the prevalence of physical illness in patients admitted to a challenging behaviour unit and to assess whether they were physically examined and investigated.

Method: Retrospective case note analysis of patients admitted to the challenging behaviour unit during the period of July 1997 to July 2003.

Results: All patients were suffering from serious and enduring mental illness and challenged the ordinary mental health services by behaviour such as assault, fire setting, aggression, self harm, multiple substance misuse and non-compliance at least for six months.

On admission 76% of patients had examination of the cardiovascular, respiratory and gastro intestinal system and 69% of the central nervous system. During the hospital stay, all the patients had cardio vascular, respiratory and gastrointestinal system examination and 83% had central nervous system examination. All patients had base line investigations including full blood count, ESR, liver function test, urea and electrolytes, random glucose, thyroid function test and follow up investigations.

51(73%) patients were found to be suffering from some physical illness during their hospital stay. The physical illness spanned all the systems. There were newly detected cases of systemic lupus erythematosus, diabetes mellitus, glaucoma, hypertension, seizure disorder, male urinary tract infection, severe incontinence and haematological problems.

Conclusion: There is a high prevalence of physical health problems among patients admitted to a challenging behaviour unit. Some problems were associated with the mental illness, some as a complication of the mental health problem and others secondary to psychotropic medication. This study highlights the importance of a proper medical history, physical examination, base line investigations and regular monitoring of the physical health of mentally ill patients.

Keywords

Mental health challenging behaviour unitlow secure unitphysical health problems
Type
Original Paper
Information
Journal of Psychiatric Intensive Care , Volume 1 , Issue 2 , December 2005 , pp. 77 - 83
Copyright
© 2006 NAPICU

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References

David, C.H., Enrico, C., Colin, G., Rima, A.N., Doug, L.H., David, A.S. and Donald, C.G. (2000) Clozapine, Diabetes Mellitus, Weight Gain, and Lipid Abnormalities: A Five-Year Naturalistic Study. American Journal of Psychiatry. 157: 975–981.Google Scholar
David, P.J. and James, P.W. (1998) Assessing the physical health of psychiatric patients. Psychiatric Bulletin. 22: 695–697.Google Scholar
Glassman, A.H. and Bigger, J.T. (2001) Antipsychotic drugs – prolonged QT interval, torsade des pointes and sudden death. American Journal of Psychiatry. 158: 1774–1782.Google Scholar
Halbreach, U. and Palter, S. (1996) Accelerated osteoporosis in psychiatric patients, possible patho-physiological processes. Schizophrenia Bulletin. 22: 447–454.Google Scholar
Harris, E. and Brian, B. (1998) Excess mortality of mental disorder. British Journal of Psychiatry. 173(7): 11–53.Google Scholar
Hughes, S. (1991) The physical examination in psychiatry. Psychiatric Bulletin. 15: 615–616.Google Scholar
Irene, C., David, M., Michel, F. (2004) Improving the physical health of long stay psychiatric inpatients. Advances in Psychiatric Treatment. 10: 107–115.Google Scholar
Jogin, H.T. (2004) Metabolic disturbance in first-episode schizophrenia. British Journal of Psychiatry. 184(suppl.47): 76–79.Google Scholar
Joukamaa, M., Heliovaara, M., Knekt, P., Aroma, A., Raitasalo, R. and Lehtinen, V. (2001) Mental disorders and cause-specific mortality. British Journal of Psychiatry. 179: 498–502.Google Scholar
Kostakoglu, A., Yazici, K., Erbas, T. and Guvener, N. (1996) Ketoacidosis as a side-effect of clozapine: a case report. Acta Psychiatrica Scandinavica. 93(3): 217–218.Google Scholar
Koran, M., Harold, C.S., Keith, I., Sally, M., Carol, H.S., Helena, C.K., Imai, C., Thomas, G.K., Theodore, G.R. Jr., Larry, C.L. and Satish Chandra. (1989) Medical evaluation of psychiatric patients. Archives of General Psychiatry. 46: 733–740.Google Scholar
Lindenmayer, J.P., Nathan, A.M. and Smith, R.C. (2001) Hyperglycaemia associated with the use of atypical anti-psychotics. Journal of Clinical Psychiatry. 62: 30–38.Google Scholar
Mitchell, A.C., McCabe, E.M. and Brown, K.M. (1998) Psychiatrists' attitudes to physical examination of new outpatients with major depressive disorder. Psychiatric Bulletin. 22: 82–84.Google Scholar
O'Hare, T. (1995) Improvements in practice from assessing standards of recording psychiatric case notes. Psychiatric Bulletin. 19: 352–354.Google Scholar
Patterson, C.W. (1978) Psychiatrists and physical examination: a survey. American Journal of Psychiatry. 35: 967–968.Google Scholar
Ray, W.A., Meredith, S., Thapa, P.B., et al. (2001) Anti-psychotics and the risk of sudden cardiac death. Archives of General Psychiatry. 58: 1161–1167.Google Scholar
Sanjay, G., Charles, S., Bradford, F., Madhusoodanan, S., Kari, L., Barbara, L. and Peggy, K. (2003) Hyperglycaemia and hypertriglyceridemia in real world patients on antipsychotic therapy. American Journal of Therapeutics. 10: 348–355.Google Scholar
Sernyak, M.J., Lesley, D.L., Alarcon, R.D. and Losonczy, M.F. (2002) Rosenheck R.Association of diabetes mellitus with the use of atypical neuroleptics in the treatment of schizophrenia. American Journal of Psychiatry. 159: 561–566.Google Scholar
Sheku, G.K., Paul, D.P. and Jerry, L.D. (1998) Prevalence of physical illness among psychiatric patients who die of natural causes. Psychiatric Services. 49: 788–793.Google Scholar
Smith, S., Wheeler, M.J., Murray, R. and O'Keane, V. (2002) The effects of antipsychotic induced hyperprolactine-mia on hypothalamo-pituitary-gonadal axis. Journal of Clinical Psychopharmacology. 22: 109–114.Google Scholar
Timothy, J.R.L., Dennis, V. and Christose, P. (2003) Medical co-morbidity in schizophrenia. Medical Journal of Australia. 178: 67–70.Google Scholar
Ung, G.K., Jun, S.K., Yong, M.A., Sun, J.C., Jee, H.H., Yong, J.K. and Yong, S.K. (2000) Electrocardiographic abnormalities in patients treated with clozapine. Jounal of Clinical Psychiatry. 61(6): 441–446.Google Scholar