User‐held information is where the ill person holds personal information about their care. Such records are becoming the norm in many settings and are becoming more popular with patients. This is especially the case where the person concerned is not in hospital and receives care from more than one professional. Providing people with information about their care is thought to increase their feelings of involvement in their treatment and aims to increase people’s satisfaction and participation with services, ensure early treatment and prevent hospital admission.
The value of user‐held personal information for those with severe mental illnesses is not known however and research evaluating the effectiveness is rare. Some research suggests that while many people decline the offer of a user‐held record, the majority of those who carry their records report this to be useful.
Based on a search in 2011, this review includes four trials with a total of 607 people and evaluates the effects of user‐held information for people with severe mental illness. In the main, the number of relevant studies is low, with poor reporting of some outcomes. Based on moderate quality evidence, the review found that user‐held information did not decrease hospital admissions, and did not decrease compulsory admissions or encourage people with severe mental illness to attend appointments (when compared to treatment as usual). Other important outcomes, such as satisfaction with care, costs and effect on mental health, were not available due to the limited quality of the four studies. There is therefore a gap in knowledge and evidence regarding user‐held information for people with severe mental health problems. Further evidence is also required on the different types of user‐held information (for example, if it involves the mental health team and what type of information is included in the record). Large‐scale, well‐conducted and well‐reported studies are required to assess the effects of user‐held information for people with mental illness. Two important randomised studies are currently taking place. For the present, despite a gap in evidence, user‐held information is low cost and acceptable to patients, so its use is likely to grow. However, it cannot be assumed that user‐held information is of benefit to people and is cost‐effective without further large‐scale, well‐conducted and well‐reported trials.
Thursday, 14 November 2013
Haloperidol dose for the acute phase of schizophrenia
Schizophrenia is a mental illness where the person often experiences both positive symptoms (such as hearing voices, seeing things and having strange beliefs) and negative symptoms (such as tiredness, apathy and loss of emotion). Antipsychotic drugs are used to treat schizophrenia. The antipsychotic drug, haloperidol, is one of the most frequently used drugs worldwide for people with schizophrenia.
The benefits of antipsychotic drugs, such as haloperidol, need to be weighed against their tendency for causing debilitating side effects (such as movement disorders, weight gain, lack of drive) and in some cases an increased likelihood of physical illnesses such as diabetes and heart disease. These debilitating side effects may mean that people stop taking their medication, which can lead to relapse and going into hospital. It is, therefore, important to find a tolerable and effective dose of haloperidol, which helps control the symptoms of schizophrenia but with fewer side effects.
The main aim of this review was to determine the best range of doses of haloperidol for the treatment of schizophrenia. Nineteen trials were included that compared varying doses of haloperidol. Despite over 30 years of trials, data on the effects of differing doses of haloperidol are sparse and poorly reported. This is especially so for the lower dose ranges generally used for the treatment of schizophrenia today. However, lower doses of haloperidol may be just as effective as higher doses but result in fewer side effects. This review also suggests that an important bias against haloperidol may exist in modern trials comparing new drugs with haloperidol. Results are not conclusive and are based on small, short studies of limited quality.
The authors of the review note that it would be understandable if psychiatrists were cautious about prescribing doses above 7.5 mg a day and if people with schizophrenia did not want to take higher dosages. Further research is needed to assess the tolerability and effectiveness of lower doses. Low doses of haloperidol may be just as good as higher doses, but with fewer side effects.
The benefits of antipsychotic drugs, such as haloperidol, need to be weighed against their tendency for causing debilitating side effects (such as movement disorders, weight gain, lack of drive) and in some cases an increased likelihood of physical illnesses such as diabetes and heart disease. These debilitating side effects may mean that people stop taking their medication, which can lead to relapse and going into hospital. It is, therefore, important to find a tolerable and effective dose of haloperidol, which helps control the symptoms of schizophrenia but with fewer side effects.
The main aim of this review was to determine the best range of doses of haloperidol for the treatment of schizophrenia. Nineteen trials were included that compared varying doses of haloperidol. Despite over 30 years of trials, data on the effects of differing doses of haloperidol are sparse and poorly reported. This is especially so for the lower dose ranges generally used for the treatment of schizophrenia today. However, lower doses of haloperidol may be just as effective as higher doses but result in fewer side effects. This review also suggests that an important bias against haloperidol may exist in modern trials comparing new drugs with haloperidol. Results are not conclusive and are based on small, short studies of limited quality.
The authors of the review note that it would be understandable if psychiatrists were cautious about prescribing doses above 7.5 mg a day and if people with schizophrenia did not want to take higher dosages. Further research is needed to assess the tolerability and effectiveness of lower doses. Low doses of haloperidol may be just as good as higher doses, but with fewer side effects.
Atypical antipsychotic medications for adolescents with psychosis
Schizophrenia and other serious mental illnesses often begin in adolescence, and treatment of adolescents with psychosis usually involves use of antipsychotic drugs. Newer drugs (atypical antipsychotics) are more popular than older ones (typical antipsychotics). However, this determination is based on the generalisation of adult treatment to a younger age group, with evidence from studies on adults generally guiding the treatment of adolescents. Adolescents may respond differently to medication compared with adults. This review looks at evidence derived from trials in which the participants are adolescents receiving atypical or typical antipsychotics or a placebo (dummy treatment) and/or high or low doses of medication. A total of 13 trials consisting of 1112 people between 13 and 18 years of age are included. Most studies were short‐term trials (completed within 12 weeks). In the main, no convincing evidence shows that newer drugs (atypical antipsychotics) are better than older ones (typical antipsychotics) in terms of their ability to treat the symptoms of psychosis. However, newer drugs may be more acceptable for young people to take because they produce fewer side effects in the short term. Furthermore, very little evidence is available to support the superiority of one atypical antipsychotic over another atypical antipsychotic. The nature of side effects also differs markedly between medications. For example, treatment with olanzapine, risperidone and clozapine is associated with weight gain, but aripiprazole is not associated with weight gain. Some evidence indicates that adolescents respond better to standard‐dose as opposed to lower‐dose risperidone. However, for aripiprazole and ziprasidone, a lower dose and a standard dose may be equally effective. Longer, clearer and more detailed research trials that use systematic ways of reporting and comparing the side effects of different antipsychotic drugs are much needed. So too is a research focus on other important outcomes such as hospital admission, service use, costs, behaviour change and possible improvements in people’s thinking. Until such research is completed, very little evidence suggests that newer drugs (atypical antipsychotics) are better than older drugs (typical antipsychotics) for the treatment of adolescents with schizophrenia.
Thursday, 26 September 2013
Oral fluphenazine versus placebo for schizophrenia
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.
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.
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.
Monday, 5 August 2013
Intermittent drug techniques for schizophrenia
Antipsychotic medication is the main treatment for schizophrenia and helps people cope with positive symptoms such as hearing voices, seeing things and having strange beliefs. However, long-term exposure to these drugs has been associated with serious side effects, such as: weight gain; uncontrollable shaking of the head, body or hands; tremors; muscle stiffness; difficulties with walking and balance; sleepiness or apathy; and even death. Some people stop taking their medication as these side effects limit people’s quality of life. Not taking medication can be a contributory factor that leads to relapse and hospitalisation. Against this backdrop, there is cause to consider the role of intermittently administering antipsychotic medication compared to the continuous use of antipsychotic medication.
Read the full summary here: http://summaries.cochrane.org/CD006196/intermittent-drug-techniques-for-schizophrenia
From a service user perspective (SUPER), the review notes that the landscape of psychiatric care has transformed dramatically over the past 50 years. There is an increased emphasis placed on a person-centred approach, where people with mental health issues are increasingly treated in outpatient or community settings and have more of a say in what treatment they would prefer. People with mental health issues who are prescribed drug treatment are now more likely to also receive psychological/ supportive therapy.
There is an increasing dialogue between psychiatrists and people with mental health issues about pathways of treatment.
There is also a growing and grassroots based recovery movement, where psychological, counselling and peer support activities help people in their journey toward rehabilitation outside the confines of psychiatry and traditional antipsychotic medication. Often, these new recovery activities are run by people who have experienced mental illness, for people experiencing mental health problems and with people collectively, making it a more holistic and personalised form of treatment.
For example, see:
http://www.intervoiceonline.org/
http://www.workingtorecovery.co.uk/
http://rufusmay.com/
http://www.peter-lehmann-publishing.com/
http://www.runciman.dk/The_harmful_concept_of_schizophrenia.pdf
Read the full summary here: http://summaries.cochrane.org/CD006196/intermittent-drug-techniques-for-schizophrenia
From a service user perspective (SUPER), the review notes that the landscape of psychiatric care has transformed dramatically over the past 50 years. There is an increased emphasis placed on a person-centred approach, where people with mental health issues are increasingly treated in outpatient or community settings and have more of a say in what treatment they would prefer. People with mental health issues who are prescribed drug treatment are now more likely to also receive psychological/ supportive therapy.
There is an increasing dialogue between psychiatrists and people with mental health issues about pathways of treatment.
There is also a growing and grassroots based recovery movement, where psychological, counselling and peer support activities help people in their journey toward rehabilitation outside the confines of psychiatry and traditional antipsychotic medication. Often, these new recovery activities are run by people who have experienced mental illness, for people experiencing mental health problems and with people collectively, making it a more holistic and personalised form of treatment.
For example, see:
http://www.intervoiceonline.org/
http://www.workingtorecovery.co.uk/
http://rufusmay.com/
http://www.peter-lehmann-publishing.com/
http://www.runciman.dk/The_harmful_concept_of_schizophrenia.pdf
Friday, 14 June 2013
Treatments to help prevent psychosis in women who have just given birth.
There is a small percentage of women for whom giving birth leads to psychosis. Postnatal psychosis affects one to two in every 1000 new mothers and is almost always a mood disorder accompanied by loss of contact with reality, hearing voices and seeing things (hallucinations), having strange beliefs (delusions), severe thought disturbance, and abnormal behaviour. It can be a life-threatening condition with an abrupt onset within a month of childbirth.
Read the full summary here: http://summaries.cochrane.org/CD009991/treatments-to-help-prevent-psychosis-in-women-who-have-just-given-birth
Read the full summary here: http://summaries.cochrane.org/CD009991/treatments-to-help-prevent-psychosis-in-women-who-have-just-given-birth
From a service user perspective (SUPER), it is surprising that there is so little research on women’s mental health just after childbirth, particularly as postnatal psychosis is potentially life- threatening. There is risk of suicide, child neglect and abuse and even in some extreme cases killing the child. News coverage has highlighted the devastating story of a mother with severe postnatal depression who smothered her 10-day-old son after her medication was taken away (Steven Morris, The Guardian, Friday 12th November, See: http://www.guardian.co.uk/uk/2010/nov/12/mother-smothered-baby-son-court). Recent news has also centred on a pregnant mother who killed her three children before committing suicide (http://www.dailymail.co.uk/news/article-2309426/Lowestoft-deaths-Father-Craig-McLelland-pays-tribute-3-children-killed-pregnant-mother-Fiona-Anderson.html). This makes the prevention of postnatal psychosis even more urgent and important.
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