Clozapine induced constipation - a service evaluation

Background Clozapine is an atypical antipsychotic drug successfully used in the treatment of psychotic disorders. However, it is associated with life-threatening conditions including constipation and there is evidence to show that death from constipation may now exceed death from agranulocytosis. Aim To discover the rate of constipation among clozapine-treated patients and to raise awareness of the need for thorough assessment and treatment of these patients. Method At routine clinic appointments, 155 patients were asked about their bowel habit and use of laxatives using a nine-question structured interview form. Visual prompts were used including the Bristol stool chart and pictures of packaging from laxative products. Constipation was identified using the Rome III criteria. Results Forty three per cent of the sample scored positively for constipation. Patients who took laxatives were between two and four times more likely to have constipation than those who did not take laxatives. Conclusion All nursing staff need to be aware of the dangers associated with clozapine-induced constipation and that prescription of laxatives does not preclude patients being constipated

Add-on topiramate reduces weight in overweight patients with affective disorders: a clinical case series

BACKGROUND: The weight-gain caused by many psychotropic drugs is a major cause for poor compliance with such medications and could also increase cardio-vascular morbidity among psychiatric patients. Recent reports have shown that the anticonvulsant topiramate causes weight loss in various patient groups. The drug has also shown effectiveness in open trials as a mood stabilizer in patients with affective disorders, but not in controlled trials in the acute treatment of mania. We used topiramate to treat 12 patients with affective disorders who had a body-mass index >30 kg/m(2). METHODS: Topiramate was prescribed as part of our routine clinical practice, as an add-on medication, or as a replacement of a mood stabilizer. Patients' weight was recorded in 1 to 2 monthly intervals. Patients were followed up for between 6 and 12 months. The final dose of topiramate varied from 200 to 600 mg/day. RESULTS: Topiramate was effective in reducing the weight in 10 out of the 12 patients. At six months the 12 patients had lost a mean of 7.75 kg (SD = 6.9 kg, p < 0.001) and at 12 months 9 patients had lost a mean of 9.61 kg (SD = 6.7 kg, p = 0.003). Three patients stopped the treatment: one due to side effects, one due to possible side effects, and one suffered a manic relapse and showed no sustained weight loss. There were no other clear changes in the course of illness of the patients. CONCLUSION: The evidence of a strong weight-reducing potential of topiramate is indisputable and clinically significant. Topiramate could be considered in the treatment of bipolar patients who are overweight, or whose concerns about weight gain compromise their compliance with long-term prophylactic medication. So far there is no evidence that topiramate has anti-manic effect and it should not be used as monotherapy

The aetiology, presentation and treatment of personality disorders

Personality disorders are a heterogeneous collection of conditions with common features, which may include an exaggerated self-centred nature, little regard for the feelings of others, or the regular fabrication of stories to explain the behaviour of self or others. Whilst such features might be recognized as being present in many people at different times of their lives, it is the persisting nature and extremes of personality traits that distinguishes those who have personality disorders from those who do not. Apart from the problems that personality disorders bring on their own (such as dysfunctional relationships), when they coexist with mental disorders it makes the latter more difficult to treat. People with personality disorders are often depicted as being dangerous, yet only a few are and it is this minority group that attract public attention. Personality disorders are recognized as belonging to the group known as the serious mental illnesses, a group that mental health nurses are being encouraged to focus their attentions on, but it is accepted that there is a paucity of education and training in appropriate interventions for this group of people. This article provides an overview of the aetiology and presentation of personality disorders together with an examination of evidence-based therapeutic interventions

Group psycho-education for bipolar disorder

Group psycho-education for bipolar disorder. Nursing Times; 109: 5, 21-23. Psycho-education is an established intervention for various physical and mental health conditions. This article describes a psycho-education programme developed for people with bipolar disorder. The courses appear to have been beneficial to participants and appraisal of the intervention is ongoing. One area that needs further consideration is whether courses should be run by a person who has bipolar disorder; the advantages and disadvantages of this are discusse

Group psycho-education for bipolar disorder

Group psycho-education for bipolar disorder. Nursing Times; 109: 5, 21-23. Psycho-education is an established intervention for various physical and mental health conditions. This article describes a psycho-education programme developed for people with bipolar disorder. The courses appear to have been beneficial to participants and appraisal of the intervention is ongoing. One area that needs further consideration is whether courses should be run by a person who has bipolar disorder; the advantages and disadvantages of this are discusse

Transcranial magnetic stimulation for patients with depression

Transcranial magnetic stimulation (TMS) is a relatively new technique which has been used to treat depression. It delivers magnetic radiation to the head using a hand-held coil. Some studies have indicated clinical remission of depressive symptomatology with use of TMS. Methodological limitations remain, however, and more studies are recommended to determine its efficacy

Effects of chronic lithium treatment on renal function

Introduction Lithium treatment is associated with renal side effects which vary from mild nephrogenic diabetes insipidus to end stage renal disease (ESRD). A review of the literature suggests that ESRD is a very rare side effect, caused after very long-term lithium treatment, and that it might be preventable if lithium is stopped early. Methods Sixty-one patients were treated with lithium for a mean of 15.6 years (range 3–32, SD = 6.4). Their kidney function was monitored at an Affective Disorders Clinic for a mean of 11.5 years (range 2–29, SD = 5.4). We estimated their glomerular filtration rate (eGFR) at the end of monitoring. As a control group we used 53 patients who received ECT at our hospital, and had not taken lithium, and nine patients from the same clinic who were taking other mood-stabilisers. Results Lithium patients had lower eGFR compared to controls: 66.1 vs. 75.0 mL/min/1.73 m2, p = 0.0006 after controlling for age and gender. The percentage of patients with an eGFR < 60 ml/min/1.73 m2 (grade 3 chronic kidney disease) was 34.4%, vs. 13.1% in the controls, and was much increased compared to the general population in the respective age ranges. There was a modest but non-significant correlation between the number of years that patients had taken lithium and their eGFR, (beta = − 0.177, B = − 0.43, p = 0.1). One patient reached an eGFR of 28 mL/min/1.73 m2 and her lithium was stopped. One patient required dialysis 6 years after leaving the clinic. Conclusions Lithium causes a modest decline in renal function. However the available research suggests that ESRD is a very rare complication of long-term lithium treatment, affecting ∼ 1% of patients who have taken lithium for over 15 years

A cross-sectional and a prospective study of thyroid disorders in lithium-treated patients

BACKGROUND: The effects of lithium treatment on the thyroid gland have been demonstrated in a number of studies. Most of this research is based on cross-sectional studies and prospective studies are required to confirm these observations. METHOD: During our genetic association studies, we recruited 115 males and 159 females suffering with affective disorders who had received lithium treatment. We observed longitudinally 57 of these patients, who attended our clinic for between 1 and 7 years and had no thyroid abnormalities at baseline. We performed regular checks of thyroid antibodies, thyroid function tests and lithium levels. RESULTS: Hypo- and hyperthyroidism, including cases that developed prior to lithium treatment, were more common in women (25.8%) than in men (8.7%) and increased with age. By the age of 65, the risk in women increased to 50%. Hypothyroidism was induced by lithium in 17% women. In the prospective study, 4 out of 33 women developed hypothyroidism (an incidence of 27.4 cases per 1000 years). One woman developed thyrotoxicosis. CONCLUSIONS: The risk for hypothyroidism induced by lithium is especially increased in women over the age of 50. Women should be warned of the risks involved when offered lithium treatment. The frequency of lithium-induced thyrotoxicosis is very low