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Issue

Vol 124 No 1336: 10 June 2011

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Issue Summary

SUMMARY

Patterns of prescription drug misuse presenting to provincial drug clinics

Geoffrey Robinson, Graeme Judson, Richard Loan, Timothy Bevin, Patrick OConnor

In the absence of imported heroin into NZ, prescription opiate drugs have become the street supply. Prescription opiates have been increasingly misused in the USA. In our region, this study found morphine and methadone were the commonest street opiates being used. The costs to users of these drugs are considerable, but may be reducing. Prescription opiate misuse is a complex Public Health issue which requires multiple responses to contain.

SUMMARY

Quetiapine for the treatment of behavioural and psychological symptoms of dementia (BPSD): a meta-analysis of randomised placebo-controlled trials

Gary Cheung, Janli Stapelberg

The efficacy of quetiapine for the treatment of behavioural and psychological symptoms of dementia (BPSD) was examined using six sets of international data published on this issue. This analysis found a small magnitude of improvement of these symptoms but the observable change by clinicians is questionable.

SUMMARY

How do intoxicated patients impact staff in the emergency department? An exploratory study

Fiona Imlach Gunasekara, Shaun Butler, Taisia Cech, Elizabeth Curtis, Michael Douglas, Lynda Emmerson, Rachel Greenwood, Sara Huse, Julia Jonggowisastro, Camilla Lees, Yang Li, Daniel McConnell, Andreea Mogos, Nur I M Azmy, Scotty Newman, Kirstie ODonnell

Despite a high burden of intoxicated patients in emergency departments in New Zealand, there has been little research into the impact of these patients on staff or on how staff view these patients. We surveyed and interviewed staff at Wellington Regional Hospital Emergency Department for their experiences. We found that staff commonly encountered verbal assault from intoxicated patients, and staff reported increased workload and increased overall waiting times with intoxicated patients. Staff also observed that intoxicated patients impacted negatively on the care and safety of other patients in the emergency department. Alcohol-related presentations may impair the quality of care for all patients in the emergency department and reduce the safety and wellbeing of staff.

SUMMARY

Controlled intoxication: the self-monitoring of excessive alcohol use within a New Zealand tertiary student sample

Brett McEwan, David Swain, Maxine Campbell

The majority of drinkers in the study who consumed alcohol with the intention of getting intoxicated, typically drank to a predetermined level of intoxication, and maintained that level by monitoring a range of drinking effectsthis behaviour was termed controlled intoxication. Future harm-minimisation strategies could be developed that encourage heavy-drinkers to adopt safer drinking-effect signals as indicators to slow down or stop their drinking.

SUMMARY

Five-year follow-up of an acute psychiatric admission cohort in Auckland, New Zealand

Amanda Wheeler, Stuart Moyle, Carol Jansen, Elizabeth Robinson, Jane Vanderpyl

This study reports the 5-year readmission rates of a cohort of mental health patients admitted to an acute inpatient service in 2000. Almost 40% of the group had no further acute admissions for psychiatric reasons anywhere in New Zealand during the 5-years after discharge. The two factors associated with readmission were having a history of previous admissions or being of M ori ethnicity. One-third of the group had three or more admissions in the 5 years following index discharge with longer bed stays. The findings highlight the need for reliable community-based data to enable exploration of the use of community services following acute discharge, especially in preventing readmission, and the impact of acute service alternatives to inpatient units for times of crisis. This is particularly important given the negative and distressing experience reported by people admitted to acute psychiatric inpatient units.

SUMMARY

The benefits and harms of alcohol use in New Zealand: what politicians might consider

Nick Wilson, Fiona Imlach Gunasekara, George Thomson

The New Zealand Government is currently considering ways to reduce alcohol-related harm, following on from a detailed report by the Law Commission. To inform discussions we briefly summarise the benefits and harms of alcohol use in this country. The most substantive benefits to society are probably pleasure to users and economic benefits (largely to industry). The most substantive harms are probably those to mental and physical health, harm to society (e.g., from crime) and adverse net economic impacts. Overall the picture is suggestive that New Zealand society would be likely to achieve a large net benefit from reducing heavy and binge drinking, and shifting alcohol consumption towards a pattern of smaller amounts. The substantial harm to non-users is a key argument for democratic governments to use regulations and taxes to minimise harm from alcohol.

SUMMARY

Narcolepsy in New Zealand: pathway to diagnosis and effect on quality of life

Angela J Campbell, T Leigh Signal, Karyn M OKeeffe, Jessie P Bakker

Narcolepsy is a neurological sleep disorder characterised by excessive daytime sleepiness, with other symptoms including sudden episodes of muscle weakness, disrupted sleep, sleep paralysis and hallucinations occurring during sleep onset or while awakening. We aimed to survey patients diagnosed with narcolepsy in New Zealand in order to gather data regarding their pathway to diagnosis, treatment, and general quality of life. Responses were received from 54 patients, on average 55 years old. Diagnosis of narcolepsy took place at an average age of 33, despite symptoms first appearing by age 21. The respondents reported greater daytime sleepiness and poorer health-related quality of life compared with the general New Zealand population, and we also identified a number of inconsistencies between the diagnostic/treatment pathway of these patients and internationally published guidelines.

SUMMARY

Alcohol’s harm to others: self-reports from a representative sample of New Zealanders

Sally Casswell, Jessica F Harding, Ru Q You, Taisia Huckle

A survey of New Zealand households asked about the experience of heavy drinkers in peoples lives. One in four reported having a heavy drinker in their life and a wide range of negative experiences were reported by interviewees to have been associated with this exposure.

SUMMARY

Off-label use of atypical antipsychotic medications in Canterbury, New Zealand

Erik Monasterio, Andrew McKean

The purpose of the current study is to determine how often the new generation of antipsychotic medications (designed and licensed to treat illnesses such as schizophrenia and manic depressive illness) are used to treat other, non-psychotic related problems. This is known as coff-label d prescribing and while it is not illegal, the use of medications in this way is seldom backed by scientific evidence of efficacy and safety. We surveyed 70% of all the psychiatrists in the Canterbury region and found to 96% of them prescribed these medications coff-label d. More than 50% of psychiatrists did so at least once a week and the most common problems for which they were prescribed were anxiety, sleeplessness, post-traumatic stress disorder and dementia. The findings suggest that there is an over reliance on antipsychotic medications to treat common symptoms of psychological distress.

ALL ARTICLES
SUMMARY

Medical image. A case with refractory wheezes

Hsiao-Li Lo, Sheng-Hsiang Lin

Important questions about healthcare expenditure and the allocation of resources in the last year of life

Phillipa J Malpas

Patterns of prescription drug misuse presenting to provincial drug clinics

Geoffrey Robinson, Graeme Judson, Richard Loan, Timothy Bevin, Patrick OConnor

Consequences of a flawed epidemiological approach to air quality regulation

John Hoare

Why we get fat—and what to do about it (Gary Taubes)

Jeffrey Barron

Quetiapine for the treatment of behavioural and psychological symptoms of dementia (BPSD): a meta-analysis of randomised placebo-controlled trials

Gary Cheung, Janli Stapelberg

Advocacy for General Practice

Bill Douglas

Editorial. Our scale of fees

How do intoxicated patients impact staff in the emergency department? An exploratory study

Fiona Imlach Gunasekara, Shaun Butler, Taisia Cech, Elizabeth Curtis, Michael Douglas, Lynda Emmerson, Rachel Greenwood, Sara Huse, Julia Jonggowisastro, Camilla Lees, Yang Li, Daniel McConnell, Andreea Mogos, Nur I M Azmy, Scotty Newman, Kirstie ODonnell

Medical image. Bilateral diffuse cystic, cavitary lung metastasis of adenocarcinoma

Talha Dumlu, Bekir Sami Karapolat, 00dcmran Y 0131ld 0131r 0131m, Adem G 00fcngor, Leyla Y 0131lmaz Ayd 0131n

Nicotine replacement therapy in grocery stores; but wait, there’s more

Stephen Vega

Controlled intoxication: the self-monitoring of excessive alcohol use within a New Zealand tertiary student sample

Brett McEwan, David Swain, Maxine Campbell

Five-year follow-up of an acute psychiatric admission cohort in Auckland, New Zealand

Amanda Wheeler, Stuart Moyle, Carol Jansen, Elizabeth Robinson, Jane Vanderpyl

Can many anterior cruciate ligament (ACL) ruptures heal without surgery?

Andrew Montgomery

Use of Asthma Control Test (ACT) affects New Zealand primary care doctors' perception of asthma control

Shaun Holt, Davitt Sheahan, Bill Mackey, Carl Jacobsen

The benefits and harms of alcohol use in New Zealand: what politicians might consider

Nick Wilson, Fiona Imlach Gunasekara, George Thomson

The impact of alcohol-related presentations in the emergency department and the wider policy debate

Taisia Huckle, Sally Casswell, Sarah Greenaway

Narcolepsy in New Zealand: pathway to diagnosis and effect on quality of life

Angela J Campbell, T Leigh Signal, Karyn M OKeeffe, Jessie P Bakker

Alcohol’s harm to others: self-reports from a representative sample of New Zealanders

Sally Casswell, Jessica F Harding, Ru Q You, Taisia Huckle

Lifetime cardiovascular risk

Ben Gray

Revenge of the ACL

Nicholas Cooper

Off-label use of atypical antipsychotic medications in Canterbury, New Zealand

Erik Monasterio, Andrew McKean

Off-label use of quetiapine in New Zealand—a cause for concern?

Paul Glue, Chris Gale

SUMMARY

Patterns of prescription drug misuse presenting to provincial drug clinics

Geoffrey Robinson, Graeme Judson, Richard Loan, Timothy Bevin, Patrick OConnor

In the absence of imported heroin into NZ, prescription opiate drugs have become the street supply. Prescription opiates have been increasingly misused in the USA. In our region, this study found morphine and methadone were the commonest street opiates being used. The costs to users of these drugs are considerable, but may be reducing. Prescription opiate misuse is a complex Public Health issue which requires multiple responses to contain.

SUMMARY

Quetiapine for the treatment of behavioural and psychological symptoms of dementia (BPSD): a meta-analysis of randomised placebo-controlled trials

Gary Cheung, Janli Stapelberg

The efficacy of quetiapine for the treatment of behavioural and psychological symptoms of dementia (BPSD) was examined using six sets of international data published on this issue. This analysis found a small magnitude of improvement of these symptoms but the observable change by clinicians is questionable.

SUMMARY

How do intoxicated patients impact staff in the emergency department? An exploratory study

Fiona Imlach Gunasekara, Shaun Butler, Taisia Cech, Elizabeth Curtis, Michael Douglas, Lynda Emmerson, Rachel Greenwood, Sara Huse, Julia Jonggowisastro, Camilla Lees, Yang Li, Daniel McConnell, Andreea Mogos, Nur I M Azmy, Scotty Newman, Kirstie ODonnell

Despite a high burden of intoxicated patients in emergency departments in New Zealand, there has been little research into the impact of these patients on staff or on how staff view these patients. We surveyed and interviewed staff at Wellington Regional Hospital Emergency Department for their experiences. We found that staff commonly encountered verbal assault from intoxicated patients, and staff reported increased workload and increased overall waiting times with intoxicated patients. Staff also observed that intoxicated patients impacted negatively on the care and safety of other patients in the emergency department. Alcohol-related presentations may impair the quality of care for all patients in the emergency department and reduce the safety and wellbeing of staff.

SUMMARY

Controlled intoxication: the self-monitoring of excessive alcohol use within a New Zealand tertiary student sample

Brett McEwan, David Swain, Maxine Campbell

The majority of drinkers in the study who consumed alcohol with the intention of getting intoxicated, typically drank to a predetermined level of intoxication, and maintained that level by monitoring a range of drinking effectsthis behaviour was termed controlled intoxication. Future harm-minimisation strategies could be developed that encourage heavy-drinkers to adopt safer drinking-effect signals as indicators to slow down or stop their drinking.

SUMMARY

Five-year follow-up of an acute psychiatric admission cohort in Auckland, New Zealand

Amanda Wheeler, Stuart Moyle, Carol Jansen, Elizabeth Robinson, Jane Vanderpyl

This study reports the 5-year readmission rates of a cohort of mental health patients admitted to an acute inpatient service in 2000. Almost 40% of the group had no further acute admissions for psychiatric reasons anywhere in New Zealand during the 5-years after discharge. The two factors associated with readmission were having a history of previous admissions or being of M ori ethnicity. One-third of the group had three or more admissions in the 5 years following index discharge with longer bed stays. The findings highlight the need for reliable community-based data to enable exploration of the use of community services following acute discharge, especially in preventing readmission, and the impact of acute service alternatives to inpatient units for times of crisis. This is particularly important given the negative and distressing experience reported by people admitted to acute psychiatric inpatient units.

SUMMARY

The benefits and harms of alcohol use in New Zealand: what politicians might consider

Nick Wilson, Fiona Imlach Gunasekara, George Thomson

The New Zealand Government is currently considering ways to reduce alcohol-related harm, following on from a detailed report by the Law Commission. To inform discussions we briefly summarise the benefits and harms of alcohol use in this country. The most substantive benefits to society are probably pleasure to users and economic benefits (largely to industry). The most substantive harms are probably those to mental and physical health, harm to society (e.g., from crime) and adverse net economic impacts. Overall the picture is suggestive that New Zealand society would be likely to achieve a large net benefit from reducing heavy and binge drinking, and shifting alcohol consumption towards a pattern of smaller amounts. The substantial harm to non-users is a key argument for democratic governments to use regulations and taxes to minimise harm from alcohol.

SUMMARY

Narcolepsy in New Zealand: pathway to diagnosis and effect on quality of life

Angela J Campbell, T Leigh Signal, Karyn M OKeeffe, Jessie P Bakker

Narcolepsy is a neurological sleep disorder characterised by excessive daytime sleepiness, with other symptoms including sudden episodes of muscle weakness, disrupted sleep, sleep paralysis and hallucinations occurring during sleep onset or while awakening. We aimed to survey patients diagnosed with narcolepsy in New Zealand in order to gather data regarding their pathway to diagnosis, treatment, and general quality of life. Responses were received from 54 patients, on average 55 years old. Diagnosis of narcolepsy took place at an average age of 33, despite symptoms first appearing by age 21. The respondents reported greater daytime sleepiness and poorer health-related quality of life compared with the general New Zealand population, and we also identified a number of inconsistencies between the diagnostic/treatment pathway of these patients and internationally published guidelines.

SUMMARY

Alcohol’s harm to others: self-reports from a representative sample of New Zealanders

Sally Casswell, Jessica F Harding, Ru Q You, Taisia Huckle

A survey of New Zealand households asked about the experience of heavy drinkers in peoples lives. One in four reported having a heavy drinker in their life and a wide range of negative experiences were reported by interviewees to have been associated with this exposure.

SUMMARY

Off-label use of atypical antipsychotic medications in Canterbury, New Zealand

Erik Monasterio, Andrew McKean

The purpose of the current study is to determine how often the new generation of antipsychotic medications (designed and licensed to treat illnesses such as schizophrenia and manic depressive illness) are used to treat other, non-psychotic related problems. This is known as coff-label d prescribing and while it is not illegal, the use of medications in this way is seldom backed by scientific evidence of efficacy and safety. We surveyed 70% of all the psychiatrists in the Canterbury region and found to 96% of them prescribed these medications coff-label d. More than 50% of psychiatrists did so at least once a week and the most common problems for which they were prescribed were anxiety, sleeplessness, post-traumatic stress disorder and dementia. The findings suggest that there is an over reliance on antipsychotic medications to treat common symptoms of psychological distress.

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