Antipsychotic drugs are the first line and mainstay of treatment for schizophrenia. They help to effectively treat psychotic symptoms such as hearing voices and seeing things (hallucinations) and having strange beliefs (delusions). Fluphenazine was one of the first antipsychotics and has been available for around 50 years. Fluphenazine is inexpensive and in developing countries, may be one of the only drug treatments available. In most of Europe and North America, despite still being available, the arrival of newer antipsychotic drugs has reduced the use of fluphenazine and its market share. Fluphenazine has debilitating side effects, including: dizziness; movement disorders such as involuntary movements or spasms; shaking and tremors; inner restlessness and the inability to sit still; and problems with blood pressure, fever and muscle stiffness.
This review included seven studies and compared the effects of fluphenazine taken by mouth with placebo (‘dummy’ treatment). In the main, the findings of the review support the widespread view that fluphenazine is a potent and effective antipsychotic but has considerable side effects, other antipsychotic drugs may well be preferable. Fluphenazine is an imperfect treatment with serious side effects, so other inexpensive antipsychotic drugs with fewer side effects may be better for people with schizophrenia. Despite this, fluphenazine has a low cost and is widely available, so is likely to remain one of the most widely used treatments for schizophrenia worldwide. However, some of fluphenazine's side effects could be expensive in terms of human suffering and personal cost of treatment. Even though fluphenazine has been used as an antipsychotic drug for decades, there are still a surprisingly small number of well-conducted studies measuring its effectiveness and potential to cause side effects. Future large-scale research should report on important outcomes such as improvement in mental health, relapse, hospital discharge and admission, levels of satisfaction with treatment and quality of life.
Thursday 26 September 2013
Monday 9 September 2013
Interventions to encourage cancer screening uptake in severe mental illness.
Cancer is a leading cause of death worldwide, accounting for approximately 13% of all deaths in 2007. Some studies have reported an increased incidence of cancer in people with mental health problems. The Schizophrenia Commission reports that people with schizophrenia who develop cancer are three times more likely to die than those in the general population with cancer.
Mental illness is associated with certain health problems, including: obesity; smoking; drinking alcohol; and poor diet, all of which increase risk of cancer. It has been estimated that approximately one‐third of cancer deaths could be prevented with early detection, of which cancer screening is the most effective method. However, people with mental illness are less likely than others to take up available cancer screening. Reasons for non‐uptake include: low income; increasing age; lack of transport; embarrassment; lack of reminders; and lack of familiar care providers.
In the general population, telephone invitations, telephone counselling, prompts following the initial invitation and opportunistic screening are good at increasing uptake of cancer screening. Reducing financial barriers (i.e. providing free screening tests, bus passes or postage) may also help. GPs have also been offered incentives under the Quality and Outcomes Framework to provide regular physical health checks to people with mental illness. People with mental illness may require more individualised care, such as more intense counselling, to encourage screening.
A comprehensive search showed that currently there is no trial evidence for any method of encouraging uptake of cancer screening for people with mental illness. No specific approach can therefore be recommended. Early detection of cancer through screening is effective in improving patient outcomes, including death. Given that people with mental illness are at greater risk of cancer but less likely than others to take up available screening, better approaches that encourage uptake of cancer screening are needed urgently. Further research is required to ensure that people with mental illness do not miss out on cancer screening.
From a service user perspective (SUPER), it has been found that people with mental illness die on average 20 years younger than the general population, often from preventable diseases (such as cancer, heart disease and diabetes). Rethink Mental Illness is campaigning to ensure that the physical health needs of people with mental health problems are not neglected and calling for physical health champions.
Of chief concern is ‘diagnostic overshadowing’. This is where a diagnosis of mental illness overshadows and makes invisible any physical health problems. There is a need for health professionals, especially in primary care and GP surgeries, to be more aware of the physical health problems of people with mental illness. Mental illness is associated with certain health problems, including: obesity or being overweight; smoking; drinking alcohol; and poor diet, all of which increase risk of cancer. These unhealthy behaviours can often be prevented by GPs and nurses in primary care with information and advice about stopping smoking, eating a healthier diet and the need to take regular exercise. However, these behaviour changes are often very difficult for people with mental illness, so more intense and individual care is required for people to make and maintain a healthier lifestyle.
Mental illness is associated with certain health problems, including: obesity; smoking; drinking alcohol; and poor diet, all of which increase risk of cancer. It has been estimated that approximately one‐third of cancer deaths could be prevented with early detection, of which cancer screening is the most effective method. However, people with mental illness are less likely than others to take up available cancer screening. Reasons for non‐uptake include: low income; increasing age; lack of transport; embarrassment; lack of reminders; and lack of familiar care providers.
In the general population, telephone invitations, telephone counselling, prompts following the initial invitation and opportunistic screening are good at increasing uptake of cancer screening. Reducing financial barriers (i.e. providing free screening tests, bus passes or postage) may also help. GPs have also been offered incentives under the Quality and Outcomes Framework to provide regular physical health checks to people with mental illness. People with mental illness may require more individualised care, such as more intense counselling, to encourage screening.
A comprehensive search showed that currently there is no trial evidence for any method of encouraging uptake of cancer screening for people with mental illness. No specific approach can therefore be recommended. Early detection of cancer through screening is effective in improving patient outcomes, including death. Given that people with mental illness are at greater risk of cancer but less likely than others to take up available screening, better approaches that encourage uptake of cancer screening are needed urgently. Further research is required to ensure that people with mental illness do not miss out on cancer screening.
From a service user perspective (SUPER), it has been found that people with mental illness die on average 20 years younger than the general population, often from preventable diseases (such as cancer, heart disease and diabetes). Rethink Mental Illness is campaigning to ensure that the physical health needs of people with mental health problems are not neglected and calling for physical health champions.
Of chief concern is ‘diagnostic overshadowing’. This is where a diagnosis of mental illness overshadows and makes invisible any physical health problems. There is a need for health professionals, especially in primary care and GP surgeries, to be more aware of the physical health problems of people with mental illness. Mental illness is associated with certain health problems, including: obesity or being overweight; smoking; drinking alcohol; and poor diet, all of which increase risk of cancer. These unhealthy behaviours can often be prevented by GPs and nurses in primary care with information and advice about stopping smoking, eating a healthier diet and the need to take regular exercise. However, these behaviour changes are often very difficult for people with mental illness, so more intense and individual care is required for people to make and maintain a healthier lifestyle.
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