Establishing a physical health monitoring service for patients on depot antipsychotic medication

2016 ◽  
Vol 33 (S1) ◽  
pp. S564-S564
Author(s):  
M. Gill ◽  
M. McCauley
Keyword(s):  
Side Effects ◽  
Physical Health ◽  
Antipsychotic Medication ◽  
Health Monitoring ◽  
Side Effect ◽  
Blood Test ◽  
Best Practice ◽  
Self Report ◽  
Physical Parameters ◽  
Depot Antipsychotic

IntroductionPatients with major mental illness are recognised to be at risk of premature death for a multitude of reasons. Those with schizophrenia and bipolar disorder are at highest risk.ObjectivesInternational best practice recommends monitoring of blood tests, physical parameters such as weight, BMI, waist circumference and blood pressure, and side effects of patients prescribed antipsychotic medication. A clinic was established to target these interventions.AimsThis initiative aimed to improve the physical health monitoring of patients prescribed depot antipsychotic medication in a catchment area of approximately 36,000 in Ireland.MethodsA twice-yearly, multidisciplinary monitoring clinic was established. A protocol was drawn up, following a literature review and inspection of current international guidelines, and a proforma assisted as an aide-mémoire. A self-report questionnaire, the Glasgow Antipsychotic Side Effect Scale, was used to enquire about side effects.ResultsEvaluation took place in descriptive form with audit used to examine outcomes. Full blood test monitoring improved from 9% of patients to 61% in one year, with 78% of patients having had at least one blood test recorded. Prior to the clinic's establishment, only one patient had had any physical parameters recorded, but this improved to 96% recorded after the clinics were run. Side effect documentation also improved.ConclusionsThe clinic was well-received and led to improved teamwork. Future recommendations include organising the clinic so as to include simultaneous blood testing. A similar project is being planned to target all patients attending who are prescribed antipsychotic medication.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Establishing a physical health monitoring service for patients on depot antipsychotic medication

2016 ◽  
pp. 1-7 ◽  
Author(s):  
M. Gill ◽  
K. McKenna ◽  
M. McCauley ◽  
M. Gulzar
Keyword(s):  
Physical Health ◽  
Antipsychotic Medication ◽  
Health Monitoring ◽  
Blood Test ◽  
Best Practice ◽  
Premature Death ◽  
Physical Parameters ◽  
Blood Testing ◽  
Depot Antipsychotic ◽  
Long Acting

IntroductionPatients with major mental illness are recognised to be at risk of premature death for a multitude of reasons. This initiative aimed to improve the physical health monitoring of patients prescribed depot antipsychotic medication in a catchment area of ~36 000 in Ireland.ObjectivesInternational best practice recommends monitoring of blood tests, physical parameters such as weight, BMI, waist circumference and blood pressure, and side effects of patients prescribed antipsychotic medication. A clinic was established to target these interventions.MethodsA cohort of patients receiving antipsychotics in long-acting injectable form was chosen. A twice-yearly, multidisciplinary health monitoring clinic was established. Evaluation involved an audit of medical records which measured the proportion of those attending the clinic who had blood test monitoring and physical parameters recorded.ResultsBefore the clinic’s implementation, 30% of patients had evidence of some blood test monitoring, 9% had evidence of complete blood testing and one patient had evidence of physical health parameters having been recorded. One year after the implementation 78% of patients had evidence of some blood test monitoring, 61% had evidence of full blood test monitoring and 100% had evidence of physical parameters recorded.ConclusionsThe clinic was positively received by patients, and led to improved teamwork. Recommendations include organising concurrent psychiatric and phlebotomy clinics so that patients may avail of psychiatric review and blood testing at a single appointment. As a result of the increased focus on physical health monitoring, a similar project is planned to target all patients prescribed antipsychotics.

scholarly journals What side effects are problematic for patients prescribed antipsychotic medication? The Maudsley Side Effects (MSE) measure for antipsychotic medication

2017 ◽  
Vol 47 (13) ◽  
pp. 2369-2378 ◽  
Author(s):  
T. Wykes ◽  
J. Evans ◽  
C. Paton ◽  
T. R. E. Barnes ◽  
D. Taylor ◽  
...  
Keyword(s):  
Side Effects ◽  
Antipsychotic Medication ◽  
Side Effect ◽  
Self Report ◽  
Psychotic Symptoms ◽  
Service Users ◽  
Good Reliability ◽  
Starting Point ◽  
Two Samples ◽  
Life Impact

BackgroundCapturing service users’ perspectives can highlight additional and different concerns to those of clinicians, but there are no up to date, self-report psychometrically sound measures of side effects of antipsychotic medications.AimTo develop a psychometrically sound measure to identify antipsychotic side effects important to service users, the Maudsley Side Effects (MSE) measure.MethodAn initial item bank was subjected to a Delphi exercise (n = 9) with psychiatrists and pharmacists, followed by service user focus groups and expert panels (n = 15) to determine item relevance and language. Feasibility and comprehensive psychometric properties were established in two samples (N43 and N50). We investigated whether we could predict the three most important side effects for individuals from their frequency, severity and life impact.ResultsMSE is a 53-item measure with good reliability and validity. Poorer mental and physical health, but not psychotic symptoms, was related to side-effect burden. Seventy-nine percent of items were chosen as one of the three most important effects. Severity, impact and distress only predicted ‘putting on weight’ which was more distressing, more severe and had more life impact in those for whom it was most important.ConclusionsMSE is a self-report questionnaire that identifies reliably the side-effect burden as experienced by patients. Identifying key side effects important to patients can act as a starting point for joint decision making on the type and the dose of medication.

scholarly journals Physical health monitoring of patients prescribed depot antipsychotic medication in north west Edinburgh community mental health team

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S336-S337
Author(s):  
Douglas Murdie ◽  
Jakub Wojtowicz ◽  
Alexandra Thompson ◽  
Anne MacLeod ◽  
Adam Mallis ◽  
...  
Keyword(s):  
Mental Health ◽  
Physical Health ◽  
Antipsychotic Medication ◽  
Health Monitoring ◽  
Community Mental Health Team ◽  
Mental Health Team ◽  
North West ◽  
Depot Antipsychotic ◽  
Major Mental Disorder

AimsTo monitor the quality of physical health monitoring of patients prescribed depot antipsychotic medication in the North West Edinburgh Community Mental Health Team (CMHT). We also evaluated the completeness of prescriptions and Mental Health Act (Scotland) (Act) 2003 paperwork where relevant.BackgroundAntipsychotic medications are medicines for treating conditions such as Schizophrenia, but some may be associated with an increased risk of Metabolic Syndrome. Moreover, evidence indicates that patients with major mental disorder have a reduced life expectancy in comparison to those without such diagnoses. These two factors illustrate the importance of the physical health of this patient cohort being monitored on a regular basis. This project will evaluate how a local CMHT is performing, with the possibility of enacting service improvements if required.MethodThe records of the 60 patients prescribed depot antipsychotic medication administered by this CMHT were reviewed. A check-list was created consisting of 14 categories analysing the quality of physical health monitoring, as well as compliance with prescription standards and, where relevant, Mental Health Act (Scotland) (Act) 2003 paperwork. We compared patient records against our checklist for the calendar year of 2019. The Scottish Intercollegiate Guidelines Network (SIGN) 131 (Management of Schizophrenia) section 5.2 was used as the gold standard for physical health monitoring against which the data we collected was compared.ResultWe identified a wide range of flaws with the current system and implementation of monitoring, and difficulty in locating the required information. There was no consistent monitoring of physical observations on electronic record, nor an accepted alternative way in which this was documented. Furthermore, blood tests were not consistently obtained either by the service or GP practices in a reproducible manner. This led to discussions within the CMHT regarding creation of a new pathway for the monitoring of this patient cohort using a Quality Improvement model, with the ultimate goal to establish a regular physical health clinic.ConclusionThere is significant evidence that patients with major mental disorder do not access healthcare as consistently as those without, leading to a disparity in life expectancy. In light of the fact that antipsychotic medications can be associated with Metabolic Syndrome, we have an even greater responsibility to tackle this marked health inequality by appropriately monitoring our patients. This was not done well in this particular CMHT, but this project will lead to improvements in the service and ultimately patient care.

scholarly journals Audit of physical health monitoring during initiation and ongoing treatment with antipsychotic medication in a tier 3 outpatient CAMHS service, Belfast

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S323-S324
Author(s):  
Pam Hamlyn ◽  
Aaron McMenamin ◽  
Hilary Boyd ◽  
Lara Patton
Keyword(s):  
Young People ◽  
Physical Health ◽  
Antipsychotic Medication ◽  
Health Monitoring ◽  
Care Pathway ◽  
Electronic System ◽  
Clinical Notes ◽  
Medication Monitoring ◽  
Tier 3 ◽  
Health Parameters

AimsTo evidence that physical health monitoring during antipsychotic initiation and continued treatment within the Child and Family Clinic is current, as per the agreed Antipsychotic Medication Monitoring Schedule for Belfast Trust CAMHS (2015), supporting Quality Network for Community CAMHS(QNCC) accreditation.BackgroundThe Antipsychotic Medication Monitoring Schedule CAMHS(2015) was agreed by a working group of consultant psychiatrists and pharmacists, based on evidence from The Canadian Alliance for Monitoring Effectiveness and Safety of Antipsychotics in Children (CAMSEA), NICE Guidelines CG 185(2014), CG155(2013) and Maudsley Guidelines, and was to be located on the electronic system (PARIS).MethodIn January 2019, a list of all children/young people on antipsychotic medication was collated (n = 12). Presence of the monitoring schedule in the clinical notes or PARIS was recorded. The Electronic Care Record was reviewed for blood results and PARIS letters for documentation of physical health parameters (heart rate, blood pressure, height, weight, BMI, extrapyramidal side effects, ECG) and to identify documentation of risk/benefit review where monitoring was declined. Re-audit January 2020 (n = 9). Criteria:All patients commenced on antipsychotic medication will have baseline blood investigations and other physical health parameters documented as per the monitoring schedule. If monitoring was declined, the reason for this and indications for prescribing must be documented as a risk/benefit analysis.All patients on antipsychotic medication will be current with their physical health Monitoring Schedule.All patients will have their Monitoring Schedule completed in clinical notes or on PARIS.ResultFirst cycle results (n = 12):Baseline bloods (or documented declined) = 92%, Baseline ECG (or documented declined) = 75%Complete monitoring bloods = 33%, Physical health monitoring parameters complete = 42%Monitoring schedule present in the notes and current = 42% (0% on PARIS).Initial Recommendations: Standardised recording of monitoring using PARIS clinic letters and the schedule in front of clinical notes; Baseline ECG mandatorySecond cycle results (n = 9):Baseline bloods (or declined) = 89%, Baseline ECG (or declined) = 67%Complete monitoring bloods = 44%, Physical health monitoring parameters complete = 56%Monitoring schedule present in notes and current = 38%, Present, not current = 50% (0% on PARIS).ConclusionLower numbers at re-audit limit interpretation.Further recommendations: Antipsychotic initiation checklist; Central bloods diary for clinicians; Antipsychotic care-pathway booklet, co-produced with young people, incorporating the monitoring schedule.

scholarly journals Off-label prescribing of quetiapine in south locality crisis teams

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S87-S87
Author(s):  
Mamta Kumari ◽  
Arun Kumar Gupta ◽  
Peter Clarke
Keyword(s):  
Side Effects ◽  
Physical Health ◽  
Health Monitoring ◽  
Treatment Options ◽  
General Medical Council ◽  
Evidence Base ◽  
Medical Council ◽  
Team Members ◽  
Off Label ◽  
Psychotropic Medicines

AimsThe audit was carried out to determine the frequency of off label prescribing of quetiapine and compliance with standards within Trust Policy (UHM PGN 02 PPT PGN 08) – Physical Health Monitoring of Patients Prescribed Antipsychotics and other Psychotropic Medicines, NICE CG178, General Medical Council Ethical Standards and Royal College of Psychiatrists – College Report CR210.The main objectives of the audit were to determine if:Patients have been appropriately informed of off-label status and consent recorded.Alternative licensed treatment first used/ruled out.Appropriate communication on transfer of care.Appropriate physical health monitoring completed.BackgroundQuetiapine is associated with various physical side effects. Patients should be fully informed of the expected risks and benefits of treatment, and the limited evidence base for off-label prescribing.There are additional issues around the transfer of prescribing to primary care.MethodThe sample consisted of 50 consecutive patients selected from the crisis team caseload in the month of December 2018.Data reviewed in this audit were taken from six months period.Records audited were obtained from RiO (electronic records) and prescription charts.Data collection was started in January 2019 and completed in March 2019The audit tool was a dichotomous scale questionnaire based on NICE guidelines.Result4 patients from the sample (8%) were prescribed off-label quetiapine.100% had physical health monitoring completed as per Trust policy.100% off-label indication been clearly documented in notes.100% Consent to treatment was documented.100% had medication reviewed in the previous 6 months.75% had licensed medication used or ruled out before considering off-label quetiapine use25% risks/benefits of treatment were documented as part of a patient discussion.25% had documented evidence that alternative treatment options were discussed.25% had documented evidence of Community consultant/GP consent/agreement was obtained before transfer of prescribing75% had a documented plan for review of quetiapine for treatment efficacy and side effects50% had a documented plan in place for ongoing physical health monitoringConclusionSuggested a wider audit may be required with greater patient numbers and which specifically filters for patients prescribed quetiapine.Audit result has been shared with Crisis team members, Medicines Optimisation Committee and South Locality Quality Standards Committee in the trust.

scholarly journals Audit of ADHD medication prescription and monitoring in intellectual disability services, Greater Glasgow & Clyde

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S66-S66
Author(s):  
Neha Bansal ◽  
Muzammil Hayat
Keyword(s):  
Intellectual Disability ◽  
Side Effects ◽  
Physical Health ◽  
Health Monitoring ◽  
Symptom Severity ◽  
Adhd Medication ◽  
Audit Tool ◽  
Medication Prescription ◽  
Ongoing Treatment ◽  
Medication Dosage

AimsStudies have shown that people with intellectual disability (ID) show a greater severity of attention deficit hyperactivity disorder (ADHD) symptoms and atypical presentation, as well as having a greater risk of developing comorbidities, such as challenging behaviour, anxiety, tic disorders and sleep problems. It is estimated that 1.5% of patients with ID will have a clinical diagnosis of ADHD.The aim of this audit was to find whether individuals with ID and ADHD, who are prescribed medication for ADHD are adequately monitored and reviewed in accordance with the ADHD medication prescription guidance by NICE and the Royal College of Psychiatrists (RCPsych).MethodThis audit looked at ADHD medication prescription for the ID population within Greater Glasgow & Clyde NHS. This is the 6th audit cycle where electronic records (EMIS) were analysed between 28/9/19 to 09/10/20. (The 5th cycle data collection period ended on 28/9/19). We collected data on all patients aged over 18 years.An audit tool was developed to find whether the following were documented; patient demographics, physical health monitoring, symptom severity, medication dosage, side effects, need for ongoing treatment and frequency of review. 100% of patients should have all components on the ADHD audit tool documented, as per NICE/ RCPsych prescription guidance.Result32 patients were identified as being diagnosed with ADHD prescribed medication. One patient was impacted by the COVID-19 pandemic which meant that the required monitoring was not fully carried out. The age ranged from 18 to 56 years. 75% had mild intellectual disability, 19% had moderate and 6% had severe, with no cases of profound intellectual disability. Blood Pressure/pulse was recorded in 84% of patients. Height/weight/ BMI was recorded in 81% of patients. 97% of patients had ADHD symptom severity, medication dosage, side effects, need for ongoing treatment and frequency of review recorded.ConclusionThere is further scope for improvement in the monitoring and documentation of physical health observations, however there was a significant improvement compared to the previous cycle of the audit. Other aspects of monitoring and documentation appear to be recorded in almost 100% of patients. This finding emphasises the challenges of physical health monitoring and compliance in psychiatry as a whole. We need to continue to encourage awareness and education around the physical health risks to our patients, not only due to their comorbidities but also as a result of the psychotropic medications we prescribe them.

Hostility Conflict and Reporting of Side Effects by Psychiatric Outpatients

1980 ◽  
Vol 47 (1) ◽  
pp. 319-324 ◽  
Author(s):  
Robert W. Downing ◽  
Karl Rickels
Keyword(s):  
Side Effects ◽  
Side Effect ◽  
Self Report ◽  
Partial Replication ◽  
Drug Trials ◽  
Psychiatric Outpatients ◽  
Double Blind ◽  
The Relationship ◽  
Report Measure

The Irritability, Indirect Hostility, Verbal Hostility, and Resentment scales from the Buss-Durkee Hostility Inventory, along with a newly constructed scale intended as a self-report measure of Hostility Conflict, were administered to 84 non-psychotic, primarily anxious psychiatric outpatients receiving an active anxiolytic and participating in one of several 4-wk. double-blind drug trials. Patients who complained of one or more side effects after 2 wk. of treatment were classified as side reactors; the remaining patients, as non-side reactors. Compared to non-side reactors, the side reactors obtained higher hostility conflict scores and lower scores on the Irritability and Indirect Hostility scales. Also, the relationship between side effect status and hostility conflict was stronger in those patients who obtained higher scores on the Irritability, Indirect Hostility, and Verbal Hostility scales and among patients obtaining lower scores on the Resentment scale. Findings were regarded as providing partial replication of and further verification of earlier results.

Prevalence of Extrapyramidal Side Effects in Patients Receiving Depot Antipsychotic Medication

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
B. Luft ◽  
E. Berent
Keyword(s):  
Side Effects ◽  
Tardive Dyskinesia ◽  
Antipsychotic Medication ◽  
Rating Scales ◽  
Involuntary Movement ◽  
Extrapyramidal Side Effects ◽  
Drug Induced ◽  
Adherence To Medication ◽  
Depot Antipsychotic ◽  
Long Acting

Introduction:Long-acting depot antipsychotic medication is associated with extrapyramidal side effects (EPS). This may reduce adherence to medication, and precipitate relapse (1). Clearly, EPS is a major drawback and early detection is essential. However, in an earlier review of patients’ medical notes, we identified only one patient with an examination that recorded the presence of EPS. Despite the fact that a number of rating scales are available. We proposed that the application of these rating scales, would allow us to improve the assessment of EPS.Method:All patients prescribed a depot antipsychotic or long-acting risperidone injection, were identified. the Barnes Akathisia Scale (2) was chosen to rate akathisia, a modified Simpson-Angus scale (3) was chosen to rate parkinsonism and the Abnormal Involuntary Movement Scale (4) was chosen to rate tardive dyskinesia.Results:A total of 43 patients were evaluated. 23 (53%) patients showed drug induced EPS. the total number of positive cases of akathisia was 12 (28%), and 10 (23%) patients were found to have tardive dyskinesia. 13 (30%) patients were found to have drug induced parkinsonism.Conclusions:Our screening programme has identified high rates of previously undiscovered drug induced EPS.

Clinical validation of the self-reported Glasgow Antipsychotic Side-effect Scale using the clinician-rated UKU side-effect scale as gold standard reference

2020 ◽  
Vol 34 (8) ◽  
pp. 820-828
Author(s):  
Marlene Schouby Bock ◽  
Oona Nørgaard Van Achter ◽  
David Dines ◽  
Maria Simonsen Speed ◽  
Christoph U Correll ◽  
...  
Keyword(s):  
Side Effects ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Gold Standard ◽  
Side Effect ◽  
Self Report ◽  
Measurement Based Care ◽  
Gold Standard Reference ◽  
Antipsychotic Side Effects

Background: Antipsychotics are key for the treatment of psychotic and several non-psychotic disorders. Unfortunately, antipsychotic medications are associated with side effects, which may reduce quality of life and treatment adherence. Therefore, regular screening of antipsychotic side effects is essential. The Glasgow Antipsychotic Side-effect Scale is a patient self-report scale developed for this purpose. However, the Glasgow Antipsychotic Side-effect Scale has only been validated against another self-report side effect measure, which is suboptimal. Objective: We aimed to validate the Glasgow Antipsychotic Side-effect Scale using the clinician-rated Udvalg for Kliniske Undersøgelser side-effect rating scale as the gold standard reference. Results: 81 antipsychotic-treated outpatients with schizophrenia-spectrum disorders (age = 42±13 years; males = 43%, schizophrenia = 77%, illness duration: median = 11 years) completed the Glasgow Antipsychotic Side-effect Scale and were subsequently scored on the Udvalg for Kliniske Undersøgelser by trained raters. Sensitivity, specificity, positive predictive value and negative predictive value were calculated for paired Glasgow Antipsychotic Side-effect Scale and Udvalg for Kliniske Undersøgelser items. Sensitivity of Glasgow Antipsychotic Side-effect Scale items ranged from 33–96%, with 19 (86%) having >75% sensitivity. Lowest sensitivity emerged for “nocturnal enuresis” (33%), “galactorrhea” (50%) and “hyperkinesia” 14–99%, with 14 items (64%) having >75% specificity, being lowest for “asthenia” (14%), “polyuria/polydipsia” (35%), “sedation” (41%), “akathisia” (53%), “dystonia” (65%), “hyperkinesia” (68%), “hypokinesia” (70%) and “accommodation” (70%). Positive predictive value ranged from 7–85%, with six items (27%) having a positive predictive value >75%. Negative predictive value ranged from 40–98%, with 21 items (95%) having a negative predictive value >75%. The mean time to complete the Glasgow Antipsychotic Side-effect Scale was 4±2 minutes. Conclusion: The Glasgow Antipsychotic Side-effect Scale demonstrated satisfactory validity as a self-rated tool for antipsychotic side effects and may aid measurement-based care and decision-making.

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