Thursday 22 November 2012

Flupenthixol versus placebo for schizophrenia.

Flupenthixol is an antipsychotic drug, first made available in the UK in 1965. Although this drug has been available for many years, few systematic reviews of its effectiveness are available and the effects of this drug in helping people cope with the symptoms of schizophrenia are not currently well measured, quantified and known.

Read the full summary here: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0049715/

From a service user perspective (SUPER), it may at first appear quite shocking that the use of flupenthixol is more rooted in the clinical experience and the everyday decision making of psychiatrists instead of being based on firm scientific knowledge.  This is often the case, though.  In my and other service users’ experience, we often progress through different medications until one is found that helps in coping with symptoms such as hearing voices and which lead to feelings of better stability. 

Side- effects from medication are nearly always a problem, with feelings of sleepiness, weight gain, restlessness, and shaking hands.  But the dosage of medication can always be reduced over time.  Newer drugs with less side- effects can be introduced by talking openly with a psychiatrist about your feelings and difficulties with side- effects.       

It has also been found that medication works better when combined with more person- centred care, such as psychotherapy, counselling, cognitive behavioural therapy, hearing voices and stress management groups, creative writing, music and art therapy. 

Benjamin Gray
Service User Expert
Rethink Mental Illness.  

Haloperidol as a means of calming people who are aggressive or agitated due to psychosis.

Haloperidol is a drug that can be taken as by mouth or injected. As well as being an antipsychotic (preventing psychosis), it calms people down or helps them to sleep.

Read the full summary here: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0049743/

From a service user perspective (SUPER), the experience of hearing voices, being agitated and seeing things can be confusing, frightening and sometimes terrifying.  If people’s voices are shouting at them, putting them down, being derogatory or abusive, then it is perhaps not surprising that people become aggressive and sometimes violent.  After all, if someone shouted at you in the street, many people would just shout back!  This is what it is like for people who hear voices or see things: it is like someone shouting straight into your ear and never going away. 

Many people choose to shout back at their goading voices and this can be taken as being aggressive and violent.  No one can hear the voice, the verbal abuse or what the voice is saying, so an aggressive response to hearing an internal voice can seem to come from nowhere.  A service user that I met some time ago would often walk along the hospital corridors, screaming back at her voices.  She would sometimes hit herself violently on the head, as if trying to physically knock the voices out of her mind.  This was seen as aggression and unexplained violence by onlookers, but left me with mixed feelings of pity, consternation and fear.  

Similarly, three other people who I met in hospital would often hear voices that seemed to come from the television.  This would make them frightened and aggressive.  On one occasion, this led to the television being smashed and the individual being forcibly injected with tranquillisers to calm him down.  

Unfortunately, some people may become very aggressive or violent towards others.  They may have panic attacks or be in emotional turmoil.  Sometimes sedatives and tranquillisers are necessary to help people calm down (and some people even ask for them to help them cope). 

The use of these sedatives is never ideal, and the use of forced injection can feel like a violation.  It can break the trust between the person with mental health problems and nurses.  Nurses want to foster and build therapeutic relationships with people.  But all the time it takes to build up feelings of trust and intimacy can be broken in an instant, when force is used to restrain or inject the person.

I was unfortunate enough to witness the injection of sedatives on two other occasions: the first time involving a young girl called ‘B’ who was trying to cut herself with the shards of a broken bottle; and the second time a man called ‘R’ who was violently kicking the door of the nurse station and shouting abuse at staff.  The use of sedatives in these two situations could perhaps be said to be necessary but never ideal or therapeutic in the long term.

Often, all it takes is for a nurse or member of staff to ‘de-escalate’ the situation.  This involves nurses talking to the individual, to calm them down before they become agitated or aggressive.  Other techniques, such as seclusion, can often give people some space and time to calm down in their own room. 

Benjamin Gray
Service User and Service User Expert
Rethink Mental Illness

Management of sexual problems due to antipsychotic drug therapy.

Drugs commonly used to treat schizophrenia often cause sexual problems. This may affect erection, lubrication, orgasm, desire or libido, ejaculation, sexual arousal or overall sexual satisfaction. This may have serious negative consequences such as putting people off taking their medication or stopping taking drugs at an early stage. Sexual problems may limit a person’s quality of life, worsen self-esteem and cause relationship problems. Strategies to manage these sexual problems are taking additional drugs (Viagra TM), short drug holidays when people temporarily stop antipsychotic medication, reduction of dose and switching to another antipsychotic drug.

Read the full summary here: http://summaries.cochrane.org/CD003546/management-of-sexual-problems-due-to-antipsychotic-drug-therapy

From a service user perspective (SUPER), having a mental health problem can affect all aspects of life and limit people’s quality of life.  People with mental health problems face difficulties in education, employment, stigma and social exclusion.  Having a mental health problem, combined with side- effects from medication, can make you feel very tired and reduce being able to feel emotions such as pleasure, satisfaction and happiness.  People may also experience sexual and relationship problems.

Many partners of people with mental health problems who I have spoken with say that mental illness has changed the person they love, so that they are almost unrecognisable.  They feel that they have lost the person they love, causing problems of intimacy and trust in sexual relationships.

Having a mental health problem can make you feel like a non- person, whose views, life and sexuality feel like they are unimportant and eroded. 

Several strategies to manage sexual problems are mentioned (such as additional drugs like Viagra, short drug holidays when people temporarily stop antipsychotic medication, reduction of dose and switching to another antipsychotic drug).  Talking therapies, such as psychotherapy and sex therapy, may also help to improve people’s relationships and sex lives.




Benzodiazepines for Schizophrenia.

Benzodiazepines can be taken alone or in combination with more traditional antipsychotic drugs. They cause sedation, calmness and relax the muscles, so are helpful in calming down agitated people with anxiety, sleep problems, seizures, alcohol withdrawal and acute mental health problems.

Read the full summary here: http://summaries.cochrane.org/CD006391/benzodiazepines-for-schizophrenia

From a service user perspective (SUPER), benzodiazepines are frequently used as a drug of choice for schizophrenia.  It is sobering that this is the case even though there is little information or evidence to support their widespread use.  Furthermore, the range and complexity of drugs available to treat mental health issues is large and confusing.  Many drugs have triple barrelled and long names, which are hard to say and pronounce (Benzodiazepines, Risperidone; Antiglucocorticoid).

If people are taking one type of drug, then it can be quite daunting and scary to switch to a new drug or a combination of several new drugs.  New drugs do have the promise to work better for people who use mental health services, but there is always doubt at the back of the mind about possible relapse, not least because most drugs have side- effects (such as weight gain, sleepiness, shaking and dizziness).

This points out the fact that there needs to be better information sharing between psychiatrists and people who use mental health services.  The benefits of taking certain drugs need to be explained, as well as the potential side- effects, to promote better understanding and to encourage people to regularly take their medication. 

However, if there is little information and evidence to support a drug’s prescription, then psychiatrists might be basing their prescription of drugs on daily clinical judgement and experience, rather than strong and proven research evidence.  Although this means that better information and research evidence is needed to support the use of a drug, it also means that psychiatrists and service users hopefully know each other quite well.  They can talk to one another, collaborate and discuss which medication works best for them and come up with practical and real- life solutions to improve the lives of people who use mental health services.   

Benjamin Gray
Service User and Service User Expert
Rethink Mental Illness.

Wednesday 7 November 2012

Information and Communication Technology for People with Schizophrenia.

Patient education and support for people with schizophrenia by using information and communication technology.

Information and Communication Technology (ICT) includes the use of computers, telephones, television and radio, video and audio recordings. It consists of all technical means used to handle information and communication. During the last twenty years there has been a growing trend towards the use of ICT for the delivery of education, treatment and social support for people with mental illness.

Education about illness and treatment has been found to be a good way to increase a person's awareness of their health. ICT has the potential to improve many aspects of overall care, including: better education and social support; improved information and management of illness; increased access to health services; improved quality of care; better contact and continuity with services and cut costs. Recent studies show that ICT and the web may also support people in their working lives and social relationships plus help cope with depression and anxiety. However, there is a lack of knowledge about the specific effectiveness of ICT for helping people with severe mental health problems such as schizophrenia.

This review includes six studies with a total of 1063 people. Although education and support using ICT shows great promise, there was no clear benefit of using ICT (when compared with standard or usual care and/or other methods of education and support) for people with severe mental illness. However, the authors of the review suggest that this should not put off or postpone future high quality research on ICT, which is a promising and growing area of much importance.

Find the full summary here: http://summaries.cochrane.org/CD007198/patient-education-and-support-for-people-with-schizophrenia-by-using-information-and-communication-technology


From a service user perspective (SUPER), Information and Communication Technology (ICT) and especially the World Wide Web (WWW) are a growing and global part of our everyday lives.  This includes a growing number of websites, telephone lines and ICT resources that help people with their health and social support.  Although these should never stand in place of face-to-face care, they are easily accessed and can help people with information to better manage their mental health. 

In some families, a computer may not be available and be seen as an expensive luxury.  Phone calls may not be as good as meeting someone in person.  However, there are websites and phone lines that help people as a first port of call, as an initial contact that leads to fuller treatment and support (such as NHS Direct).

There are also a growing number of ICT packs and websites that are produced by people who use mental health services for people who use mental health services.  In other words, people with mental health issues are producing ICT training materials, websites, service user forums, chat rooms and discussion lists for people to help in their treatment, care and recovery.

For example, see:

http://www.intervoiceonline.org/

http://www.hearing-voices.org/

http://www.asylumonline.net/

http://www.mindfreedom.org/about-us

http://www.workingtorecovery.co.uk/

http://health.groups.yahoo.com/group/voice-hearers/