Sean Jespersen

Regenerate: assessing the feasibility of a strength-training program to enhance the physical and mental health of chronic post stroke patients with depression

The Regenerate pilot study explored whether a 10‐week, community‐based progressive resistance training (PRT) program could reduce depressive symptoms in depressed chronic stroke survivors.

Monitoring the Safe Use of Clozapine A Consensus View from Victoria, Australia

Clozapine is an important antipsychotic agent that has a unique profile of clinical benefits, but that has also been associated with several serious and potentially life-threatening safety concerns. In order to minimise the impact of haematological adverse events, health professionals treating patients with clozapine are currently required to register their patients on a centrally administered data network and to conform to strict protocols. The consensus statement documented in this article extends existing protocols by recommending monitoring of patients treated with clozapine for additional adverse effects during treatment. This consensus statement reflects the current practice at five major public psychiatric hospitals in Victoria, Australia, for the monitoring and management of clozapine-related adverse events, and has been implemented at these sites because of emerging safety concerns associating clozapine with cardiovascular and metabolic adverse effects.

Use of the Strengths and Difficulties Questionnaire in Identifying Emotional and Behavioural Problems in Children of Parents with a Mental Illness in Australia

Abstract Thirty six children of parents who attended the adult outpatient service in the Werribee Mercy Mental Health Program were screened for possible emotional and behavioural problems using the Strengths and Difficulties Questionnaire. The proportion of children identified with difficulties was 50 percent, much higher than in the general population. Fifty eight percent of the children had chronic problems and the difficulties were perceived to be moderate to severe in 53 percent of the sample. The burden of these difficulties on the family was also high. Despite this, only a small proportion of children were then referred for further assessment and treatment. More psycho-education for both clinicians in the adult service and for parents is required. Difficulties in recruitment resulted in low numbers for this study. There continues to be difficulty in parents consenting for their children to be assessed.

Outcome of planned discharge from case management: a 3 year retrospective study

Objective: To investigate the rates of relapse of mental illness in adults requiring acute intervention at a mental health service following a planned discharge process from community case management. Method: A planned approach to identifying and facilitating patient discharge was identified and incorporated into clinical team reviews. Data regarding service contacts of all discharged patients were collected at 1 year and then 3 years following planned discharge and reviewed in detail. Demographic factors and clinical variables were collected in anticipation that useful predictors for successful discharge might be identified. Results: Using a planned approach, a greater number of patients were discharged from case management to the care of a primary treating practitioner. Discharges increased from 11 in 2000 to 46 in 2001. Of the 46 patients discharged from case management, 22 patients (47.8%) had no contact with the service during the first 12 months. Twenty-four patients accessed the Service requiring no further action, but at some point nine (19.6%) required acute intervention. The remaining 15 patients (32.6%) were managed successfully either by the triage service or non-urgent referral for psychiatric consultation. During the 3 year period 10 patients (21.7%) continued to have no contact with the service. Nineteen patients (41.3%) required acute intervention; the remaining 17 (36.9%) were successfully managed through triage or via non-urgent psychiatric review requiring no further action by the Service. Of the seven patients who had been on a community treatment order during their treatment, only one had further contact with the Service. Conclusions: A planned approach to the discharge of patients from case management to the community resulted in an increased number of patient discharges. While most patients did not rapidly relapse, a number of patients did have contact with the Service and 19 (41.3%) required at least one acute intervention during the 3 year follow-up period. The findings reflect the importance of relapse prevention and management and service re-entry planning with triage services, patients, carers and other key workers. The frequency of service use and the variation of services required by patients highlight the importance of availability of a variety of adequately resourced levels of service response.

Reflections on facilitated discharge from a mental health service.

Objective: The aim of this paper is to review research evidence and describe our experience of facilitated discharge from mental health services to primary care. Method: A literature review of facilitated discharge was conducted. In addition, the clinical characteristics of 21 discharged and 21 non-discharged patients from one shared care service were compared in a retrospective file review. Thirty-one patients in another facilitated discharge program were surveyed. Results: Discharged patients had a higher level of function. There was a trend towards discharged patients being female and employed with less chronic illness, involuntary treatment, behavioural symptoms, depot medication, triage contact, service contact with family, and more mood disorder. Of the 10 survey respondents, 60% reported feeling better compared with their last service contact, 70% felt not having contact was a good thing and most saw their doctors regularly and reported a good relationship. Conclusions: There was a trend towards more stable patients being discharged and it appeared that they responded positively to this, without a clear indication of which factors best determine suitability for discharge. Consequently, we elected to incorporate discharge planning processes as a core function of case management and increase shared care with the primary care sector.

Clinical characteristics and patterns of referral to a primary mental health team: A retrospective study

Introduction: The Primary Mental Health Team (PMHT) initiative in Victoria began almost 10 years ago, but there has been little evaluation of this important strategy to improve integration between mental health services and primary care. The present study investigated the demographic and clinical characteristics of patients referred to a PMHT in order to guide development of the service and better meet the needs of primary care providers and their patients.

A pilot randomised, double-blind, placebo controlled study of granisetron in the treatment of sexual dysfunction in women associated with antidepressant use

A pilot study was conducted to evaluate the usefulness of granisetron for the treatment of antidepressant induced sexual dysfunction in women. Twelve women with antidepressant induced sexual dysfunction (AISD) were assigned granisetron (n=5) or placebo (n=7) in a 14-day randomized, double-blind, placebo-controlled study. One participant in the granisetron group did not complete the study. Participants were assessed at baseline, day 7 and day 14 using the Feiger Sexual Function and Satisfaction Questionnaire and the Arizona Sexual Experience Scale. No statistical differences were measured at baseline or at endpoint between the granisetron or placebo group. This study did not produce evidence supporting the usefulness of granisetron in AISD.