Allys Guerandel

Two psychiatric presentations linked with ‘head shop’ products.

We report two cases of acute onset and rapid resolution of psychotic symptoms, the first following oral ingestion and the second following intravenous injection of some head shop products (HSPs). Both were associated with autonomic instability and negative results on urine toxicology screening using standard techniques. They highlight the potential dangers of managing such cases in acute stand-alone psychiatric units. Recent advance in characterising some HSPs by toxicology screening is also discussed.

SHARED CARE BETWEEN SPECIALIZED PSYCHIATRIC SERVICES AND PRIMARY CARE: THE EXPERIENCES AND EXPECTATIONS OF CONSULTANT PSYCHIATRISTS IN IRELAND*

Background: Internationally, there has been a growing interest in the pursuit of collaborative forms of care for patients with enduring mental health difficulties. Objective: The study aims to explore the views of consultant psychiatrists in Ireland on shared care between specialized psychiatric services and primary care for patients with mental health difficulties. Method: A self-administered questionnaire was designed and posted to 470 consultant psychiatrists who are members of the College of Psychiatry of Ireland. Stamped self-addressed envelopes were included for the return of completed questionnaires. Results: Overall, 213 questionnaires were returned, giving a response rate of 45%. Of the respondents, 194 (91%) reported that they would support a general policy on shared care between primary care and specialized psychiatric services for patients who are stable on their treatment. However, 181 (85%) reported that they foresaw difficulties for patients in implementing such a policy including: increased financial burden on some patients (141, 66%); some patients may lack confidence in GP care (100, 47%); primary care is not adequately resourced with allied health professionals to support provision of psychiatric care (128, 60%); primary care providers are not adequately trained to provide psychiatric care (111, 52%); and lack of adequate cooperation between primary care and specialized mental health services (96, 45%). Conclusion: The Irish government and the Colleges of General Practitioners and Psychiatrists in Ireland need to work together to remove the bottlenecks that hinder the active involvement of primary care in the management of patients with enduring mental health difficulties. Also, the health care systems need to be organized along a shared care model to facilitate effective collaboration between primary and specialized psychiatric services.

Computer-assisted learning in undergraduate psychiatry (CAL-PSYCH): evaluation of a pilot programme

OBJECTIVES To introduce and evaluate a computer assisted learning programme in undergraduate psychiatry (CAL-PSYCH). METHODS An interactive e-learning environment was created within the University College Dublin portal to assist students in acquiring the necessary skills in undergraduate psychiatry. The pilot phase consisted of providing their lectures on-line on the interactive site. Data were gathered from the last group of students in 2001 (pre-CAL-PSYCH) and the first group of students using CAL-PSYCH in 2002. We included assessment of percentage of students accessing the site, attendance rates at face-to-face lectures and tutorials, and also a feedback questionnaire from students who accessed the site. RESULTS All responders had used CAL-PSYCH. Students gave higher ratings for quality and interactivity of lectures compared with the pre-CAL-PSYCH curriculum. Students also expressed enthusiasm about CAL-PSYCH and encouraged us to develop it further. CONCLUSIONS Computer-assisted learning environments such as CAL-PSYCH provide the opportunity to bring modern e-learning techniques to medical education, and may provide a new model for life-long learning in medicine.

Pharmacological management of diabetes in severe mental illness: a comprehensive clinical review of efficacy, safety and tolerability

ABSTRACT Introduction: The increased prevalence of Type 2 diabetes mellitus (T2DM) in severe mental illness (SMI) contributes to increased cardiovascular morbidity and reduced life expectancy for people with SMI. Areas covered: In the present clinical review, we summarize the efficacy, safety and tolerability of selected diabetic pharmacotherapy options in SMI and discuss the quality and strength of evidence. Expert commentary: General principles for treating T2DM in SMI involve identifying treatments which promote weight loss and which have low or no risk of hypoglycemia. Patient engagement in decision making about treatment choices is an important factor to ensure adherence and successful use of the chosen therapy. The first line therapeutic option for T2DM in SMI for which there is most evidence is metformin. Based on general population data, second line treatment options in combination with metformin to achieve glycated haemoglobin treatment goals include GLP-1R agonists, DPP-4 inhibitors, sulphonylureas, SGLT2 inhibitors, pioglitazone and insulin, with most evidence for the use of GLP-1R agonists in SMI. Alongside efficacy and tolerability, treatment for T2DM in SMI should be considered on a patient-tailored basis.

Dermatitis artefacta: an unusual diagnosis in psychodermatology

We report the case of a 22 year old female diagnosed with dermatitis artefacta. This is an uncommon diagnosis and provides a unique therapeutic challenge for psychiatrists and dermatologists alike. We describe how early intervention and a close collaborative approach is central to securing a favourable outcome for patients.