• A survey of the prescribing of selective serotonin reuptake inhibitors by psychiatrists

      Lawton, John D.; Naik, Prakash (1995)
      Questionnaires were sent to 92 doctors asking them aspects of their antidepressant prescribing; 72 returned them. Sixty had prescribed selective serotonin reuptake inhibitors (SSRIs) in the previous year. The ratio of SSRIs to all antidepressants prescribed in the previous year exceeded 40% in only eight doctors. Inability to tolerate and failure to respond to established antidepressants were the most common indications for prescribing SSRIs. Side effects and cost were the most common reasons deterring doctors from prescribing SSRIs. SSRIs being new products and doubtS regarding their efficacy were factors that were significantly more likely to deter 'doctors of other grades' than consultants from prescribing them. Fluoxetine and paroxetine were the most frequently prescribed SSRIs.
    • Inappropriate antidiuretic hormone secretion and SSRIs

      Bouman, Walter P.; Johnson, Hazel; Pinner, Gill (1997)
    • Recording adverse drug reactions in a forensic psychiatry unit: How can we improve standards?

      Gibbon, Simon D.; Khalifa, Najat (2005)
      Adverse drug reactions (ADRs) are increasingly recognised as an important cause of morbidity and mortality. Psychiatric patients, and especially those in forensic units, may be at increased risk of ADRs. Detection and documentation of previous ADRs are essential in reducing the risk of future ADRs. A baseline audit was undertaken, and subsequently the recording of ADRs on the drug cards of patients in a forensic psychiatry unit was re?audited. Poor levels of documentation of ADRs were found. Following the baseline audit, a number of simple measures were undertaken which improved performance at re?audit.
    • QTc-interval abnormalities in a forensic population

      Huckstep, Bernard; Oakley, Janette; Ferriter, Michael (2007)
      Background: Antipsychotic drugs have been linked to sudden death among psychiatric patients, with a suggestion that prolongation of the QT-interval detectable on a standard electrocardiogram may be linked to fatal cardiac arrhythmias in these circumstances. Patients in secure forensic psychiatric facilities may be particularly likely to be on high-dose antipsychotic medication, and yet, as far as the authors are aware, no study of QT-intervals among such patients has been reported. Aim: To investigate the prevalence of QT-interval abnormalities and associated known risk factors for fatal cardiac arrhythmias in a sample of forensic patients. Method: Participants had a 12-lead electrocardiogram taken at 50 mm/s. Information was collected on their age, gender, psychiatric diagnosis, history of cardiovascular, liver and kidney diseases, and smoking, on all medications and on history of seclusion over the previous 12 months. Analysis was carried out using binary logistic regression. Results: Lower rates of QT-interval abnormalities than might be expected for this population were found. It was also found that a high dose of antipsychotics was associated with QTc prolongation (Adjusted OR = 9.5, 95% CI 2.6-34.2), a result consistent with previous literature. Conclusion: Forensic patients need not be at increased risk of QTc abnormality provided risk factors are properly managed. A high dose of antipsychotic medication increases the risk of QTc prolongation. Copyright © 2007 John Wiley & Sons, Ltd.
    • Mirtazapine antagonises the subjective, hormonal and neuronal effects of m-chlorophenylpiperazine (mCPP) infusion: A pharmacological-challenge fMRI (phMRI) study

      Vollm, Birgit A. (2011)
      Aberrant signalling through central 5-HT<inf>2C</inf> receptor pathways has been implicated in various psychiatric disorders but this has not been amenable to experimental investigation in the absence of a valid in-vivo biomarker of functional 5-HT<inf>2C</inf> neurotransmission. One approach is drug-challenge pharmaco-magnetic resonance imaging (phMRI). We have previously shown that intravenous administration of the 5-HT<inf>2C</inf> agonist m-chlorophenylpiperazine (mCPP) elicits increases in blood oxygenation dependent signal (BOLD) in regions consistent with the distribution of 5-HT<inf>2C</inf> receptors. In the current study we determined whether BOLD signal responses to mCPP could be blocked by pre-treatment with a 5-HT<inf>2C</inf> antagonist. Healthy male volunteers received oral mirtazapine, 5-HT<inf>2</inf>/5-HT<inf>3</inf> receptor antagonist, or placebo 90min prior to intravenous mCPP challenge phMRI. BOLD signal increases following mCPP infusion occurred in areas known to be rich in 5-HT<inf>2C</inf> receptors such as the substantia nigra, hypothalamus, pallidum and amygdala. These responses were attenuated by mirtazapine pre-treatment. The results suggest that mCPP-challenge phMRI produces reliable patterns of response that are mediated by 5-HT<inf>2C</inf> receptors; these responses may therefore be useful in-vivo measures of 5-HT<inf>2C</inf> function in psychiatric disorders. © 2011 Elsevier Inc.
    • A case report of clozapine augmentation with granulocyte colony stimulating factor (G-CSF)

      Broughton, Trevor; Millward, Tim; Geelan, Steve (2012)
      For some patients clozapine represents the only option for controlling the debilitating symptoms of schizophrenia. More tragic are those cases where previously successful treatment with clozapine is withdrawn as a result of blood dyscrasia. In this article, the authors describe such a case. In this instance it was possible to continue treatment with clozapine to good effect by using granulocyte colony stimulating factor (G-CSF) as an adjunct. This article further explores the decision-making process and the clinical evidence behind this approach. © 2012 Copyright Taylor and Francis Group, LLC.
    • Rapid tranquillisation: Practice in Zambia, before and after training

      Adams, Clive E. (2013)
      The evidence base for rapid tranquillisation is small in higher-income countries but is even smaller in sub-Saharan Africa. We initiated the first ever survey on the use of rapid tranquillisation in Zambia in 2009; a further survey was then done in 2010, after a programme of teaching and training. It demonstrated an overall improvement in clinical practice, safety, awareness and use of medications within therapeutic doses. It also led to a reduction in inappropriate use of medications. These improvements in practice occurred within a short time span and with minimal effort. Further international collaborative partnerships are required to build stronger mental health infrastructure in Zambia.
    • Psychiatric drugs and capacity

      Clifford, Adam (2014)
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    • Critical thinking offers a more person-centred approach to drug treatments

      Middleton, Hugh (2014)
      Background: The science supporting use of antipsychotic agents, antidepressants and mood stabilizers is not noncontroversial. There are criticisms of the honesty with which trial data are presented, allegations of common interest between academics and commercial sponsors and concerns about other ways in which products have been promoted. These justify critical reappraisal of the bases upon which psycho-pharmaceuticals have acquired a reputation as effective therapies. Objectives: Summarize two recent books (1,2). To use their interpretations of such data as the basis of a more relational, person-centred approach to the use of psychotropic medication. Methods: The Myth of the Chemical Cure asks a number of specific questions of the science behind antipsychotic agents, antidepressants and mood stabilizers which test whether or not these agents fulfill what might expected of a therapeutic agent. The Bitterest Pill provides an account of the way in which the notion of psychosis as "correctable chemical abnormality" has been developed. Findings: A critical reading of scientific and clinical trials findings suggests that the notion of psycho-pharmaceuticals as targeted therapeutic agents correcting abnormalities of brain chemistry over-interprets available knowledge. An historical perspective can now look back and recognize that our understanding of "antipsychotic" agents has been shaped by commercial interests (3). Conclusions: Psychopharmacology's therapeutic effects might be better understood as a complex processes including the subjective experiences psycho-active agents induce, expectancy and the affirming effect of receiving a prescription. Ways in which commercial interests exploit these have to recognized if unwanted consequences are to be minimized.
    • Feedback on SMS reminders to encourage adherence among patients taking antipsychotic medication: A cross-sectional survey nested within a randomised trial

      Adams, Clive E. (2015)
      OBJECTIVES: To explore feedback on tailored SMS reminders to encourage medication adherence and outpatient treatment among patients taking antipsychotic medication, and associations related to the feedback.
    • Mobile phone text message reminders: Measuring preferences of people with antipsychotic medication

      Adams, Clive E. (2015)
      UNLABELLED: Mobile technology use, including Short Messaging Service (SMS) text messaging, has increased in health care services. Preferences regarding the type or timing of text messages sent by healthcare providers to people with antipsychotic medication have not yet been fully investigated. This study examines the relationship between patients' demographic characteristics and the tailored messages they select. The study ("Mobile.Net"
    • Current role of melatonin in pediatric neurology: Clinical recommendations

      Cortese, Samuele (2015)
      BACKGROUND/PURPOSE: Melatonin, an indoleamine secreted by the pineal gland, plays a key role in regulating circadian rhythm. It has chronobiotic, antioxidant, anti-inflammatory and free radical scavenging properties. METHODS: A conference in Rome in 2014 aimed to establish consensus on the roles of melatonin in children and on treatment guidelines. RESULTS AND CONCLUSION: The best evidence for efficacy is in sleep onset insomnia and delayed sleep phase syndrome. It is most effective when administered 3-5 h before physiological dim light melatonin onset. There is no evidence that extended-release melatonin confers advantage over immediate release. Many children with developmental disorders, such as autism spectrum disorder, attention-deficit/hyperactivity disorder and intellectual disability have sleep disturbance and can benefit from melatonin treatment. Melatonin decreases sleep onset latency and increases total sleep time but does not decrease night awakenings. Decreased CYP 1A2 activity, genetically determined or from concomitant medication, can slow metabolism, with loss of variation in melatonin level and loss of effect. Decreasing the dose can remedy this. Animal work and limited human data suggest that melatonin does not exacerbate seizures and might decrease them. Melatonin has been used successfully in treating headache. Animal work has confirmed a neuroprotective effect of melatonin, suggesting a role in minimising neuronal damage from birth asphyxia; results from human studies are awaited. Melatonin can also be of value in the performance of sleep EEGs and as sedation for brainstem auditory evoked potential assessments. No serious adverse effects of melatonin in humans have been identified.Copyright © 2014 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.
    • Evaluation of third party medication errors reported in a UK community and mental health care trust

      Elswood, Matthew; Lerway, Rachel (2016)
      Introduction: Medication errors have been cited as the cause of 5-8% of unplanned hospital admissions creating a significant burden on the NHS.<sup>1</sup> Learning from adverse incidents was identified as a priority in 2000<sup>2</sup> with many organisations subsequently implementing reporting and learning systems to reduce errors within their organisations. Third party incidents are incidents that have been caused by and are the responsibility of another organisation. The purpose of this evaluation was to identify trends and themes within third party medication errors reported in the trust. Methods: An analysis of third party medication related incidents reported in the trust between January 2014 and December 2015 was conducted. Incidents were extracted electronically from the trust online reporting system. All incidents were reviewed and coded by KP into categories developed during the coding process using the free text descriptions. This allowed evaluation of the types and locations of errors and the types of medicines involved. Ambiguous reports were categorised by consensus agreement of the researchers (KP and MB). Those lacking sufficient detail were categorised as unclassifiable. Analysis consisted of frequency counts and percentages. The study was approved as service evaluation by the hosting trust and therefore did not require ethical approval. Results: 223 reports were reviewed relating to 242 medication incidents (14 included multiple medications). It was found that the majority of incidents were located at private addresses (n = 87, 39%), residential homes (n = 56, 25%) and nursing homes (n = 18, 8%). The main causes of error identified were lack of communication between health workers (n = 38, 17%), followed by errors arising through the patients transfer of care (n = 30, 13%). Drug administration errors (n = 29, 13%) and supply issues (n = 29, 13%) were also common causes of error. One hundred and fifty-four of the reports indicated that the incident had been resolved by the person discovering the issue with 27% (n = 42) of these detailing procedures put in place to prevent reoccurrence. 78% of medications involved fell under the categories of endocrine, central nervous and cardiovascular systems, with the most popular medication involved in incidents being insulin (n = 48, 20%), opioid analgesics (n = 40, 17%) and anticoagulants (n = 33, 14%) respectively. 23% (n = 50) of all recorded drugs were classified as schedule 2 and 3 controlled drugs. Discussion: This evaluation suggests that there are a wide range of medication errors identified by the trust which are not as a result of errors made within the organisation and are therefore an additional burden on services. Most third party errors were linked to transfers of care or inter-professional communication. This study required the recoding of reports to allow analysis and in some cases free text descriptions were incomplete preventing accurate reclassification which would make estimate conservative. This work would suggest that transfers of care and inter-professional communication are significant factors within third party errors and therefore consideration needs to be given to further understand the cause of these to reduce both the immediate impact of the error but also the use of trust resources to resolve issues created external to the organisation.
    • BAP Position Statement: Off-label prescribing of psychotropic medication to children and adolescents

      Hollis, Chris P. (2016)
      The off-label use of medicines for children and adolescents remains a common and important issue for prescribing practice across child and adolescent psychiatry, paediatrics and primary care. This editorial focusses on psychotropic drug treatment, which plays an essential part in the comprehensive management of a range of child and adolescent psychiatric disorders. Despite a growing evidence base for drug treatment in child and adolescent psychiatric disorders, much psychotropic medication continues to be prescribed off-label (i.e. outside the limits of the marketing authorisation or product license). The reasons for and implications of off-label prescribing, including the potential clinical benefits/risks and medico-legal implications, are often poorly understood by both patients and prescribers. An important unintended consequence of the uncertainties and confusion surrounding the status of off-label prescribing for children and adolescents may be that effective drug treatments are being withheld or underused. This BAP Position Statement aims to clarify these issues, challenge some of the myths surrounding off-label prescribing for children and adolescents and offer practical guidance for prescribers. Copyright © The Author(s) 2016.