scholarly journals Mind and body: physical health monitoring in clozapine treatment

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S168-S168
Author(s):  
Moataz Abdelreheem ◽  
Olivia Connell ◽  
Daniel McNally ◽  
Itunuayo Veronica Ayeni ◽  
Clare Smith
Keyword(s):  
Mental Health ◽  
Blood Pressure ◽  
Waist Circumference ◽  
Physical Health ◽  
Antipsychotic Medication ◽  
Health Monitoring ◽  
Blood Count ◽  
Full Blood Count ◽  
Clozapine Treatment ◽  
Health Review

AimsTo evaluate physical health monitoring standards in patients on Clozapine in the community.StandardsNICE and BNF guidelines for patients on established clozapine treatment advise annual monitoring of weight, waist circumference, pulse, blood pressure, fasting blood glucose, HbA1c, blood lipids and overall physical health assessment. Full blood count is monitored 1-4 weekly.BackgroundIn the management of schizophrenia, antipsychotic medication remains the cornerstone of treatment. Patients affected carry a significant physical health burden with a reduced life expectancy of 10-25 years. Factors that contribute include sedentary lifestyles, consequent obesity and cardiovascular disease, disengagement from health services, a higher incidence of suicide and the physical side effects of antipsychotic medication. For these reasons, comprehensive routine physical assessment of patients on antipsychotic treatment is of central importance.MethodThis audit is a retrospective study of patients known to South Kensington & Chelsea Community Mental Health Team (CMHT). Patients (n = 48) were audited from the Clozapine clinic SystemOne database over a one year period (October 2018-2019) to assess annual monitoring of full blood count (FBC), urea and electrolytes (U&Es), lipid profile, liver function tests (LFTs), HbA1C, thyroid function tests (TFTs), clozapine levels, ECG, and general physical and mental health review.ResultOf the 48 patients, one was transferred to a different service so was excluded (n = 47 total).All (100.0%) of the patients had annual FBC tests. All but one (97.9%) of the patients had a physical health review including blood pressure, pulse, weight and BMI measurement. Three quarters (74.5%) received annual U&Es and LFTs. Almost two thirds of patients had annual lipid and HBA1c screening (63.8%) and over half the cohort had annual TFTs (61.7%). Regarding annual multidisciplinary mental health review, this was performed for the majority of the patients (70.2%).Contrastingly, only a quarter of the patients received annual screening of glucose and Clozapine levels (27.7% for both). Only 12 patients had annual ECG (25.5%).ConclusionFollowing review it is clear that most parameters were monitored annually in a majority of patients. However, shortcomings were detected, specifically annual ECG and waist circumference monitoring.In order to ensure comprehensive monitoring of mental and physical health of patients on Clozapine, flow charts of tests and reviews needed for each patient were written up clearly and will be included in the management pathway for every patient on Clozapine. This was agreed to minimise missing any step, particularly annual ECGs.

scholarly journals The physical health and side-effect monitoring of patients prescribed clozapine: data from a clinical audit conducted in UK mental health services

2020 ◽  
Vol 10 ◽  
pp. 204512532093790
Author(s):  
Thomas R. E. Barnes ◽  
James H. MacCabe ◽  
John M. Kane ◽  
Oriana Delgado ◽  
Carol Paton
Keyword(s):  
Mental Health ◽  
Blood Pressure ◽  
Heart Rate ◽  
Body Weight ◽  
Physical Health ◽  
Side Effect ◽  
Plasma Lipids ◽  
Clinical Audit ◽  
Clozapine Treatment ◽  
Effect Monitoring

Background: In addition to mandatory haematological monitoring, treatment guidelines recommend routine monitoring of adverse effects and physical health in patients prescribed clozapine. Methods: NHS trusts/healthcare organisations participated in a clinical audit in the context of a UK quality improvement programme addressing clozapine-prescribing practice. Results: Data relating to 6948 adult patients prescribed clozapine were submitted by 63 NHS trusts/healthcare organisations. Of 481 patients treated with clozapine for up to 18 weeks, there was documented pretreatment screening of blood pressure, heart rate and ECG in at least 90%, and body weight, plasma lipids, plasma glucose/glycated haemoglobin (HbA1c) and physical examination in approximately 80%. During the first 2 weeks of clozapine treatment there was documented daily measurement of both heart rate and blood pressure in 82% and body temperature in 77%. In a subsample of 411 patients, of the 72% who had weekly side-effect assessments documented in the first month of treatment, a structured assessment tool had been used in 29%. Treatment monitoring up to 18 weeks included an ECG in 90%, C-reactive protein (CRP) or creatine kinase in 42%, and troponin or B-type natriuretic peptide (BNP) in 29%. In the 5908 patients prescribed clozapine for at least 1 year, blood pressure and body weight/body mass index were documented in at least 80%, plasma lipids in 78% and plasma glucose in 73%, with an ECG in 55%. Two-thirds were prescribed medication to manage side effects of clozapine and one third of those with a diagnosis of schizophrenia were prescribed a second antipsychotic medication. Conclusion: The findings suggest that for most patients treated with clozapine in UK mental health services, physical health screening and side-effect monitoring follow recommended practice, but there was limited use of structured side-effect assessment tools. Monitoring for clozapine-induced myocarditis during the early risk period using markers of inflammation such as CRP, and cardiac damage such as troponin and BNP, was less consistent. This may partly reflect the variation in guideline recommendations for monitoring for myocarditis and partly the selected use of such tests when prompted by cardiac symptoms. The relatively common coprescription of medications for the majority of people on longer-term clozapine treatment may well further increase side-effect burden and physical health risks, reinforcing the need for continuing systematic monitoring.

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.

Monitoring the physical health of individuals with serious mental illness

2008 ◽  
Vol 25 (3) ◽  
pp. 108-115
Author(s):  
Majella Cahill ◽  
Anne Jackson
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Mental Health Service ◽  
Physical Health ◽  
Serious Mental Illness ◽  
Health Monitoring ◽  
Service Providers ◽  
Psychiatric Service ◽  
Service Users ◽  
Effective Models

AbstractDeveloping effective models of identifying and managing physical ill health amongst mental health service users has become an increasing concern for psychiatric service providers. This article sets out the general professional and Irish statutory obligations to provide physical health monitoring services for individuals with serious mental illness. Review and summary statements are provided in relation to the currently available guidelines on physical health monitoring.

scholarly journals Do you mind if I take your blood pressure? Physical health monitoring of children and young people on ADHD medication amidst a pandemic

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S183-S184
Author(s):  
Emma Davies ◽  
Maham Khan ◽  
Claire Jones
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Young People ◽  
Physical Health ◽  
Health Monitoring ◽  
Neurodevelopmental Disorder ◽  
Adhd Medication ◽  
Children And Young People ◽  
Nice Guidance ◽  
The Impact

AimsTo establish whether physical health monitoring for CYP on ADHD medication is according to NICE guidance (2018).To determine the impact of COVID-19 pandemic restrictions on physical health monitoring for CYP on ADHD medication.Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder, characterised by a persistent pattern of inattention and/or hyperactivity-impulsivity, directly impacting on academic, occupational, or social functioning. It affects between 1-5% of children and young people (CYP) most often presenting in early-mid childhood.Pharmacological treatment can be considered in CYP if certain criteria are met, where licensed medications include methylphenidate, dexamfetamine, lisdexamfetamine, atomoxetine and guanfacine. Stimulant and non-stimulant medications require frequent physical health monitoring due to their side effects including an increase in blood pressure and/or heart rate, loss of appetite, growth restriction and tics.MethodStandards and criteria were derived from the NICE guidance (2018), whilst local trust policies were reviewed, demonstrating discrepancies. Standards were expected to be met for 100% of patients.Electronic patient records were reviewed retrospectively from a representative cohort of CYP reviewed by clinicians in a community CAMHS service during March-November 2020. Data were entered manually into a spreadsheet for evaluation.ResultA total of 27 CYP records were reviewed, average age 13yo, on a range of stimulant/non-stimulant preparations.5 (19%) had height checked every 6 months, with 4 delayed to 7-8 months.For those >10yo, only 5 (19%) had weight checked every 6 months.Only 2 (7%) had their height and weight plotted on a growth chart and reviewed by the healthcare professional responsible for treatment.Just 4 (15%) had heart rate and blood pressure recorded before and after each dose change, whilst similarly only 4 (not the same) had these parameters recorded every 6 months.17 patients were reviewed by telephone/video call, where 5 patients provided physical health parameters (measured at home).ConclusionAcross all parameters, standards are not being met for the required physical health monitoring for CYP on ADHD medication.The COVID-19 pandemic has significantly changed the working conditions for community teams, impacting face to face reviews, creating challenges for physical health monitoring.Our ongoing implementations for change include the use of a proforma for physical health measurements, improving psychoeducation for families, exploring potential barriers with senior colleagues and collaborating with pharmacy colleagues to update local guidelines in accordance with the latest NICE recommendations. We aim to re-audit in June 2021.

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 Beta Inflated Regression Models on the Physical and Mental Health of Nigerian Stroke Survivors

2021 ◽  
Vol 7 (3) ◽  
pp. 302-312
Author(s):  
KS Oritogun ◽  
OO Oyewole
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Blood Pressure ◽  
Health Risk ◽  
Physical Health ◽  
Regression Models ◽  
Outcome Variable ◽  
Stroke Survivors ◽  
Physical And Mental Health ◽  
Health Risk Factors

Background: Stroke is one of the major public health problems worldwide. Physical and mental health data of stroke survivors are often expressed in proportions. Therefore, the Beta Regression models family for data between zero and one will be appropriate. Objectives: To identify a suitable model and the likely risk factors of physical and mental health of stroke survivors. Method: Secondary data of stroke survivors from two tertiary health Institutions in Ogun State, Nigeria, were analysed. Inflated Beta (BEINF) and Inflated-at-one-Beta (BEINF1) models were compared using Deviance (DEV), Akaike Information Criterion (AIC) and Bayesian Information Criteria (BIC) for model selection. The model with minimum DEV, AIC and BIC was considered to be better. Results: The deviance (-86.0604,), AIC (-46.0604) and BIC (6.4391) values of the BEINF1 model for physical health and the deviance (-20.1217), AIC (19.8783) and BIC (72.3778) values of BEINF1 model for mental health were smaller than BEINF models. Therefore, BEINF1 was the better model to identify the health risk factors of stroke survivors. Age, marital status, diastolic blood pressure, disability duration and systolic blood pressure had a significant association with physical health, while BMI had a significant positive association with mental health.  Conclusion: The beta-inflated-at-one (BEINF1) model is suitable for identifying health risk factors of stroke survivors when the outcome variable is a proportion. Both demographic and clinical characteristics were significantly associated with the health of stroke survivors. This study would assist researchers in knowing the appropriate model for analysing proportion or percentage response variables.

scholarly journals The Southside Simple Suppers Scale-Up (S4): Effects of a Family Meals Program on Head Start Caregivers

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 279-279
Author(s):  
Amy Sharn ◽  
Leah May ◽  
Miranda Westrick ◽  
Ashley Walther ◽  
Carolyn Gunther
Keyword(s):  
Mental Health ◽  
Blood Pressure ◽  
Waist Circumference ◽  
Data Collection ◽  
Head Start ◽  
Perceived Stress ◽  
Low Income ◽  
Family Meals ◽  
Post Test ◽  
The Impact

Abstract Objectives Assess the impact of an 8-week Head Start family meals intervention (Simple Suppers) on participating caregiver's weight status and health outcomes. Methods This is a single arm pre- to post-test study. The intervention is occurring during the 2019–20 school year (fall, winter, and spring sessions) at 3 Head Start sites. Caregiver outcomes include: BMI (kg/m2), waist circumference (cm), blood pressure (mm Hg), and mental health measures (depression (Patient Health Questionnaire-9 (PHQ-9)), perceived stress (Perceived Stress Scale (PSS)), and anxiety (Generalized Anxiety Disorder-7 (GAD-7))). Regression models factoring in attendance will be used to examine pre- to post-test changes. Results Nineteen caregivers completed data collection for the fall session. 55.6% of families were low-income and 21.1% had low/very low food security. Mean (SD) caregiver age was 37.6 (12.1) yr, 94.7% were female, and 84.2% were non-Hispanic Black. There were no significant changes in BMI, blood pressure, waist circumference, depression, or perceived stress from pre- to post-test according to attendance level, however anxiety significantly decreased with increasing attendance (P < 0.05). Data collection for the remaining sessions will be completed in spring 2020. Conclusions This study can be expected to have a positive impact by understanding the role of healthy family mealtime routines in caregiver's physical and mental health among racial minorities residing in low-income households. Funding Sources USDA NIFA.

Physical health monitoring in a scottish cohort of schizophrenia patients - the role of ECG and blood pressure monitoring

2007 ◽  
Vol 22 ◽  
pp. S106-S107 ◽  
Author(s):  
C. Bushe ◽  
O'Neil J. ◽  
C. Wood ◽  
A. Bradley ◽  
M. Farren ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Physical Health ◽  
Health Monitoring ◽  
Blood Pressure Monitoring ◽  
Pressure Monitoring

scholarly journals Longitudinal trends in the quality, effectiveness and attributes of highly rated smartphone health apps

2020 ◽  
Vol 23 (3) ◽  
pp. 107-111 ◽  
Author(s):  
Mara Mercurio ◽  
Mark Larsen ◽  
Hannah Wisniewski ◽  
Philip Henson ◽  
Sarah Lagan ◽  
...  
Keyword(s):  
Mental Health ◽  
Blood Pressure ◽  
Physical Health ◽  
High Rate ◽  
Health Conditions ◽  
High Turnover ◽  
Medical Claims ◽  
Health Apps ◽  
App Store ◽  
Google Play

BackgroundWhile there are numerous mental health apps on the market today, less is known about their safety and quality. This study aims to offer a longitudinal perspective on the nature of high visibility apps for common mental health and physical health conditions.MethodsIn July 2019, we selected the 10 top search-returned apps in the Apple App Store and Android Google Play Store using six keyword terms: depression, anxiety, schizophrenia, addiction, high blood pressure and diabetes. Each app was downloaded by two authors and reviewed by a clinician, and the app was coded for features, functionality, claims, app store properties, and other properties.ResultsCompared with 1 year prior, there were few statistically significant changes in app privacy policies, evidence and features. However, there was a high rate of turnover with only 34 (57%) of the apps from the Apple’s App Store and 28 (47%) from the Google Play Store remaining in the 2019 top 10 search compared with the 2018 search.DiscussionAlthough there was a high turnover of top search-returned apps between 2018 and 2019, we found that there were few significant changes in features, privacy, medical claims and other properties. This suggests that, although the highly visible and available apps are changing, there were no significant improvements in app quality or safety.

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