The Department of Health & Social Care has issued urgent guidance relating to supply disruption of Mylan EpiPens for all health care professionals who prescribe, dispense or administer adrenaline auto-injectors.
Results of discontinuation of antipsychotics in people with intellectual disability are variable and may depend on staff factors.. Please contact the library to request a copy of this article - http://bit.ly/1Xyazai
Large‐scale epidemiological studies have demonstrated a protective effect of clozapine on mortality in people with schizophrenia. Clozapine is reserved for use in patients with treatment‐resistant schizophrenia (TRS), but evidence of clozapine's effect on mortality exclusively within TRS samples is inconclusive. Hence, we aimed to investigate the effect of clozapine use on all‐cause mortality in TRS patients.. To read the full article, log in using your MPFT NHS OpenAthens details.
This review is an abridged version of a Cochrane review previously published in the Cochrane Database of Systematic Reviews, 2018, April 10, Issue 4. To read the full article, log in using your MPFT NHS OpenAthens details.
Ketamine has been documented for its rapid antidepressant effects. However, optimal dose and delivery route have not yet been thoroughly investigated. The objectives of this study were to document the safety and test the antidepressant and antisuicidal effects of a single rapid 1-minute injection of ketamine 0.5 mg/kg in treatment-resistant depression (TRD). . MPFT 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.
Observational studies show an association between nightmares and suicide. Prazosin is proposed as a nightmare treatment. This pilot, randomized clinical trial tested whether treatment of nightmares with prazosin would reduce suicidal ideas in suicidal posttraumatic stress disorder (PTSD) patients. . MPFT 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.
Newer-generation antidepressants used in monotherapy or in combination with other newer-generation antidepressants or other psychotropic drugs are usually preferred as first- or second-step treatment options in resistant depression. According to our clinical experience, tricyclic antidepressants still are one of our preferred first choices in treatment-resistant moderate to severe unipolar major depressive episodes.. MPFT 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.
Case report. Two Manic Episodes Related to a Levetiracetam-Based Treatment in a 34-Year-Old Female Patient. MPFT 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.
Open access. Bipolar and other psychiatric disorders are associated with considerably increased risk of suicidal behaviour, which may include self-poisoning with medication used to treat the disorder. Therefore, choice of medication for treatment should include consideration of toxicity, especially for patients at risk. The aim of this study was to estimate the relative toxicity of specific drugs within two drug categories, antipsychotics and mood stabilizers, using large-scale databases to provide evidence that could assist clinicians in making decisions about prescribing, especially for patients at risk of suicidal behaviour.
Depression is considered to have the highest disability burden of all conditions. Although treatment-resistant depression (TRD) is a key contributor to that burden, there is little understanding of the best treatment approaches for it and specifically the effectiveness of available augmentation approaches.. To read the full article, log in using your MPFT NHS OpenAthens details.
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Why you should read this article:
> To enhance your understanding of the pharmacological interventions that can be used in people with dementia, ensuring appropriate and effective care for these patients
> To be aware of the challenges and cautions associated with medicines administration in people with dementia, thus supporting patient safety
> To count towards revalidation as part of your 35 hours of CPD, or you may wish to write a reflective account (UK readers)
> To contribute towards your professional development and local registration renewal requirements (non-UK readers)
To read the full article, log in using your MPFT NHS OpenAthens details.
The study raises concern that management of bipolar disorder may be out of line with best practice.
It's notable that prescription of lithium was low, however the investigation spanned from 2009 to 2016 and lithium was only recommended as the first-line drug in the NICE guideline from 2014. Prior to that lithium was reserved for people who did not respond to other drugs because of concerns about toxic side effects and the need for frequent blood tests. So it may be that there has been a delay in the guidelines being taken up.
We have worked with NHS England on a programme to ensure children and young people with a learning disability, autism or both are able to access appropriate medication, and are not prescribed inappropriate psychotropic medication. Find out more and read our full pledge.
Generalised anxiety disorder is a disease that can be associated with substantial dysfunction. Pharmacological treatment is often the first choice for clinicians because of the cost and resource constraints of psychological alternatives, but there is a paucity of comparative information for the multiple available drug choices.. Please contact the library to request a copy of this article - http://bit.ly/1Xyazai
Editorial. . To read the full article, log in using your NHS Athens details. To access full-text: click “Log in/Register” (top right hand side). Click ‘Institutional Login’ then select 'OpenAthens Federation', then ‘NHS England’. Enter your Athens details to view the article.
Antipsychotic use appears to increase mortality risk among older adults with dementia. Whether this risk is similar for regular or intermittent use is unknown. This scoping review aims to explore the temporal association between antipsychotic use and mortality risk for older institutionalized adults.. To read the full article, log in using your NHS Athens details. To access full-text: click “Log in/Register” (top right hand side). Click ‘Institutional Login’ then select 'OpenAthens Federation', then ‘NHS England’. Enter your Athens details to view the article.
From 1 April 2019 pregabalin and gabapentin will be reclassified as class C controlled substances in the UK. The change, announced in October 2018, is expected to prompt a decline in the use of the drugs as prescribing, dispensing, and collecting them becomes more onerous for doctors, pharmacists, and patients. To read the full article, log in using your NHS OpenAthens details.
Editorial. Two articles in this issue of JAMA Psychiatry explore adjunctive treatments for individuals with schizophrenia using large, observational data sets. Results from randomized clinical trials (RCTs) of adjunctive pharmacologic treatments in schizophrenia have been inconsistent and often difficult to interpret because of poor quality.1 Although RCTs are the standard for evaluating the efficacy of an intervention, they are costly, are not always feasible, and the results may not be generalizable to typical clinical populations. In addition, high placebo response rates and heterogeneity of illness further limit our ability to detect an efficacy signal. In the absence of data from large and methodologically rigorous RCTs, we must avail ourselves of other sources of data to identify potential therapeutic approaches.. Please contact the library to request a copy of this article - http://bit.ly/1Xyazai
There are risks to the safety of medicines management when patient care is transferred between healthcare organisations, for example, when a patient is discharged from hospital. Using the theoretical concept of resilience in healthcare, this study aimed to better understand the proactive role that patients can play in creating safer, resilient medicines management at a common transition of care. To read the full article, log in using your NHS OpenAthens details.
Open access. Take-home naloxone can prevent death from heroin/opioid overdose, but pre-provision is difficult because naloxone is usually given by injection. Non-injectable alternatives, including naloxone nasal sprays, are currently being developed. To be effective, the intranasal (i.n.) spray dose must be adequate but not excessive, and early absorption must be comparable to intramuscular (i.m.) injection. We report on the pharmacokinetics (PK) of a specially produced concentrated novel nasal spray. The specific aims were to: (1) estimate PK profiles of i.n. naloxone, (2) compare early systemic exposure with i.n. versus i.m. naloxone and (3) estimate i.n. bioavailability.
Open access. Letter. Thank you for this excellent and concise article outlining the complexities involved in neuroleptic malignant syndrome (NMS) in association with atypical antipsychotics.1 It serves as a reminder of how guidelines and diagnostic criteria can, for all their clarity, lead to vexing and imperfect choices.
GPs issued 1.1 billion prescription items at a cost of £9.2 billion in 2015/16. The vast majority were appropriate but many were for medicines, products or treatments that do not require a prescription and can be purchased over the counter from pharmacies, supermarkets, petrol stations, corner shops or other retailers in some cases at a much lower cost than the price paid by the NHS.
The NHS could save around £190 million a year by cutting such prescriptions for minor, short-term conditions, many of which will cure themselves or cause no long term effect on health.
Long-acting injectable antipsychotics (LAI) can optimize adherence for high-risk serious mental illness (SMI). This customized adherence-enhancement approach delivered by social worker interventionists was combined with LAI (CAE-L) of paliperidone palmitate for homeless, poorly adherent individuals with SMI. 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.
Schizophrenia has a 1% prevalence in the population; 30% of these patients are treatment refractory. Clozapine is the only drug licensed to treat treatment refractory psychosis, but concerns about potential adverse effects result in only a proportion of eligible patients being treated. Although a well-documented neutropenia risk is mitigated by routine blood testing, cardiac toxicity is a commonly cited reason to discontinue clozapine treatment. However, there is little data on the real-life cardiac outcomes in those receiving clozapine treatment. 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.
In this cohort study of 2654 pregnant women followed up through pregnancy and the postpartum period, neither panic disorder nor generalized anxiety disorder was associated with maternal or neonatal outcomes of interest. With maternal benzodiazepine treatment, rates of ventilatory support increased by 61 of 1000 neonates and duration of gestation was shortened by 3.6 days; with maternal serotonin reuptake inhibitor use, gestation was shortened by 1.8 days, 152 of 1000 additional newborns required minor respiratory interventions, and 53 of 1000 additional women experienced hypertensive diseases of pregnancy. Please contact the library to request a copy of this article - http://bit.ly/1Xyazai
Antipsychotics are a known cause of hyperprolactinaemia and can be associated with significant health issues in short term and long term. The effects vary with gender and age of the individual and can contribute towards non-concordance and hence relapse in mental health of our patients. Clinicians need to educate the patients about this significant side effect of not only antipsychotic medications but other medications causing hyperprolactinaemia commonly prescribed in primary care. To read the full article, log in using your NHS OpenAthens details.
When patients are discharged from hospital to home, it is a highlighted vulnerable period for which medication - related problems are prevalent. Researchers have proposed a telephone follow-up intervention as a means to reduce hospital readmissions. However, the outcome of the intervention with the engagement of pharmacists in managing patients’ medicines after discharge has not been well explored. The objectives of this study were (1) to determine whether a pharmacist telephone follow-up intervention focusing on patients’ medicines management support is associated with a reduction in 30-day readmission rates and (2) to describe the number and types of pharmacist interventions in care transitions from 2 UK acute hospitals.
Prescribing is a high-volume primary care routine where both speed and attention to detail are required. One approach to examining how organisations approach quality and safety in the face of high workloads is Hollnagel’s Efficiency and Thoroughness Trade-Off (ETTO). Hollnagel argues that safety is aligned with thoroughness and that a choice is required between efficiency and thoroughness as it is not usually possible to maximise both. This study aimed to ethnographically examine the efficiency and thoroughness trade-offs made by different UK general practices in the achievement of prescribing safety. To read the full article, log in using your NHS OpenAthens details.
Letter. 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 use of psychotropic medication to manage challenging behaviours of people with intellectual disabilities is a contentious issue which NHS England has now focused on. This paper looks to evaluate this within the multidisciplinary context. To read the full article, log in using your SSSFT NHS OpenAthens details.
It had long been believed that placebo response rates in antidepressant trials have been increasing and that they were responsible for rising numbers of so-called failed antidepressant trials. Two recent systematic reviews examined this issue and reached completely opposite findings. Furukawa and colleagues in a paper published in 2016 found that the placebo response rates are stable since 1991 and the apparent increase up to 2000 was confounded by changes in trial design features. By contrast, Khan and colleagues more recently concluded that placebo response rates had grown steadily in the past 30 years. The two reviews differed in the datasets they used, definitions of placebo response and statistical analyses. In this perspective article, we examined if such differences were responsible for the two reviews’ contrasting conclusions..... To read the full article, log in using your NHS OpenAthens details.
This systematic review and meta-analysis of randomized controlled trials (RCTs) examined the efficacy and safety of adjunctive N-acetylcysteine (NAC), an antioxidant drug, in treating major depressive disorder (MDD), bipolar disorder, and schizophrenia.. To read the full article, log in using your SSSFT NHS OpenAthens details. SSOTP - You can request a copy of this article by replying to this email. Please ensure you are clear which article you are requesting.
The Parliamentary Under Secretary of State for Public Health and Primary Care has commissioned Public Health England (PHE) to review the evidence for dependence on, and withdrawal from, prescribed medicines. Withdrawal is more accurately defined as discontinuation syndrome in relation to anti-depressants.
This is a UK-wide consultation, issued on behalf of the 4 UK health departments, with their support.
The 2 draft orders are:
The Pharmacy (Preparation and Dispensing Errors – Hospitals and Other Pharmacy Services) Order 2018
The Pharmacy (Responsible Pharmacists, Superintendent Pharmacists etc) Order 2018
The first draft order seeks to extend defences that already exist for pharmacy professionals working at or from registered pharmacies in the case of accidental preparation and dispensing errors. It would cover pharmacy professionals working in hospitals and other relevant pharmacy services.
Previous studies have demonstrated ketamine to have a rapid antidepressant effect in some patients with treatment-resistant depression (TRD), but the effect is unfortunately not sustained in the long term. In this study, we report on the clinical use of ongoing maintenance ketamine infusions in a group of patients with TRD, beyond an acute course of 6 to 8 ketamine infusions.. MPFT 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.
Antidepressants are one of the most prescribed classes of medications. A number of case reports have linked these drugs to extrapyramidal symptoms (EPSs), but no large epidemiologic study to date has examined this association. We sought to quantify the association of EPSs with different antidepressants by undertaking a large pharmacoepidemiologic study.. MPFT 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.
Commentary on: Tiihonen J, Mittendorfer-Rutz E, Majak M, et al. Real-world effectiveness of antipsychotic treatments in a nationwide cohort of 29 823 patients with schizophrenia. JAMA Psychiatry 2017;74:686–693.
What is already known on this topic
It is essential to identify differences in efficacy and effectiveness between antipsychotic options to inform treatment decisions in schizophrenia. Presence or absence of superiority has recently been particularly controversial for clozapine and long-acting injectable antipsychotics (LAIs), triggered by contrasting positive, negative and inconsistent meta-analyses of randomised controlled trials (RCTs).1–4 These inconsistencies may have been largely the result of selection bias since patients enrolled in RCTs may have a less severe illness, more insight, greater adherence and an overall better prognosis.4 This selection bias may be particularly important for clozapine and LAIs, which may be most effective in treatment-resistant patients and those with greater likelihood of non-adherence-related poor outcomes.. To read the full article, log in using your NHS OpenAthens details.
Letter. . MPFT 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.
Letter. . MPFT 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.
Antipsychotic drugs are frequently prescribed to older adults, but they may be associated with serious adverse effects. The objective was to investigate the association between use of antipsychotics in older adults and the risk of urinary tract infections (UTIs).. MPFT 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.
Prolactin-related adverse effects contribute to nonadherence and adverse health consequences, particularly in women with severe mental illness. Treating these adverse effects may improve treatment acceptability, adherence, and long-term outcomes.. MPFT 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.
Comment. Second-generation antipsychotic medications such as aripiprazole, olanzapine, quetipaine, and risperidone are widely used for the treatment of psychotic disorders and other psychiatric conditions. Concerns have been raised as to their role in patients' mortality. In this issue of The Lancet Psychiatry, Johannes Schneider-Thoma and colleagues report on a systematic review and meta-analysis of the mortality outcomes in randomised, placebo-controlled trials of second-generation anti-psychotics.1 The authors conclude that there is no evidence that second-generation antipsychotics are associated with an overall increase in mortality when all clinical populations are considered. Please contact the library to request a copy of this article - http://bit.ly/1Xyazai