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Editorial. Login at top right hand side of page using your SSSFT NHS Athens for full text. SSOTP - request a copy of the article from the library http://www.sssft.nhs.uk/library
Combining antidepressants (ADs) for therapy of acute depression is frequently employed, but randomized studies have yielded conflicting results. We conducted a systematic review and meta-analysis aimed at determining efficacy and tolerability of combination therapy. Login using your SSSFT NHS OpenAthens for full text. SSOTP - request a copy of the article from the library - www.sssft.nhs.uk/library
Library Services do not currently have access to this journal, but you can request a copy of the article online and we will try to get a copy to you: http://bit.ly/1Xyazai
There are huge volumes of drug trials published, and for clinicians it’s clearly difficult to keep up to date with the latest evidence.
It is also clear that huge volumes of medicines are routinely prescribed, at a considerable cost to health services worldwide. For example, in the UK we spend £14.4bn per year on prescriptions, and most of this spend focuses on common conditions.
The aim of this recent meta-analysis by Leucht and colleagues (2015) was to explore the efficacy of 20 commonly prescribed medicines.
Approximately 6.2 % of women in the USA and 3.7 % of women in the UK, use Selective Serotonin Reuptake Inhibitors (SSRIs) during their pregnancies because of depression and/or anxiety. In the Netherlands, this prevalence is around 2 %. Nonetheless, SSRI use during pregnancy is still controversial. On the one hand SSRIs may be toxic to the intrauterine developing child, while on the other hand relapse or recurrence of depression during pregnancy poses risks for both mother and child. Among patients and professionals there is an urgent need for evidence from randomized studies to make rational decisions regarding continuation or tapering of SSRIs during pregnancy. At present, no such studies exist.
Attention deficit hyperactivity disorder (ADHD) can be treated with stimulant medication such as methylphenidate. Although effective, methylphenidate can cause serious side-effects, including suppressed appetite, growth retardation and sleep problems. A drug holiday is a deliberate interruption of pharmacotherapy for a defined period of time and for a specific clinical purpose, for example for appeasing side-effects. While some international guidelines recommend introducing drug holidays in ADHD treatment, this is not practised routinely. Our aim was to examine the views and experiences of planned drug holidays from methylphenidate with adults who have responsibility for treatment decisions in children and adolescents with ADHD. Login using your SSSFT NHS OpenAthens for full text. SSOTP - request a copy of the article from the library - http://bit.ly/1Xyazai
Debate surrounding assisted outpatient treatment has mostly focused on issues of due process, cost-effectiveness, and efficacy as measured by readmission and incarceration rates. Less attention has been paid to whether long-term use of antipsychotic treatment is supported by sufficient evidence to warrant its compulsory use in assisted outpatient treatment programs. The authors examine the rationale and evidence for long-term use of antipsychotics, noting the pervasive belief within the psychiatric community that psychotic illness, especially schizophrenia, requires lifelong medication. They argue that although antipsychotics are clearly indicated for patients in the acute phase of psychotic illness, the evidence for long-term use is less convincing and may not justify compulsory long-term use. Login at top right hand side of page using your SSSFT NHS Athens for full text. SSOTP - request a copy of the article from the library http://bit.ly/1Xyazai
The study was a randomised trial to see if clonidine decouples stress-related cocaine and heroin administration in patients maintained on buprenorphine. To read the full article, log in using your NHS OpenAthens details
A new systematic review published last week in BMJ Open by Eiring and colleagues aimed to investigate patients’ preferences for outcomes associated with psychoactive medications.
Opioid antagonists (eg, naltrexone) and positive modulators of γ-aminobutyric acid type A receptors (eg, alprazolam) each modestly attenuate the abuse-related effects of stimulants. A previous study demonstrated that acute pretreatment with the combination of naltrexone and alprazolam attenuated a greater number of the subject-rated effects of D-amphetamine than the constituent drugs alone. This study tested the hypothesis that maintenance on the combination of naltrexone and alprazolam XR would attenuate the reinforcing and “positive” subject-rated effects of methamphetamine to a greater extent than the constituent drugs alone. Please contact the library to receive a copy of this article - http://bit.ly/1Xyazai
Despite evidence for their comparable efficacy, psychotherapy faces a dramatic decline relative to pharmacotherapy in psychiatry. A deep ideological reason for this decline centres on the belief that psychotherapy is a psychosocial treatment whereas pharmacotherapy is a biological treatment. Modern cognitive neuroscience demonstrates that this distinction is a myth.Please contact the library to receive a copy of this article - http://bit.ly/1Xyazai
Library Services do not currently have access to this journal, but you can request a copy of the article online and we will try to get a copy to you: http://bit.ly/1Xyazai
Pharmacological treatments for agitation and aggression in patients with Alzheimer’s disease have shown limited efficacy. The authors assessed the heterogeneity of response to citalopram in the Citalopram for Agitation in Alzheimer Disease (CitAD) study to identify individuals who may be helped or harmed. Login at top right hand side of page using your SSSFT NHS Athens for full text. SSOTP - request a copy of the article from the library http://www.sssft.nhs.uk/library
Adherence to medicines has been identified as a key issue by the Royal Pharmaceutical Society of Great Britain,1 the WHO2 and, most recently, by the UK Academy of Medical Sciences.3 Estimates of adherence vary widely but are often reported to be as low as 50%.4 When a patient does not take their prescribed medicines as intended, they may not derive the expected outcomes. As well as implications for the individual patient, this can result in increased costs associated with patient hospitalisations or avoidable escalation in other costs of care.3 It may also result in unused medicines, the cost of which is estimated at £300 million per year in England alone.3 To read the full article, log in using your NHS OpenAthens details
Aims and method To identify training needs of the next generation of psychiatrists and barriers in prescribing first-generation antipsychotics (FGAs). We have surveyed psychiatry trainees in East Anglia with regard to their training experience, knowledge and attitudes to the use of oral FGAs as regular medication.
Bipolar disorder is a serious and common psychiatric disorder characterized by manic and depressive mood switches and a relapsing and remitting course. The cornerstone of clinical management is stabilization and prophylaxis using mood-stabilizing medications to reduce both manic and depressive symptoms. Lithium remains the gold standard of treatment with the strongest data for both efficacy and suicide prevention. However, many patients do not respond to this medication, and clinically there is a great need for tools to aid the clinician in selecting the correct treatment.
This study is a useful summary of which nutrients have been tested as an add-on to antidepressants, and an overall indication of what the studies found. It shows that, for most of these nutrients, the evidence comes from small studies of varying quality and length, and that we need bigger, better studies to get a true picture of their effects.
For the nutrients where there was sufficient evidence to carry out a meta-analysis, the difficulty is that the way the results are presented makes it hard to tell how much of an effect the nutrients actually had on people's depression.
Lysergic acid diethylamide (LSD) is a potent serotonergic hallucinogen or psychedelic that modulates consciousness in a marked and novel way. This study sought to examine the acute and mid-term psychological effects of LSD in a controlled study. Please contact the library to receive a copy of this article - http://bit.ly/1Xyazai
two recent Cochrane reviews (Storebo et al, 2015; Punja et al, 2016a) questioned the quality of the evidence from available RCTs (see also a previous Mental Elf blog by Chris Hollis on this review).
Whilst meta-analyses of interventions (such as the available ones on ADHD drugs) often include parallel RCTs, no meta-analysis so far had pooled n-of-1 trials, defined as multiple crossover trials performed in a single participant, often with randomisation and blinding. Meta-analysing data from n-of-1 trials would allow aggregating data on individual response to treatment.
Punja and colleagues (Punja et al, 2016b) performed the first meta-analysis of n-of-1 trials, focusing on psychostimulants (methylphenidate and amphetamine derivatives) for ADHD, for which numerous N-of-1 trials have been published.
In May 2016, a new recommendation was added on providing information about olanzapine when choosing antipsychotic medication for children and young people with a first episode of psychosis.
Antipsychotic drug treatment can potentially lead to adverse events such as leukopenia and neutropenia. Although these events are rare, they represent serious and life-threatening hematological side effects.
There is increasing evidence that some glutamatergic drugs could have antidepressant effects. Ketamine as a promising prototype for novel glutamatergic antidepressants has a much faster onset of action and is possibly more efficacious than standard antidepressants.1 Two recent systematic reviews and meta-analyses assessed the antidepressant efficacy (including modes of administration, duration of effect and adverse effects) of ketamine and other glutamate receptor modulators in the treatment of unipolar depression (Caddy et al,2 in the Cochrane Database of Systematic Reviews), and, more generally, in mood disorders (Newport et al,3 in the American Journal of Psychiatry). To read the full article, log in using your NHS OpenAthens details
Open access. The predictable pharmacokinetic drug interaction between clozapine and rifampicin is listed in most standard reference texts but little detail is given or emphasis on its clinical significance. The interaction is based on theoretical knowledge of both drugs; to date just two case reports have been published. This article describes a third case demonstrating the significance of this interaction. This was potentially devastating for the patient who required an extended psychiatric admission. The enzyme induction was so potent that the dose of clozapine had to be increased approximately sixfold. Careful management of this significant interaction is essential for effective patient care.
Limited evidence suggests that only a minority of mental health nurses regularly use standardized assessment tools to assess antipsychotic medication side effects, but the factors that contribute to the non-routine use of these tools remain unknown.
Aim-To examine Australian mental health nurses’ awareness of, and attitudes towards, side-effect assessment tools, and also identify factors the influence the use of these tools. Login using your SSSFT NHS OpenAthens for full text. SSOTP - You can request a copy of this article by replying to this email. Please ensure you are clear which article you are requesting.
Methamphetamine dependence is a significant public health concern without any approved medications for treatment. We evaluated ibudilast, a nonselective phosphodiesterase inhibitor, to assess the safety and tolerability during intravenous methamphetamine administration. We conducted a randomized, double-blind, placebo-controlled, within-subjects crossover clinical trial. Look for 'Athens login' on OVID site, & log in using your NHS Athens.
There is increasing evidence that some glutamatergic drugs could have antidepressant effects. Ketamine as a promising prototype for novel glutamatergic antidepressants has a much faster onset of action and is possibly more efficacious than standard antidepressants.1 Two recent systematic reviews and meta-analyses assessed the antidepressant efficacy (including modes of administration, duration of effect and adverse effects) of ketamine and other glutamate receptor modulators in the treatment of unipolar depression (Caddy et al,2 in the Cochrane Database of Systematic Reviews), and, more generally, in mood disorders (Newport et al,3 in the American Journal of Psychiatry). To read the full article, log in using your NHS OpenAthens details
Schizophrenia is not a taboo topic anymore. Some aspects of the illness, like hearing voices and delusions (‘positive symptoms’), are increasingly spoken and written about by laypeople. But ‘negative symptoms’ (lack of thought content, motivation, meaningful pleasure and sociability) and the predisposition for people with schizophrenia to get depressed, are still commonly under-appreciated.
Both these domains are often treated by adding an antidepressant to an already-prescribed antipsychotic, but the evidence for this isn’t as comprehensive as we’d like. There have been multiple small studies, but there is little consensus and some subsidiary questions (like whether antidepressants might worsen positive symptoms) remain unanswered. Fortunately for us, a team based in Munich have recently published a systematic review and meta-analysis in the American Journal of Psychiatry, to pull together all of the data in this broad area (Helfer et al, 2016).
In a pragmatic clinical trial, this study sought to compare relapses among patients receiving either long-acting injectable or oral second-generation antipsychotics.
Despite significant advances in medication safety, errors related to confusion between drug names are a cause of preventable adverse events and serious harm,1 and remain a patient safety priority.2 ,3 Although drug name confusion is recognised as a factor contributing to error, its minimisation or elimination is a prevailing challenge.4 ,5 In this issue, Schroeder et al6 postulate that despite industry's efforts to follow regulators' guidance7 on how to review drug names, more objective evidence, in a standardised format, is needed to improve decision-making about the acceptability of a name. To address this concern, the authors assessed the association between error rates in laboratory-based tests of drug name memory and perception and rates of real-world errors related to drug name confusion. To read the full article, log in using your NHS OpenAthens details.
Although previous studies have assessed whether depression is a mortality risk factor, few have examined whether antidepressant medications (ADMs) influence mortality risk. You can request a copy of this article by replying to this email. Please ensure you are clear which article you are requesting.
Treatment-Emergent Psychosis With Disulfiram in a Patient With Late-Onset Alcohol Use Disorder and No Contributory Factors. You can request a copy of this article by replying to this email. Please ensure you are clear which article you are requesting.
Antidepressants are commonly used in dementia. Depression is a frequent and important co-morbidity in dementia, and antidepressants are often used to treat depression and more widely. However, there are questions about their utility in depression in dementia and other behavioural and psychological symptoms of dementia. The aim of this narrative review is to summarize the evidence on whether there is therapeutic value in prescribing antidepressants to people with dementia. Login using your SSSFT NHS OpenAthens for full text. SSOTP - You can request a copy of this article by replying to this email. Please ensure you are clear which article you are requesting.
Women needing the emergency contraceptive pill containing levonorgestrel should tell their healthcare professional if they are currently taking medicines for epilepsy and certain serious infections, or herbal remedies such as St John’s Wort as these may reduce how well the emergency contraceptive works.
Letter. Login using your SSSFT NHS OpenAthens for full text. SSOTP - You can request a copy of this article by replying to this email. Please ensure you are clear which article you are requesting.
ABSTRACT FROM: Kreinin A, Miodownik C, Mirkin V, et al. Double-blind randomized, placebo-controlled trial of metoclopramide for hypersalivation associated with clozapine. J Clin Psychopharmacol 2016;36:200–5. To read the full article, log in using your NHS OpenAthens details.
The role of community pharmacists is changing globally with pharmacists engaging in more clinically-oriented roles, including in mental health care. Pharmacists’ interventions have been shown to improve mental health related outcomes but various barriers can limit pharmacists in their care of patients. We aimed to explore the experiences of people with lived experience of mental illness and addictions in community pharmacies to generate findings to inform practice improvements.
Use of antipsychotics to treat behavioural symptoms of dementia has been associated with increased risks of mortality and stroke. Little is known about individual patient characteristics that might be associated with bad or good outcomes. You can request a copy of this article by replying to this email. Please ensure you are clear which article you are requesting.
To compare objective and subjective weight gain of second-generation antipsychotics in schizophrenia and bipolar disorder. SSSFT staff can use the OVID link, or you can request a copy of this article by replying to this email. Please ensure you are clear which article you are requesting.
The primary objective of this study was to investigate whether the choice and dosage of antipsychotic medication differ between patients with schizophrenia starting treatment in an inpatient or outpatient unit. In addition, we investigated whether the reason for the introduction of new antipsychotic medication had an impact on the treatment setting and whether the use of benzodiazepines differed between inpatients and outpatients. SSSFT staff can use the OVID link, or you can request a copy of this article by replying to this email. Please ensure you are clear which article you are requesting.
This study aimed to compare (1) the detection rates of antipsychotic-associated side effects between clinician and patient ratings and (2) differences as a function of change and absolute score definitions. SSSFT staff can use the OVID link, or you can request a copy of this article by replying to this email. Please ensure you are clear which article you are requesting.