Clinical letters to patients with intellectual disabilities after psychiatric review: A quality improvement project.

AIM: This Quality Improvement Project sought to improve communication between patients with intellectual disabilities and their psychiatrists by sharing medical information using an easy read letter format following psychiatric review. BACKGROUND: Writing directly to patients is in keeping with good medical practice. Previous studies have shown patients with intellectual disabilities prefer letters tailored to meet their needs. METHOD: An easy read letter was used by nine psychiatrists who handed them to 100 consecutive patients after review. Feedback of acceptability to patients was obtained using a three-item facial rating scale and the use of free text. Feedback of acceptability was obtained from participating psychiatrists. RESULTS: Patients found the easy read letter helpful and felt it should be used routinely. Psychiatrists felt this approach was beneficial as well as aiding patient understanding of review. CONCLUSIONS: The easy read letter was reported to improve communication following psychiatric review. Limitations are acknowledged but it is concluded that an easy read letter should be adopted as routine practice following psychiatric review, for people with intellectual disabilities.

Prodromal psychotic symptoms and psychological distress among secondary school students in Abeokuta, Nigeria.

OBJECTIVE: This study aimed to investigate the relationship between prodromal psychotic symptoms and psychological distress among Nigerian adolescents. METHOD: Students (n=508) were randomly selected from secondary schools in Abeokuta, Nigeria. A socio-demographic questionnaire, the Prodromal Questionnaire-Brief Version (PQ-B) and the Strengths and Difficulties Questionnaire (SDQ) were administered to each student. RESULTS: The mean age of the students was 15.4 years (SD 1.3), with most (63%) being female. More than half (55.3%) reported having had a lifetime experience of major life event (20.9% in the preceding 6 months) while 13.9% had experienced bullying or abuse (5.1% in the preceding 6 months). The prevalence of prodromal symptoms was 20.9% (95% CI 0.174-0.244). Abnormal scores in emotional and conduct problems were seen in 11.8% and 6% respectively, while 7.3% had abnormal scores in each of the hyperactivity and peer problems subscales of the SDQ. Abnormality in prosocial behaviour was found in 1.8% of students, with overall abnormality in 4.9%. Regression analysis showed that prodromal symptoms were predicted by female sex, lifetime and 6 month history of major life event, and lifetime and 6 month history of bullying or abuse. Prodromal symptoms were also predicted by higher total SDQ scores and higher scores in all domains of psychological distress except the prosocial domain. CONCLUSION: The study showed a relationship between reported prodromal symptoms and the occurrence of psychological distress. It also showed that early childhood trauma may be a predisposing factor to the early stages of development of psychosis, with female children being especially prone in the years of adolescence.

A 10-year descriptive study of electroconvulsive therapy at the Neuropsychiatric Hospital, Aro, Abeokuta.

OBJECTIVES: Evidence supports the use of electroconvulsive therapy (ECT) in current practice, and good quality of care is related to adherence to evidence-based guidelines. However, there are no guidelines for the practice of ECT in Nigeria and there is no regulatory body for its standards. The objective of this study therefore was to examine the practice of ECT between 2001 and 2010 at the Neuropsychiatric Hospital, Aro, Abeokuta, regarding consent procedures, staffing, training, indications, and administration with the goal of informing the development of guidelines locally. METHODS: Data were extracted from 154 complete ECT treatment records in the register and from the patients' case files. The data were qualitatively analyzed and described. RESULTS: The mean age of patients who received ECT was 35.5 years and the majority were female. Bilateral electrode placement was invariable for all treatments. The major diagnosis of the patients receiving ECT was schizophrenia, whereas poor response to medication and psychomotor retardation were commonly stated indications. Treatments were largely unmodified during the first 3 years of the review, with a gradual reversal of this pattern in the latter years. The mean number of treatments per patient was 6.6, and only 1 patient received continuation ECT. CONCLUSIONS: Although the procedure of ECT in this center is generally similar to what is obtained in many other countries in Asia and Africa, aspects such as that of informed consent require attention. Regular audits of the practice are desirable.