Academic literature on the topic 'Schizophrenia Treatment Victoria'

Objective: To assess the uses of Community Treatment Orders (CommTOs) in New Zealand. Method: A retrospective study of patients' records held by the regional administrator of mental health legislation and a survey of psychiatrists attending a conference in Dunedin. Results: Males under Community Treatment Orders (CommTOs) outnumbered females 6:4; a high proportion were considered to have a major psychotic disorder; and one fifth remained under a CommTO for more than a year without inpatient care. Among the psychiatrists, there was a high level of agreement that, when used appropriately, the benefits of CommTOs outweigh their coercive impact on the patients; the most strongly supported indicator for use was the promotion of compliance with medication. The rate of use of CommTOs in Otago is remarkably similar to the rate in Victoria, Australia. Conclusions: Records suggest that a significant proportion of patients under CommTOs are not soon readmitted; and many clinicians in New Zealand consider CommTOs to be a useful strategy for managing the community care of long-term patients with schizophrenia and major affective disorders.

Objective: The aim of the present study was to describe characteristics and post-release outcomes of Victorian homicide offenders under the Crimes (Mental Impairment and Unfitness to be Tried) Act 1997 (and/or its forerunner legislation) released from forensic inpatient psychiatric care since the development of specialist forensic services. Method: A legal database identified subjects meeting inclusion criteria: hospitalized in forensic psychiatric care due to finding of mental impairment or unfitness to stand trial for homicide in Victoria; released into the community; and released between 1 January 1991 and 30 April 2002. Using clinical records, demographics, index offence, progress in hospital, diagnosis, psychosocial and criminological data were obtained. Outcomes (offending or readmission into secure care) were obtained from the clinical records. Results: Of the 25 subjects, 19 (76%) were male. Primary diagnoses on admission to forensic hospital care were schizophrenia, n = 16 (64%); other psychotic disorder, n = 5 (20%); depression, n = 3 (12%); and personality disorder, n = 1 (4%). Mean time in custodial supervision was 11 years and 2 months, less for those whose offence occurred after the development of forensic rehabilitation services. In the first 3 years after release, there was a single episode of criminal recidivism, representing a recidivism rate of 1 in 25 (4%) over 3 years. Twelve subjects (48%) were readmitted at some point in the 3 year follow up. Conclusion: There was a very low rate of recidivism after discharge, but readmissions to hospital were common. Lengths of custodial care were reduced after the introduction of forensic rehabilitation facilities. Recidivism is low when there are well-designed and implemented forensic community treatment programmes, consistent with other data suggesting a reciprocal relationship between safe community care and a low threshold for readmission to hospital, lessening re-offending at times of crisis. Further research should be directed at timing of release decisions, based on reducing identified risk factors to acceptable levels.

SynopsisClinical analyses of 19th century psychiatric practice have been limited by the paucity of available records. Using the richly detailed casebooks of Ticehurst House Asylum, it was possible to study over 600 admissions and assess them using the Research Diagnostic Criteria. Over 80% of cases conformed to recognizable psychiatric illness, mainly schizophrenia and manicdepressive psychosis. Movement disorder, often equivalent to tardive dyskinesia, was noted in nearly one-third of schizophrenics. Violence, masturbation and severe psychopathology were also common features. The implications of these findings in terms of treatment, diagnosis and the rise of the asylum are discussed.

Objective: To critically examine a recent decision of the Victorian Supreme Court that found that the Mental Health Tribunal and the Victorian Civil and Administrative Tribunal erred in the application of the capacity test in the Mental Health Act 2014 (Vic) and that compulsory electroconvulsive therapy would infringe upon the human rights of two patients who had no insight into their chronic schizophrenia. Conclusions: After considering the concepts of insight and capacity to consent to treatment, the paper concludes that the decision in NJE and PBU v Mental Health Tribunal [2018] VSC 564 is problematic clinically.

The author, who has spent over 60 years working in a variety of mental health settings, shares his personal perspective of the way psychiatry has evolved. Treatments, both physical and psychological, have come and some have been discarded. There have been radical changes in the delivery of care, from the 2000-bed Victorian asylum to community care, and the on the whole beneficial impact of legislation such as mental health Acts and Acts dealing with suicide, abortion and sexual offences. His experience has warned him of the folly of overenthusiasm for some treatments – such as deep insulin for schizophrenia, psycho surgery, and even classical psychoanalysis which can become as addictive as any drug or a promise of salvation as convincing as a religion. On the other hand, a treatment involving passing electric shocks through the brain has stood the test of time and may be life saving for some patients.

Objectives: This paper considers the impact of having a diagnosis of substance use disorder on the utilisation of compulsory orders under the Victorian Mental Health Act (2014). Methods: We analysed the subsequent treatment episodes over 2 years of people who had been on a community treatment order for at least 3 months and determined the odds of a further treatment order if there was a diagnosis of substance use at or about the time the index community treatment order ended. Results: An additional diagnosis of a substance use disorder was coded in 47.7% and was associated with significantly increased odds of a subsequent treatment order in the following 2 years for those with a main diagnosis of schizophrenia (AOR = 3.03, p<0.001) and ‘other’ disorders (AOR = 11.60, p=0.002). Those with a main diagnosis of mood disorder had a significant increase in odds for an inpatient treatment order if there was an additional substance use disorder diagnosis (AOR = 3.81, p=0.006). Conclusions: Having an additional diagnosis of substance use disorder was associated with increased likelihood of being placed on an order. This study supports greater emphasis being given to treatment of substance use concurrently with that of mental illness.

SynopsisThe case histories of the patients newly admitted to the Retreat Asylum in York between 1880–1884 were examined. Most patients were aged under 50 years, single and non-Quaker, and a majority satisfied the Research Diagnostic Criteria for a diagnosis of schizophrenia or affective disorder. It was found that 72·9% of the patients were deluded, the most common delusions being of persecution, grandeur and guilt; in 34·9% of the deluded patients, the delusion had a religious content. Suicidal ideation was recorded in the case records of 31·4% of the patients. Drug therapy was commonly prescribed, a history of assault on other patients or asylum staff was recorded in 38·1% of the patients, and 11% of patients were force fed at some stage during their illness. Within a year of admission 49·1% of the patients were discharged, the prognosis being better for patients with an affective illness than for schizophrenia, but 31·4% remained in the asylum for five or more years.The characteristics, alleged causes of mental illness, and treatment and outcome of the Retreat patients were compared with those of patients admitted during the same period to the two other York asylums which served different socio-economic groups of the population. Mortality rates were higher in the asylum admitting mainly pauper patients, and possible reasons for this are explored.

Aggression is a serious biomedical problem associated with a high percentage of patients and a lack of selective corrective agents. The most frequent increase in aggressiveness occurs in patients with depressive disorders, schizophrenia, reactive psychoses and adjustment disorders, which are known to be characterized by immunological dysfunction. Antipsychotics are widely used in the correction of psychomotor agitation; the antipsychotic effect of these drugs is manifested in the achievement of a sedative effect. However, like other psychoactive substances, they have a number of side effects that limit their long-term use and determines the need to search for new approaches to the correction of affective disorders. Experimental modeling of aggression is one of the main approaches for studying its pathogenetic mechanisms and searching for new effective therapeutic agents for the treatment. The study of the aggression pathogenetic mechanisms and the search for approaches to therapy within the framework of neuroimmune interaction is currently extremely promising. Currently, there is a large number of clinical and experimental data indicating interrelated changes in the functional activity of the nervous and immune systems during aggression. The leading links in the pathogenetic mechanism of aggression is the violation of the production and mutual regulation of cytokines, neurotransmitters, neuropeptides, growth factors, hormones, the effects of which are mediated by the cellular elements of the immune system. Given the immune cells essential role in the pathogenesis of aggression and the psychoactive substances unidirectional effect on the immune and nervous cells, make it possible to consider immune cells as model objects for influencing the intersystem functional relationship in order to edit the aggressive phenotype. The aim of the study was to investigate the effect of in vitro neuroleptic-modulated immune cells transplantation on behavioral phenotype and brain cytokines in aggressive syngeneic recipients. Aggressive behavior was formed in active male mice (CBA × C57Bl/6) F1 as a result of the experience of 20- fold victories in inter-male confrontations (distant sensory contact model). Aggressive mice splenocytes were treated in vitro with chlorpromazine and intravenously injected to syngeneic aggressive recipients. It has been demonstrated that modulated in vitro by chlorpromazine splenocytes of aggressive mice after transplantation edit the syngeneic aggressive recipient’s behavior against the background of a decrease in cytokines IL-1β, IL-2, IL-6, IFNγ and an increase in IL-4 in pathogenetically significant for aggression brain structures. The mechanisms of the aggressive behavior correcting effect of modulated immune cells are discussed.

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Integrating mental illness, suicide and religion</strong></p><p>Volker Hitzeroth</p><p><strong>17. Cost of acute inpatient mental health care in a 72-hour assessment uniy</strong></p><p>A B R Janse van Rensburg, W Jassat</p><p><strong>18. Management of Schizophrenia according to South African standard treatment guidelines</strong></p><p>A B R Janse van Rensburg</p><p><strong>19. Structural brain imaging in the clinical management of psychiatric illness</strong></p><p>F Y Jeenah</p><p><strong>20. ADHD: Change in symptoms from child to adulthood</strong></p><p>S A Jeeva, A Turgay</p><p><strong>21. HIV-Positive psychiatric patients in antiretrovirals</strong></p><p>G Jonsson, F Y Jeenah, M Y H Moosa</p><p><strong>22. A one year review of patients admitted to tertiary HIV/Neuropsychiatry beds in the Western Cape</strong></p><p>John Joska, Paul Carey, Ian Lewis, Paul Magni, Don Wilson, Dan J Stein</p><p><strong>23. 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Urinary Cortisol secretion and traumatics in a cohort of SA Metro policemen A longitudinal study</strong></p><p>Ugash Subramaney</p><p><strong>54. Canabis use in Psychiatric inpatients</strong></p><p><strong></strong>M Talatala, G M Nair, D L Mkize</p><p><strong>55. Pathways to care and treatmt in first and multi-episodepsychosis: Findings fm a developing country</strong></p><p>H S Teh, P P Oosthuizen</p><p><strong>56. Mental disorders in HIV-infected indivat various HIV Treatment sites in South Africa</strong></p><p>Rita Thom</p><p><strong>57. Attendanc ile of long-term mental health care users at ocupational therapy group sessions at Weskoppies Hospital</strong></p><p>Ronel van der Westhuizen, Christa Kruger</p><p><strong>58. Epidemiological patterns of extra-medical drug use in South Africa: Results from the South African stress and health study</strong></p><p>Margaretha S van Heerden, Anna Grimsrud, David Williams, Dan Stein</p><p><strong>59. 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Abstract Background Assignment to a community treatment order (CTO) has been associated with reduced mortality- risk. In Victoria Australia civil-rights enhancements involving capacity to refuse involuntary-treatment has contributed to a 15% reduction between 2010-2019 in CTO-assignments among first hospitalized patients with Schizophrenia-diagnoses. Has this change impacted patient mortality-risk? Study Design This study considered mortality-risk between 2010-2019 for three patient-groups with schizophrenia diagnoses: All 4,848 hospitalized-patients assigned to a CTO for the first time in the period. 3,988 matched and randomly selected patients, first-hospitalized in the decade, without CTO-assignment, And, 1,675 never-hospitalized or CTO-assigned outpatients. Deaths of Schizophrenic-patients in each group were evaluated against expected-deaths given Standardized Mortality Ratios for Victoria. Logistic regression was used to evaluate mortality-risk for each treatment-group while taking account of race, demographics, differential access to initial diagnoses of life-threatening physical illness, mental health service resources, and indicators of social disadvantage. Study Results 78% of the 777 deaths of schizophrenia patients in all three groups were premature. The two hospitalized-groups did not differ in mortality-risk. Among Victoria’s 2010-2019 outpatients (inclusive of treatment-refusers with a recorded service-contact), 16.2% had a Schizophrenia diagnosis--up from 0.2% of 2000-2009 in the prior decade. Outpatients with Schizophrenia were at 48% greater risk of death than individuals in the hospitalized groups, taking all the afore mentioned risk factors into account. Conclusions Reductions in CTO-utilization associated with potential treatment refusals of involuntary community-treatment supervision, seems to have increased mortality-risk for this vulnerable-population. The line between civil rights protection and abandonment has been blurred.