8,323 research outputs found
Alcohol use disorder and the liver
No full textAlcohol use disorders (AUD) cause a range of physical harms, but the major cause of alcohol-related mortality is alcohol-related liver disease (ALD), in some countries accounting for almost 90% of alcohol-related deaths. The risk of ALD has an exponential relationship with increasing alcohol consumption, but is also associated with genetic factors, other life-style factors and social deprivation. ALD includes a spectrum of progressive pathology, from liver steatosis to fibrosis and liver cirrhosis. There are no specific treatments for liver cirrhosis, but abstinence from alcohol is key to limit progression of the disease. Over time, cirrhosis can progress (often silently) to decompensated cirrhosis and hepatocellular carcinoma (HCC). Liver transplantation may be suitable for patients with decompensated liver cirrhosis and may also be used as a curative intervention for HCC, but only for a few selected patients, and complete abstinence is a prerequisite. Patients with AUD are also at risk of developing alcoholic hepatitis, which has a high mortality and limited evidence for effective therapies. There is a strong evidence base for the effectiveness of psychosocial and pharmacological interventions for AUD, but very few of these have been trialled in patients with comorbid ALD. Integrated specialist alcohol and hepatology collaborations are required to develop interventions and pathways for patients with ALD and ongoing AUD.</p
'Mother's ruin'- why sex and gender differences in the field of alcohol research need consideration
No full textWe are particularly pleased that Alcohol and Alcoholism has dedicated this special collection to ‘Sex and Gender differences in Alcohol Use Disorder’. To date, a series of preclinical and clinical studies have tried to shed light on the similarities and differences in the field of alcohol research between men and women (Agabio et al., 2016a and 2017; Salvatore et al., 2017; McHugh et al., 2018; Ait-Daoud et al., 2019; Becker and Chartoff, 2019). However, our understanding of the complexities on this topic remains limited
Core principles for mental health
No full textThis editorial highlights three key principles for clinicians working with people with mental illness. These include clear communication, clinical practice in accordance with legislation (Mental Capacity Act and Mental Health Act) and reducing stigma and discrimination.<br/
Recurrent brief depression: 'nasty, brutish and short'
No full textOverview of Recurrent Brief Depression including: Historical background, development of the concept of recurrent brief depression; The Zurich Study; Diagnostic criteria; results of further epidemiological studies; similarities and differences with major depression;distinction from bipolar illness, cyclothymia and dysthymia; pharmacological treatment; future research and conclusions
Systematic review of resource utilization in the hospital management of deliberate self-harm
No full textBACKGROUND: Deliberate self-harm (DSH) is a significant public health problem, representing a major burden in terms of morbidity to the individual and health-service utilization. While clinical guidelines suggest good practice for the short-term hospital management of DSH, there remains considerable variability in the way that services are provided. METHOD: A systematic review of the literature was undertaken to examine the current evidence on hospital resource use and costs involved in the short-term hospital management of adults following DSH and to elucidate the factors that influence these differences, in terms of clinical characteristics and service provision. RESULTS: Twenty-one papers reporting on 17 studies met the inclusion criteria for review. Clinical characteristics associated with an increase in resource use included overdose with tricyclic antidepressants (TCAs) compared with selective serotonin re-uptake inhibitors (SSRIs) (weighted ratio 2.6:1) and co-ingestion of alcohol with SSRIs. Variations in service provision, including medical admissions policy and provision of a specialist liaison service, affected resource utilization independently of the clinical needs of patients. CONCLUSIONS: Overdoses of TCAs incur substantially greater hospital costs than overdoses of SSRIs. Variations in the medical seriousness of DSH, and in the structure of service provision, affect the resources used in its short-term hospital management, with little evidence about the impact these differences have on clinical outcome. Research is needed to evaluate the impact of different styles of service provision on outcome, and to incorporate these factors into the trial design of future cost-effectiveness studies of interventions following DSH.<br/
Mental health homicide inquiries in England 2010-2023: review of methodology and findings
No full textBackground: the methodology and impact of independent inquiries of homicides by people in care of mental health services have been questioned. Aims To analyse characteristics of patients who committed homicide, their victims and inquiries published in England between 2010 and 2023. Method: documentary and thematic analysis of 162 mental health homicide inquiries. We compared characteristics of perpetrators with those from the National Confidential Inquiry into Suicide and Safety (2018), and characteristics of victims with those in the general population of England and Wales. We examined methodology used by inquiries and thematically analysed root causes, contributory factors, recommendations, action plans, predictability and preventability. Results: fifty-two per cent of perpetrators had a diagnosis of schizophrenia and 52% had a history of non-adherence to medication and follow-up; 71% of victims in mental health homicides were family, friends or partners compared with 44% in the general population; 77% of inquiries used no clear methodology. The most frequent root causes and contributory factors related to deficits in assessment, treatment, follow-up or discharge, and risk assessment. There was no direct link between putative causes and resulting recommendations. The most frequent recommendations related to changing policy, improving clinical governance and training. Only 4% of inquiries deemed the homcide to be predictable and preventable. Conclusions: there is considerable variation in the methodology of mental health homicide inquiries, with little use of human factors and systems theory. Inquiries repeatedly identify the same themes, and most mental health homicides are found to be neither predictable nor preventable. We make recommendations for improving consistency and usefulness.</p
Alcohol consumption among veterinary surgeons in the UK
No full textBackground Alcohol consumption can have both medical and occupational implications and may affect fitness to practise among veterinary surgeons (vets). Aims To investigate alcohol consumption and the prevalence and associations of ‘at-risk’ drinking among vets in the UK. Methods Alcohol consumption was measured using the Alcohol Use Disorders Identification Test alcohol consumption questions (AUDIT-C) embedded in a questionnaire which included measures of mental health and psychosocial working conditions, administered to a representative sample of 1796 vets. Scores of 4 for women and 5 for men were used as an indicator of ‘at-risk’ drinking. Results The response rate was 56%. Five per cent of respondents were non-drinkers, 32% low-risk drinkers and 63% at-risk drinkers. The estimated odds of at-risk drinking was not significantly different for men and women. A 1-year increase in age was associated with a 2% reduction in the odds of at-risk drinking (OR 0.98, 95% CI: 0.97–0.99, P < 0.01). There was no significant difference across hours worked or on call in a typical week. Lower psychological demands at work were associated with reduced odds of at-risk drinking (OR 0.75, 95% CI: 0.63–0.90, P < 0.01). Conclusions It is estimated that vets drink more frequently than the general population, but consume less on a typical drinking day and have a prevalence of daily and weekly binge drinking that is similar to the general population. The level of alcohol consumption does not appear to be a negative influence on mental health within the profession as a whole.<br/
Co-morbid substance misuse in psychiatric patients: prevalence and association with length of inpatient stay
No full textImproved management of mental illness with co-morbid substance misuse is an important clinical objective. This study aimed to assess the prevalence of substance misuse in psychiatric inpatients, and to examine the relationship between alcohol misuse and length of hospital admission. A prevalence study conducted over four months, examined rates of co-morbid substance misuse in patients admitted for psychiatric inpatient care. Demographic details and length of hospital stay were collected for all patients and those who gave informed consent were screened for levels of alcohol and substance misuse. Two hundred and thirty-eight patients were admitted during the study period in which 178 (74.8%) consented to take part in the study. A group of 44 (50.6%) men and 26 (29.2%) women were screened positive for alcohol misuse (chi(2) = 8.7, P = 0.003). Cannabis use was acknowledged by 31 (35.2%) men and 10 (11.2%) women (chi(2) = 13.5, P < 0.0001). Presence of co-morbid alcohol misuse was associated with a significantly shorter hospital admission (z = 3.34, P = 0.0008). Co-morbid substance misuse (including alcohol) was reported significantly more frequently by men than women. Overall, patients with co-morbid alcohol misuse had shorter hospital admissions, suggesting different patterns of presentation and progress in hospital. Hospital admission presents an opportunity to identify substance misuse and evaluate treatments for co-morbid conditions within a safe environment<br/
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