A guide to medication adherence in depression

Depression is a common mental health disorder that affects at least 350 million people worldwide and exerts a negative effect upon a person’s physical, mental and social functions, and it is associated with an increased risk of premature death. The treatment of depression involves the use of antidepressants and selective serotonin inhibitors are currently the first line of treatment. In particular, fluoxetine is safe and effective in the treatment the disorder. It is one of the few antidepressants licensed for use in children under the age of 18 years in the UK. Fluoxetine is associated with fewer dose adjustments compared to other SSRIs and this simplifies therapy and may improve outcomes. However, fluoxetine induces a number of side effects like, nausea, insomnia, sexual dysfunction and its interaction with monoamine oxidase inhibitors can cause the serotonin syndrome

Antipsychotics in the treatment of psychosis: risks and benefits

Antipsychotics are important in the treatment and recovery of people with psychosis but current evidence suggests that mental health nurses are not always conversant with the risks and benefits of these drugs. This inadequate knowledge has important ramifications for the provision of safe and effective care. This article outlines the risks and benefit profiles associated with contemporary antipsychotic drugs to enhance mental health nurses' knowledge of medicines. Ultimately, comprehensive knowledge of medication, their actions, risk and benefits should promote mental health nurses' effectiveness in medicine

Is there a crisis in inpatient mental health care?

The standards of care in the NHS are the subject of debate. Frequently, members of the public have complained about poor staff attitudes towards patients and visitors alike and this has generated discussion as to the best way forward for the nursing profession. In mental health, poor standards have been reported on numerous occasions and the first author had firsthand experience of casual nursing attitudes when she visited a friend in an acute inpatient mental health ward. This article uses her anecdotal account to highlight poor standards in mental health. The paper then examines possible antecedents to this vexed issue before suggesting a way forward

Can student mental health nurses be prepared for medicines management?

Aim This paper reports on an evaluation of the Medicines with Respect project, which implemented a stepped approach to education and training in medicines management (MM) for mental health nurses (MHNs). Method In the retrospective qualitative study, nine MHNs were interviewed to gain their perceptions of the MM training they received at university and to find out if it still had relevance. Results Content analysis of the interview data revealed that overall the participants valued the theoretical and practical learning strategies they experienced, although criticisms relating to all aspects of the education and training were reported. The participants also reported that the approach prepared them for clinical practice as registered nurses. Such an approach may also build the capacity of MHNs to develop as prescribers

Oral liquid antipsychotic formulation in the treatment of psychosis

This article discusses oral liquid antipsychotics as a treatment option to either oral tablets or injection formulation. It discusses bioavailability, treatment in emergencies and the potential merits of using oral liquid preparations in terms of relevant practical issues

Antipsychotic medication side effects knowledge amongst registered mental health nurses in England: A national survey

© 2020 The Authors. Journal of Psychiatric and Mental Health Nursing published by John Wiley & Sons Ltd What is known on the subject?: Research findings indicate the percentage of knowledge-related errors in medicines management is high, accounting for approximately 75% of all errors, with insufficient knowledge levels one of the most significant contributors of medication errors. Patients should be able to trust nurses to engage therapeutically and actively listen to their needs and concerns, responding using skills that are helpful, providing information that is clear, accurate, meaningful and free from jargon. However, without knowledge of pharmacology, it is impossible for nurses to be able to provide adequate advice. What the paper adds to the existing knowledge?: This study has examined an area that had not yet been systematically examined previously, which draws together previous research findings on mental health nurses' knowledge of adverse events, including side effects and medication errors, related to antipsychotic medication within NHS inpatient settings. What are the implications for practice?: A recent study has found that almost three-quarters (73%) of patients taking antipsychotic medication reported side effects to some degree. This high number of people experiencing antipsychotic medication side effects is likely to compromise care, especially in situations where nurses have inadequate knowledge of side effects and are unable to provide effective advice to patients. The findings from this study allow the mental health nursing profession an opportunity to reflect on the best means to increase knowledge and increase patient safety awareness and benefits for mental health service users. Abstract: Introduction Antipsychotic medications play a significant role in the treatment and recovery of people with several psychiatric disorders. However, research findings indicate mental health nurses are insufficiently knowledgeable about antipsychotic medication side effects. Aim To assess practising mental health nurses' knowledge of antipsychotic medication side effects using a Multiple-Choice Questionnaire (MCQ) across National Health Service (NHS) Trusts in England. Hypothesis Knowledge of antipsychotic medication side effects amongst registered mental health nurses is related to their academic qualification, clinical banding and length of experience. Method A national survey of registered mental health nurses was carried out using an online questionnaire which was disseminated by Research and Development departments. Results A total of 504 questionnaires were returned, 245 of which had full data and further analysed. The mean score for the sample was 14.4 and only 21 participants attained a mark of >80%. Implications for Practice Two out of three of our hypotheses (that length of experience and clinical banding are directly related to knowledge of antipsychotic medication side effects) were supported. Our study found many nurses have a suboptimal working knowledge of antipsychotic medication side effects which has the potential to compromise care. Strategies need to be put in place to enhance pharmacology knowledge

Vitamin D: the role of the sunshine vitamin

The importance of vitamin D in physical disorders has been well documented. Deficiency in this vitamin is associated with a wide range of physical and mental disorders that include, heart problems, hypertension, stroke, diabetes, various cancers, and asthma. In mental health vitamin D deficiency is associated with schizophrenia, depression, anxiety, Alzheimer’s disease among others. Risk factors for vitamin D deficiency include darker skin, lack of adequate sun exposure, autoimmune diseases, influenza, old age and the use of certain medicines like anticonvulsants. Vitamin D is likely to play an important role in the management and prevention of various mental health problems. In particular, adequate vitamin D during the perinatal stage is likely to impact positively on the long term mental health of a person

The component structure of the scales for the assessment of positive and negative symptoms in first-episode psychosis and its dependence on variations in analytic methods.

A secondary analysis was undertaken on Scales for the Assessment of Positive and Negative Symptoms (SAPS/SANS) data from 345 first-episode psychosis (FEP) patients gathered in the West London FEP study. The purpose of this study was to determine: (i) the component structure of these measures in FEP (primary analyses), and (ii) the dependence of any findings in these primary analyses on variations in analytic methods. Symptom ratings were exposed to data reduction methods and the effects of the following manipulations ascertained: (i) level of analysis (individual symptom vs. global symptom severity ratings), (ii) extraction method (principal component vs. exploratory factor analysis) and (iii) retention method (scree test vs. Kaiser criterion). Whilst global ratings level analysis rendered the classic triad of psychotic syndromes (positive, negative and disorganisation), symptom level analyses revealed a hierarchical structure, with 11 first-order components subsumed by three second-order components, which also mapped on to this syndrome triad. These results were robust across data reduction but not component retention methods, suggesting that discrepancies in the literature regarding the component structure of the SAPS/SANS partly reflect the level of analysis and component retention method used. Further, they support a hierarchical symptom model, the implications of which are discussed

Are socioenvironmental factors associated with psychotic symptoms in people with first-episode psychosis? A cross-sectional study of a West London clinical sample.

OBJECTIVES: To determine whether neighbourhood-level socioenvironmental factors including deprivation and inequality predict variance in psychotic symptoms after controlling for individual-level demographics. DESIGN: A cross-sectional design was employed. SETTING: Data were originally collected from secondary care services within the UK boroughs of Ealing, Hammersmith and Fulham, Wandsworth, Kingston, Richmond, Merton, Sutton and Hounslow as part of the West London First-Episode Psychosis study. PARTICIPANTS: Complete case analyses were undertaken on 319 participants who met the following inclusion criteria: aged 16 years or over, resident in the study's catchment area, experiencing a first psychotic episode, with fewer than 12 weeks' exposure to antipsychotic medication and sufficient command of English to facilitate assessment. OUTCOME MEASURES: Symptom dimension scores, derived from principal component analyses of the Scale for the Assessment of Positive Symptoms and Scale for the Assessment of Negative Symptoms, were regressed on neighbourhood-level predictors, including population density, income deprivation, income inequality, social fragmentation, social cohesion, ethnic density and ethnic fragmentation, using multilevel regression. While age, gender and socioeconomic status were included as individual-level covariates, data on participant ethnicity were not available. RESULTS: Higher income inequality was associated with lower negative symptom scores (coefficient=-1.66, 95% CI -2.86 to -0.46, p<0.01) and higher levels of ethnic segregation were associated with lower positive symptom scores (coefficient=-2.32, 95% CI -4.17 to -0.48, p=0.01) after adjustment for covariates. CONCLUSIONS: These findings provide further evidence that particular characteristics of the environment may be linked to specific symptom clusters in psychosis. Longitudinal studies are required to begin to tease apart the underlying mechanisms involved as well as the causal direction of such associations

Antipsychotic medication side effects knowledge amongst registered mental health nurses in England: A National Survey

Introduction Antipsychotic medications play a significant role in the treatment and recovery of people with several psychiatric disorders. However, research findings indicate mental health nurses are insufficiently knowledgeable about antipsychotic medication side effects. Aim To assess practising mental health nurses’ knowledge of antipsychotic medication side effects using a Multiple‐Choice Questionnaire (MCQ) across National Health Service (NHS) Trusts in England. Hypothesis Knowledge of antipsychotic medication side effects amongst registered mental health nurses is related to their academic qualification, clinical banding and length of experience. Method A national survey of registered mental health nurses was carried out using an online questionnaire which was disseminated by Research and Development departments. Results 504 questionnaires were returned, 245 of which had full data and further analysed. The mean score for the sample was 14.4 and only 21 participants attained a mark of >80%. Implications for Practice Two out of three of our hypotheses (that length of experience and clinical banding are directly related to knowledge of antipsychotic medication side effects) were supported. Our study found many nurses have a suboptimal working knowledge of antipsychotic medication side effects which has the potential to compromise care. Strategies need to be put in place to enhance pharmacology knowledge