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The purpose of this paper is to understand how women with a diagnosis of schizophrenia or bipolar disorder approach medication decision making in pregnancy.

The study was co-produced by university academics and charity-based researchers. Semi-structured interviews were conducted by three peer researchers who have used anti-psychotic medication and were of child bearing age. Participants were women with children under five, who had taken anti-psychotic medication in the 12 months before pregnancy. In total, 12 women were recruited through social media and snowball techniques. Data were analyzed following a three-stage process.

The accounts highlighted decisional uncertainty, with medication decisions situated among multiple sources of influence from self and others. Women retained strong feelings of personal ownership for their decisions, whilst also seeking out clinical opinion and accepting they had constrained choices. Two styles of decision making emerged: shared and independent. Shared decision making involved open discussion, active permission seeking, negotiation and coercion. Independent women-led decision making was not always congruent with medical opinion, increasing pressure on women and impacting pregnancy experiences. A common sense self-regulation model explaining management of health threats resonated with women’s accounts.

Women should be helped to manage decisional conflict and the emotional impact of decision making including long term feelings of guilt. Women experienced interactions with clinicians as lacking opportunities for enhanced support except in specialist perinatal services. This is an area that should be considered in staff training, supervision, appraisal and organization review.

This paper uses data collected in a co-produced research study including peer researchers.

This chapter reports the results of a study that used anonymous administrative databases and statistical techniques to determine the number of people in two databases. Results indicate that fewer adults with severe and persistent mental illness got into trouble with the law after beginning new-generation anti-psychotic medication than before. This impact was not uniformly felt, however. Men experienced decreased criminal justice involvement, while criminal justice involvement for women increased. Access to new-generation anti-psychotic medication was substantially greater for people who had previously been in trouble with the law and this difference was greater among younger clients.

The purpose of this paper is to examine the extent to which, in the five integrated community teams for adults with learning disabilities (CTLDs) in an English county-wide service, the use of psychotropic medication for service users was based on the presence of an appropriate mental health condition or epilepsy.

Adult participants were recruited following referral to one of the CTLDs for assessment, treatment and/or support of a possible mental health and/or behavioural need. Data were collected about participant characteristics and psychotropic medication 12 months after recruitment.

While a total of 42 (78 per cent) of the 54 participants were apparently prescribed regular or PRN (as required) psychotropic medication, only 24 (57 per cent) of these individuals had a recorded past or current mental health condition or epilepsy for which such medicine could be appropriate.

There were several limitations: the sample size was small and its representativeness was uncertain; and data collection was compromised by barriers to explicit knowledge exchange within and across the learning disability service.

While recent guidance about the use of psychotropic medication is welcome, minimising inappropriate use requires more comprehensive person-centred interventions (including crisis management plans), underpinned by imaginative, but feasible, data collection methods and integrated formulations. Investment is needed in developments that support multi-disciplinary and inter-agency working to promote “good practice” by CTLDs in responding to referrals for possible mental health and/or behavioural needs.

Complementing recent large studies of primary care (General Practitioner) records, this is the first examination of the use of psychotropic medication by service users in English CTLDs.

People with intellectual disability are subject to increased health morbidity when compared to the general population. This paper assesses the monitoring of metabolic syndrome in people with an intellectual disability who have been prescribed antipsychotic medication.

A pre‐audit analysis was followed by an audit of 32 patients. The height, weight and body mass index was recorded in 34 per cent prior to initiation, which decreased to 22 per cent at the three monthly follow up. Blood pressure was recorded in 6 per cent of the patients at baseline, but there was no record during treatment. The biochemical parameters including plasma glucose and plasma cholesterol were measured in 40 per cent of the patients on initiation which decreased to 33 per cent at three monthly follow up in the first year. In total, 21 per cent of patients received four monthly monitoring of the biochemical parameters, i.e. their height and weight, 25 per cent of the patients had an annual monitoring of all parameters.

The results indicate inconsistent monitoring of metabolic syndrome in people with intellectual disability being treated with antipsychotic medication. While a proportion of patients may have been monitored in primary care, these data indicate the need for remedial action to improve the standard of metabolic syndrome detection in those people with intellectual disability receiving antipsychotic medication.

This study highlights the inadequate monitoring of biochemical and physical parameters of metabolic syndrome in people with an intellectual disability who are prescribed antipsychotic medication. National criteria for monitoring the prescription of antipsychotic medication in people with intellectual disability who are prescribed antipsychotic medication is proposed.

Aim ‐ To describe prescription drug use in a nationwide prison population and compare it with contemporary drug use in other relevant populations as well as in a prison population 25 years ago. Method ‐ Detailed medication sheets from 37 prisons, covering 90% of the Norwegian prison population, were collected. All drugs were transcribed into the Anatomical Therapeutic Chemical classification system, and Defined Daily Doses/100 inmates were calculated. Data enabling relevant comparisons were gathered from reliable sources. Results ‐ Among the 2,617 inmates investigated, 48% used no medication. Sixteen percent used both psychotropic and somatic drugs, 17% psychotropic drugs only, and 19% somatic drugs only. Strong correlations between drug use and gender, age, and prison characteristics were demonstrated. Psychotropic drug use was higher than in the general population but lower than in a psychiatric hospital unit. Somatic drug use was lower than in the general population, except non‐steroid antiinflammatory agents, antihistamines, and drugs to alleviate obstructive airway diseases. Psychotropic drug use, particularly antidepressant use, was higher than in prisons 25 years ago. Conclusion ‐ High levels of use of all psychotropic and a number of somatic drugs were demonstrated in this nationwide prison population. Treatment studies are needed in order to ascertain whether the high levels of use of particularly psychotropic medications are indeed improving the mental health of prisoners.

This study examined the personal characteristics and social context of two groups of women with learning disabilities and psychiatric disorders who resided in some form of community residential facility. One group of women had been admitted to hospital in the past 12 months (N = 20) and the other had been maintained in the community without any admissions (N = 33). A prospective natural group comparison design was employed over a 12‐month period to study any differences between the groups. Data was collected from the women's key workers using a pro forma and three standardised instruments: Index of Social Competence, Aberrant Behaviour Checklist and the PAS‐ADD Checklist. The groups were matched on age and level of learning disabilities. Differences were found between the groups' behavioural and psychiatric profiles. Anti‐psychotic medication was the first line of treatment. A non‐significant trend was found on negative life experiences, and a binary logistic regression analysis confirmed that high levels of challenging behaviour and having behavioural/mental health management strategies in place predicted hospital admission. The findings of this study are discussed and improvements are explored.

The use of long-term anti-psychotic medication for borderline personality disorder contravenes prescribing guidelines in the UK. There is evidence to suggest clozapine can be beneficial yet anecdotally it is prescribed almost exclusively in locked settings. A single study suggests a substantial proportion of psychiatrists disapprove of this practice. The purpose of this paper is to articulate concerns about the use of clozapine for “BPD” that are absent from current literature.

This paper summarises the reflections and experiences of the authors lived experience, academic and clinical backgrounds.

The published literature is uniformly positive when describing the prescription of clozapine for those diagnosed with BPD; however, this in no way reflects the experience of the authors. There is no body of material reflecting a study showing that a substantial number of psychiatrists have issues with this practice.

While it is a fact that there is a discrepancy between psychiatrists attitudes towards clozapine prescription for “BPD” and the published literature, the described concerns in this paper are based solely on the authors’ experiences and observations.

Those seeking literature to articulate concerns about the use of clozapine with this population will likely be disheartened by the paucity of published literature.

To the best of the authors’ knowledge, this paper is the first to raise substantial concerns about the use of clozapine for those diagnosed with “BPD” and the circumstances in which it is prescribed.

This paper briefly reviews the literature on smoking and smoking cessation programmes for people with intellectual disability, and describes the baseline audit of such a programme for patients resident in a forensic service. The audit describes the prevalence of smoking, its significant associations and the effect of an intervention programme. In total, 79 patients participated in the audit, 48 of whom were smokers on admission (60.8%). Roughly a third of smokers gave up during their hospital stay (N = 15). Those who did not give up significantly reduced the number of cigarettes they smoked per day. Female smokers appeared less likely to give up than men. Length of stay and treatment with anti‐psychotic medication were not significantly linked to smoking behaviour. A simple smoking cessation programme with an emphasis on health education and nicotine replacement therapies appeared to be effective in cutting down smoking rates and tobacco consumption in this population. One should be cautious about generalising the conclusions to all forensic hospital services for people with intellectual disability, as the audit was limited by the lack of a control group and conducted in a single service.

This study aims to understand whether psychotropic prescribing practices for people with intellectual disabilities are in keeping with best practice guidelines.

This service evaluation project was a retrospective analysis of routinely collected data from the care records of all 36 people with intellectual disability discharged from an intellectual disability assessment and treatment unit during the first five years of the Stop Over medicating People with Intellectual Disabilities and/or autistic people (STOMP) initiative. Data were gathered at four time points (pre-admission, discharge, 6- and 12-month follow-up) before being analysed to understand whether psychotropic prescribing differed among people with different clinical characteristics/traits/diagnoses. Changes over time were also explored to ascertain whether and how prescribing altered from admission to discharge, and over the subsequent year of community living.

Most people with intellectual disabilities left the assessment and treatment unit on fewer regular psychotropic medications and at lower doses than at admission. These optimised regimes were still apparent 12 months post-discharge, suggesting effective discharge planning and community care packages. Inpatients with severe intellectual disabilities generally received more anxiolytics and hypnotics, at higher doses. Autistic people tended to receive more psychotropics in total and at higher cumulative doses, a pattern that persisted post discharge. A third of the sample were admitted on regular anti-psychotic medications despite having no corresponding psychotic diagnosis, a proportion that remained relatively stable through discharge and into the community.

This study highlights subsets of the intellectual disability population at particular risk of receiving high doses of psychotropics and a feasible template for providers intending to undertake STOMP-focused evaluations.

The purpose of this paper is to discuss recent papers on trauma, sleep and psychotic experiences to highlight the lack of attention given to sleep.

A search was carried out to find recent papers on psychosis or schizophrenia, trauma and sleep.

Papers tended to focus on trauma and psychosis, or on sleep and psychosis, but not on trauma, sleep and psychosis. The two papers discussed in most detail here focussed on sleep difficulties from either a service user or professional perspective. Both concluded that sleep difficulties need more attention. The author also discussed evidence suggesting that stress and trauma cause sleep difficulties and that these, in turn, are an important cause of psychotic experiences. Severe or prolonged stress may also directly cause some psychotic experiences.

The two main papers highlight for the first time in detail service users’ own experiences of sleep difficulties, and how mental health professionals view them, suggesting more help is needed. Other papers suggest that sleep is overlooked in research into the causes of psychosis. There is growing evidence that people have sleep problems before psychotic experiences, and that many have experienced severe or prolonged stress due to life events and circumstances, often in childhood. Given that stress can interfere with sleep, it is time to investigate further the role of stress and sleep in the development and maintenance of psychosis.