Search

Aim: Mental health‐related stigma is considered a significant barrier to help‐seeking and accessing care in those experiencing mental illness. Long duration of untreated psychosis is associated with poorer outcomes. The impact of stigma on the duration of untreated psychosis, in first‐episode psychosis remains unexplored. To examine the association between mental health‐related stigma and access to care in people experiencing first‐episode psychosis in Birmingham, UK. Methods: We collected data on a prospective cohort of first‐episode psychosis. The Stigma Scale was used as a measure of mental health‐related stigma, and duration of untreated psychosis as a measure of delay in accessing care. We performed logistic and linear regression analyses to explore the relationship between mental health‐related stigma and duration of untreated psychosis, adjusting for sex, age, educational level, religion and ethnicity. Results: On the 89 participants included in this study, linear regression analysis revealed that overall stigma and the discrimination sub‐factor were significant predictors of longer duration of untreated psychosis, whereas logistic regression identified the disclosure sub‐factor to be a significant predictor of longer duration of untreated psychosis. Conclusions: These findings demonstrate that stigmatizing views of mental illness from the patient's perspectives can result in delayed access to care. This emphasizes the importance of tackling mental health‐related stigma to ensure early treatment and improved outcomes for people experiencing first‐episode psychosis. [ABSTRACT FROM AUTHOR]

• The Mental Healthcare Act India (2017) replaced the Mental Health Act of 1987. • This new Law marks a major shift in the way mental healthcare is delivered, as it aims to protect and promote the rights of people during the delivery of mental healthcare. • Within this Act, a capacitous individual cannot be coerced into receiving treatment for mental illness; admissions can be 'independent' or 'supported' and 'supported admission' replaces involuntary admissions of the previous legislation. • State mental health authorities and regional mental health review boards will play a major role in the implementation of the new Act. • It upholds patient autonomy, dignity, rights and choices during mental healthcare and thus marks a bold step in India's mental health legislation. The Mental Healthcare Act 2017 replaced the Mental Health Act 1987, subsequent to India's ratification of the United Nations Convention on the Rights of Persons with Disabilities in 2007. The Mental Healthcare Act (MHCA) 2017 upholds patient autonomy, dignity, rights and choices during mental healthcare and thus marks a bold step in India's mental health legislation. This new Law marks a major shift in the way mental healthcare is delivered, as it aims to protect and promote the rights of people during the delivery of mental healthcare. Within this Act, a capacitous individual cannot be coerced into receiving treatment for mental illness and inpatient admissions can be 'independent' or 'supported'. 'Supported admission' replaces involuntary admission from the previous legislation. State mental health authorities and mental health review boards will play a major role in the implementation of the new Act. The Mental Healthcare Act 2017 is aimed at bringing about radical transformation to mental healthcare in India. [ABSTRACT FROM AUTHOR]

Aim: Exploring how negative symptoms are experienced and understood by individuals with lived experience of psychosis has the potential to offer insights into the complex psychosocial processes underlying negative symptom presentations. The aim of the current study was to investigate lived experiences of negative symptoms through secondary analysis of interviews conducted with individuals recovering from first‐episode psychosis. Method: Transcripts of in‐depth interviews with participants (n = 24) recruited from Early Intervention in Psychosis services were analysed thematically with a focus on participants' experiences and personal understandings of features corresponding to the negative symptoms construct. Results: Descriptions of reductions in expression, motivation and sociability were common features of participants' accounts. Several participants described the experience of having difficulty interacting as like being a "zombie". Some participants experienced diminished capacity for emotion, thought or drive as underlying these experiences. However, participants typically attributed reductions in expression, motivation and sociability to medication side‐effects, lack of confidence or active avoidance intended to protect them from rejection or ridicule, sometimes linked to internalized stigma. Conclusions: Personal accounts of experiences of reduced expression, motivation and sociability during first‐episode psychosis highlight the personal meaningfulness and role of agency in these features, challenging the framing of negative symptoms as passive manifestations of diminished capacity. [ABSTRACT FROM AUTHOR]

Aim: First‐episode psychosis (FEP) can be a serious and debilitating disease, but there is limited literature on how to inform patients and carers about its diagnosis and outcome. We aimed to examine the attitudes, practices and views of clinicians working in Early Intervention Service about sharing information on diagnosis and outcome of FEP. Methods: A 26‐item questionnaire was sent electronically to clinical staff who have been involved in the discussion of FEP diagnosis in Early Intervention Services in the West Midlands, UK. Results: A total of 51 clinicians completed the questionnaire. All respondents stated that patients or carers of those presenting with FEP wish to be informed of their diagnosis, and three‐quarters (76%) felt there is a need to develop guidelines on how to inform about diagnosis; 57% stated that they usually use broad diagnostic groups such as psychosis when discussing diagnosis, and only 11% use the term schizophrenia. A total of 40% thought that the therapeutic relationship and treatment adherence (58%) would improve if patients know about their diagnosis; 42 (88%) respondents felt that the likely outcome of the illness should also be discussed with patients when the diagnosis is communicated. Conclusion: The clinicians were aware that service users wished to be informed about the diagnosis and outcome of FEP but had no guidance on the subject. Despite the limitations of an online self‐administered survey, the study highlights the need for guidance and improving clinical practice in discussing the diagnosis of FEP in a vulnerable population. [ABSTRACT FROM AUTHOR]

Aim: Early intervention services (EIS) for psychosis are being implemented, internationally. It is important to learn from established examples and define the components and intensity of services that provide good value for money. This study aims to assess the cost‐effectiveness of EIS according to how closely they adhered to the recommendations of the English Department of Health 2001 Policy Implementation Guide (PIG). Methods: EIS from the National Eden Study were assessed using a measure of fidelity to the PIG that rated the presence or absence of 64 recommended items relating to team structure and practice. EIS were then classified into three groups: those with fidelity of 75–80%, 81–90% and 91–95%. Patient‐level resource use and outcomes were measured 1 year following inception into the service; costs were calculated and combined with quality‐adjusted life years (QALYs) gained. Results: At a threshold of £20 000 per QALY, the 81–90% fidelity group had a 56.3% likelihood of being the most cost‐effective option followed by 75–80% fidelity at 35.8% and 91–95% fidelity group (7.9%). Conclusions: The results from England suggest that striving to maximize fidelity may not be warranted, but that dropping below a certain level of fidelity may result in inefficient use of resources. [ABSTRACT FROM AUTHOR]

Introduction Disruption of care during transition from child and adolescent mental health services (CAMHS) to adult mental health services may adversely affect the health and well-being of service users. The MILESTONE (Managing the Link and Strengthening Transition from Child to Adult Mental Healthcare) study evaluates the longitudinal course and outcomes of adolescents approaching the transition boundary (TB) of their CAMHS and determines the effectiveness of the model of managed transition in improving outcomes, compared with usual care. Methods and analysis This is a cohort study with a nested cluster randomised controlled trial. Recruited CAMHS have been randomised to provide either (1) managed transition using the Transition Readiness and Appropriateness Measure score summary as a decision aid, or (2) usual care for young people reaching the TB. Participants are young people within 1 year of reaching the TB of their CAMHS in eight European countries; one parent/carer and a CAMHS clinician for each recruited young person; and adult mental health clinician or other community-based care provider, if young person transitions. The primary outcome is Health of the Nation Outcome Scale for Children and Adolescents (HoNOSCA) measuring health and social functioning at 15 months postintervention. The secondary outcomes include mental health, quality of life, transition experience and healthcare score of 0.30 SD. The addition of 210 recruits for the cohort study ensures sufficient power for studying predictors, resulting in 1050 participants and an approximate 1:3 randomisation. Ethics and dissemination The study protocol was approved by the UK National Research Ethics Service (15/WM/0052) and equivalent ethics boards in participating countries. Results will be reported at conferences, in peer-reviewed publications and to all relevant stakeholder groups. [ABSTRACT FROM AUTHOR]

Prevalence of lameness was estimated in crossbred lactating cattle (337) and Murrah buffaloes (82) from 7 organised dairy farms and 100 lactating cattle and 51 lactating buffaloes from 50 unorganised (backyard) farms from different villages of Ludhiana district of Punjab. Gait of each animal was first assessed on a 5- point numerical scale on the day of observation. Clinical lameness was significantly more in crossbred cattle (8.92%) as compared to buffaloes (2.26%) and was more on organised farms (9.31%) as compared to unorganised farms (1.99%). Each animal was then examined for any claw lesion before and after removing sliver of 1mm from the solar surface. Most of the lesions were observed in hind claws [OR: 1.17] except sole avulsions (OR:0.25) and white line fissures (OR:0.37) which were more evident in fore claws. Heel erosions (45.44%), sole haemorrhages (2.26%), white line haemorrhages and under run soles (4.56%) were predominant lesions of lameness in organised dairy farms especially crossbred cattle suggesting claw horn disruption as the possible aetiology. Sole avulsions (37.37%), white line fissures (13.37%), overgrown hooves (10.53%) and overgrown soles (6.75%) were more frequent on unorganised farms suggesting poor hoof synthesis due to trace mineral deficiency. Overgrown hoofs were more frequent in buffaloes. Sole avulsions were observed for the first time in this study. [ABSTRACT FROM AUTHOR]

The present study is conducted to investigate how long the effect of feeding high grains is sustained in the rumen and how this changed or adapted rumen environment is going to affect the hoof health in approximately 10 weeks. Crossbred cows (18) from university dairy farm were divided into 2 groups keeping equal number of animals with same parity in both. Animals in the feeding group were fed with high grain diets for 75 days. The pH, sodium, potassium and different fractions of total volatile fatty acids (TVFA) of rumen liquor were studied every fortnight. All the animals were evaluated for foot lesions before the start of experiment and then at the end of feeding trial. A significant decrease in rumen liquor pH and sodium concentration was observed in the feeding group animals with the progress of time. TVFA concentration increased in the feeding group with rise in acetate, propionate and butyrate levels at the end of the trial. High prevalence of heel erosions, white line haemorrhages, white line fissures and overgrown soles were observed in the feeding group animals at the end of trial along with an increase in rear leg view index. It was concluded that constant feeding of non-structural carbohydrates may increase total volatile fatty acids and frequency of claw lesions in crossbred dairy cattle. [ABSTRACT FROM AUTHOR]

The objective of this study was to determine the clinical effects, changes in concentrations of Cu and Mo in plasma, hair, liver and red cell parameters of buffalo calves fed on high Mo diet. Male buffalo calves (12), 1-1.5 year-old were assigned to either control (4) or deficient group (8) on the basis of their body weight. Control group was regularly supplemented with 30 mg of elemental copper and calves of deficient group were fed fresh green fodder sprayed with 0.04% sodium molybdate solution to provide 30 ppm of molybdenum for 180 days. Samples of blood, hair, and liver tissue were collected at regular intervals. Hemoglobin and PCV were determined in whole blood. Concentrations of copper and molybdenum were measured in plasma, hair and liver tissue. Fodder samples were analysed for proximate principles, cell wall constituents, Ca, P, Mg, Cu, Mo and Zn. Salient clinical signs were intermittent diarrhea, varying degree of skin and hair depigmentation. Bilateral swelling of hock joints and transitory lameness occured in one calf each. Daily weight gain was lower in molybdenum fed calves as compared to control however, the weight loss occurred only during 45-135 days. Plasma copper was unaffected. Copper concentration of hair and liver declined in 180 days. There was no change in plasma molybdenum concentration. Hair molybdenum content increased after 180 days of molybdenum feeding. Liver molybdenum concentration was significantly high throughout the experiment as compared to control group. Haemoglobin and PCV were not affected by excess molybdenum feeding. Hair copper concentration of 6 ppm or below may be taken as indicator of molybdenum induced copper deficiency in buffaloes. [ABSTRACT FROM AUTHOR]

Purpose: There is substantial evidence to suggest that Black and minority ethnic (BME) patients are disproportionately detained under the Mental Health Act (MHA). We examined ethnic differences in patients assessed for detention and explored the effect of ethnicity after controlling for confounders.Methods: A prospective study of all MHA assessments conducted in 1 year (April 2009-March 2010) within Birmingham and Solihull Mental Health Foundation Trust, UK. Proportion of assessments and detentions within denominator population of service users and regional populations were calculated. Multiple regression analysis was conducted to determine which variables were associated with the outcome of MHA assessment and the role of ethnicity.Results: Of the 1115 assessments, 709 led to detentions (63.58 %). BME ethnic groups were statistically more likely to be assessed and detained under the MHA as compared to Whites, both in the service user and the ethnic population estimates in Birmingham, UK. MHA detention was predicted by having a serious mental illness, the presence of risk, older age and living alone. Ethnicity was not associated with detention under the MHA with age, diagnosis, risk and level of social support accounted for.Conclusion: The BME 'disproportionality' in detention rates seems to be due to higher rates of mental illness, greater risk and poorer levels of social support rather than ethnicity per se. [ABSTRACT FROM AUTHOR]