Category: Mental Health Treatment

Patients Dependent on Benzodiazepines: Make Alliances

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Research Paper Title

Making Alliances With Patients Dependent on Benzodiazepines: A Provider’s Experience.

Abstract

Tens of millions of benzodiazepine (BZD) prescriptions are written annually for the outpatient management of anxiety disorders and insomnia.

Many prescribers do not follow published treatment guidelines for these disorders.

Psychiatric-mental health nurse practitioners (PMHNPs) regularly meet patients who have been treated with BZDs for years.

The dangers posed by outpatient BZD use are recognised, especially among older adults, and their use should be minimised or eliminated.

There are multiple manualised approaches to outpatient down-titration of BZDs, but little evidence about which methods really work.

To effect change, it is essential that PMHNPs establish a sound therapeutic alliance with these patients, especially by using their skills in therapeutic communication.

One major conflict that may occur early in the relationship is the patient’s expectation that the BZD medication regimen will continue indefinitely and their unwillingness to risk discontinuing the drug.

This conflict commonly raises non-adherence to a down-titration plan or patient termination of the relationship.

It is essential that PMHNPs take the time and patience to build strong therapeutic alliances with patients to design and implement a successful BZD discontinuation regimen.

Reference

Amberg, A. (2020) Making Alliances With Patients Dependent on Benzodiazepines: A Provider’s Experience. Journal of Pyschosocial Nursing and Mental Health Services. 58(1), pp.29-32. doi: 10.3928/02793695-20191218-06.

Examining the Role the Inflammatory Process & Immune System Play in Mental Disorder

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Research Paper Title

Inflammatory Response and Treatment-Resistant Mental Disorders: Should Immunotherapy Be Added to Pharmacotherapy?

Abstract

Treatment resistance continues to challenge and frustrate mental health clinicians and provoke psychiatric researchers to seek additional explanatory theories for psychopathology.

Because the inflammatory process activates symptoms of depression, anxiety, and psychosis, it is a reasonable route to follow for primary and/or indirect contribution to mental disorders.

The current article reviews the research literature regarding the role the inflammatory process and immune system play in mental disorders as well as novel treatments under investigation for resistant depression, anxiety, substance use, and psychotic disorders.

Reference

Limandri, B.J. (2020) Inflammatory Response and Treatment-Resistant Mental Disorders: Should Immunotherapy Be Added to Pharmacotherapy? Journal of Psychosocial Nursing and Mental Health Services. 58(1), pp.11-16. doi: 10.3928/02793695-20191218-03.

MedSupport: Patient Perceptions & Perceived Support

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Research Paper Title

Enabling patients to cope with psychotropic medication in mental health care: Evaluation and reports of the new inventory MedSupport.

Background

This cross sectional study examined patients’ perceptions of professional support regarding use of psychotropic medication in a specialist mental health care setting.

The aims were to evaluate reliability and validity of the MedSupport inventory, and investigate possible associations between MedSupport scores and patient characteristics.

Methods

A cross-sectional study was performed. The patients completed the MedSupport, a newly developed self-reported 6 item questionnaire on a Likert scale ranged 1 to 5 (1 = strongly disagree to 5 = strongly agree), and the Beliefs about Medicines Questionnaire.

Diagnosis and treatment information were obtained at the clinical visits and from patient records.

Among the 992 patients recruited, 567 patients (57%) used psychotropic medications, and 514 (91%) of these completed the MedSupport and were included in the study.

Results

The MedSupport showed an adequate internal consistency (Cronbach alpha.87; 95% CI.86-89) and a convergent validity toward the available variables.

The MedSupport mean score was 3.8 (standard deviation.9, median 3.8).

Increasing age and the experience of stronger needs for psychotropic medication were associated with perception of more support to cope with medication, whereas higher concern toward use of psychotropic medication was associated with perception of less support.

Patients diagnosed with behavioural and emotional disorders, onset in childhood and adolescence perceived more support than patients with Mood disorders.

Conclusions

The MedSupport inventory was suitable for assessing the patients’ perceived support from health care service regarding their medication.

Awareness of differences in patients’ perceptions might enable the service to provide special measures for patients who perceive insufficient medication support.

Reference

Drivenes, K., Vederhus, J.K., Haaland, V.Ø., Ruud, T., Hauge, Y.L., Regevik, H., Falk, R.S. & Tanum, L. (2020) Enabling patients to cope with psychotropic medication in mental health care: Evaluation and reports of the new inventory MedSupport. Medicine (Baltimore). 99(1):e18635. doi: 10.1097/MD.0000000000018635.

New Channel 4 TV Series on Mental Health – Losing It: Our Mental Health Emergency

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Introduction

As attitudes to mental health change during a surge in the number of people asking for help or harming themselves, this series joins the frontline care services in Nottinghamshire

Outline Series 01

Channel 4 begins broadcasting a new series on mental health on Tuesday 21 January 2020 at 10 pm.

Titled Losing It: Our Mental; Health Emergency, the series gains access to Nottinghamshire Healthcare, one of the UK’s largest mental health trusts.

With demand rising and resources stretched like never before, this series explores the unprecedented pressure on mental health services and the seemingly impossible decisions that clinicians have to make every day.

The series places viewers at the heart of the complex decision-making process, giving a unique insight into the pressures and challenges mental health trusts and patients must deal with daily.

Told with a frank first person perspective, this series gives a very personal view of mental illness in 2019; the tragedy, humour and complex challenges.

Outline Series 01, Episode 01

Two weeks after becoming a mum, Laura is sectioned having tried to drive into a brick wall.

And is 11-year-old Briena really suicidal, or is the underlying diagnosis more complicated?

About Nottinghamshire Healthcare NHS Foundation Trust

Nottinghamshire Healthcare provides integrated healthcare services, including mental health, intellectual disability and physical health services.

Over 9000 dedicated staff provide these services in a variety of settings, ranging from the community through to acute wards, as well as secure settings.

The Trust manages two medium secure units, Arnold Lodge in Leicester and Wathwood Hospital in Rotherham, and the high secure Rampton Hospital near Retford.

It also provides healthcare in prisons across the East Midlands.

Its budget for 2019/20 is £465m.

Why Do It?

The Trust made the decision to take part in the series in April 2019 to try and further reduce the stigma associated with mental illness.

The production company, Story Films, has an impressive track record in making sensitive films that deal with difficult topics.

Filming took place across Nottinghamshire during the summer of last year and features patients with a wide variety of diagnoses, including young people, families and people in crisis.

Production & Filming Details

  • Production: Story Films.
  • Distributor: Channel 4.
  • Release Date: 21 January 2020 (UK).
  • Running Time: 50 minutes.

Have Antidepressant Prescriptions, Including Tricyclics, Increased in Canadian Children?

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Research Paper Title

Antidepressant Prescriptions, Including Tricyclics, Continue to Increase in Canadian Children.

Background

Few studies have longitudinally followed trends in antidepressant prescribing for Canadian children following the Black Box warning issued in 2004.

Using a national data source, we aim to describe trends in antidepressant recommendations for Canadian children ages 1-18 during 2012 to 2016.

Methods

A database called the Canadian Disease and Therapeutic Index (CDTI), provided by IQVIA, was used to conduct analyses. The CDTI dataset collects a quarterly sample of paediatric antidepressant recommendations, projected using a weight procedure from a dynamic sample of 652 Canadian office-based physicians.

The term “recommendations” is used because nonprescription drugs may be recommended and there is no confirmation in the database that the prescriptions were filled or medications taken.

The data were collected from 2012 to 2016 and the sample population was projected by IQVIA to be representative of the entire Canadian paediatric population.

Results

The total number of projected antidepressant recommendations for children increased from 2012 to 2016. Selective serotonin reuptake inhibitors were the most recommended class of antidepressants.

Analysis indicated that fluoxetine was the most frequently recommended drug.

Findings also suggest that recommendations for tricyclic antidepressants (TCAs) are increasing, but predominantly for reasons other than treatment of depression.

Conclusions

Overall, antidepressant use in Canadian children increased over the study period.

Unsurprisingly, fluoxetine was the most recommended antidepressant for Canadian children.

However, the observed increase in TCA use for a paediatric population is unexpected.

The data source is descriptive and lacks detailed measures supporting comprehensive explanation of the findings, therefore, further research is required.

Reference

Lukmanji, A., Pringsheim, T., Bulloch, A.G., Stewart, D.G., Chan, P., Tehrani, A. & Patten, S.B. (2020) Antidepressant Prescriptions, Including Tricyclics, Continue to Increase in Canadian Children. Journal of Child and Adolescent Psychopharmacology. doi: 10.1089/cap.2019.0121. [Epub ahead of print].

Inflammatory Response & Treatment-Resistant Mental Disorders

Published on by Andrew MarshallLeave a comment

Research Paper Title

Inflammatory Response and Treatment-Resistant Mental Disorders: Should Immunotherapy Be Added to Pharmacotherapy?

Abstract

Treatment resistance continues to challenge and frustrate mental health clinicians and provoke psychiatric researchers to seek additional explanatory theories for psychopathology.

Because the inflammatory process activates symptoms of depression, anxiety, and psychosis, it is a reasonable route to follow for primary and/or indirect contribution to mental disorders.

The current article reviews the research literature regarding the role the inflammatory process and immune system play in mental disorders as well as novel treatments under investigation for resistant depression, anxiety, substance use, and psychotic disorders.

Reference

Limandri, B.J. (2020) Inflammatory Response and Treatment-Resistant Mental Disorders: Should Immunotherapy Be Added to Pharmacotherapy? Journal of Psychosocial Nursing and Mental Health Services. 58(1), pp.11-16. doi: 10.3928/02793695-20191218-03.

Benzodiazepines & Older Adults

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Research Paper Title

Little Helpers No More: A Framework for Collaborative Deprescribing of Benzodiazepines in Older Adults.

Abstract

Benzodiazepines are a class of medications that tend to fly “under the radar” within the general population but nonetheless post a significant risk to older adults when not used appropriately.

The current article aims to shine a spotlight on this medication class along with a framework for a team-based approach to successfully de-escalate use when clinically appropriate.

Reference

Suss, T. & Oldani, M. (2020) Little Helpers No More: A Framework for Collaborative Deprescribing of Benzodiazepines in Older Adults. Journal of Pyschosocial Nursing and Mental Health Services. 58(1), pp.23-28. doi: 10.3928/02793695-20191218-05.

A Provider’s Experience of Making Alliances With Patients Dependent on Benzodiazepines

Published on by Andrew MarshallLeave a comment

Research Paper Title

Making Alliances With Patients Dependent on Benzodiazepines: A Provider’s Experience.

Background

Tens of millions of benzodiazepine (BZD) prescriptions are written annually for the outpatient management of anxiety disorders and insomnia.

Many prescribers do not follow published treatment guidelines for these disorders. Psychiatric-mental health nurse practitioners (PMHNPs) regularly meet patients who have been treated with BZDs for years.

The dangers posed by outpatient BZD use are recognised, especially among older adults, and their use should be minimised or eliminated.

There are multiple manualised approaches to outpatient down-titration of BZDs, but little evidence about which methods really work.

To effect change, it is essential that PMHNPs establish a sound therapeutic alliance with these patients, especially by using their skills in therapeutic communication.

One major conflict that may occur early in the relationship is the patient’s expectation that the BZD medication regimen will continue indefinitely and their unwillingness to risk discontinuing the drug.

This conflict commonly raises non-adherence to a down-titration plan or patient termination of the relationship.

It is essential that PMHNPs take the time and patience to build strong therapeutic alliances with patients to design and implement a successful BZD discontinuation regimen.

Reference

Amberg, A. (2020) Making Alliances With Patients Dependent on Benzodiazepines: A Provider’s Experience. Journal of Pyschosocial Nursing and Mental Health Services. 58(1), pp.29-32. doi: 10.3928/02793695-20191218-06.

Benzodiazepine Use during Hospitalisation

Published on by Andrew MarshallLeave a comment

Research Paper Title

Let’s Talk About Benzodiazepine Use: Inpatient Psychiatric Nurses Initiating the Conversation.

Abstract

Inpatient psychiatric nurses regularly dispense pro re nata (PRN) medication to individuals during their psychiatric hospitalisation.

International studies indicate that 66% to 90% of patients receive PRN medications during hospitalisation, a large percentage of which are benzodiazepines (BZDs).

Although clear opportunities exist for nursing intervention to reduce BZD use, there is little recent US literature on inpatient psychiatric nurses’ proactive approach to the issue.

The current article examines the factors that support BZD use during inpatient hospitalisation, including nurses’ attitudes around BZD use, the perceived effectiveness of the medication to address difficult situations, and the barriers to using alternative nonpharmacological methods.

Suggestions are presented for how nurses might begin dialogues with patients around BZD use and alternative strategies to manage distress.

It is recommended that the specialty initiate a research agenda for reducing BZD use during inpatient psychiatric treatment and champion the issue as a focus for systematic improvement efforts.

Reference

Delaney, K.R. (2020) Let’s Talk About Benzodiazepine Use: Inpatient Psychiatric Nurses Initiating the Conversation. Journal of Psychosocial Nursing and Mental Health Services. 58(1), pp.33-38. doi: 10.3928/02793695-20191218-07.