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Letters to the Editor
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Mental health
Report is relevant
From Miss S. M. Mir, MRPharmS
Congratulations to Rethink on its report “Running
on empty” (PJ,
2 July, p6), which in my view should be embraced by all mental health
trusts and all health professionals involved in the care of those with
a severe mental illness (SMI).
The physical well-being of SMI patients has long been neglected and,
as the report states, the prevalence of cardiovascular disease and diabetes
among other health problems is higher in those with SMI than in the general
population. This may be further compounded by the use of certain psychotropic
drugs that can affect physical health.
The past 15 years have seen the introduction of newer, atypical drugs.
Extrapyramidal side effects and hyperprolactinaemia may not be as common
now, but one could argue that weight gain and diabetes have replaced
them. However, the physical monitoring of patients appears to have been
left behind.
As discussed in the report, the choice of treatment for SMI is a balance
between tolerability and efficacy. Careful consideration should be given
to all factors when choosing treatment (current physical health, ethnicity
and family medical history, to name a few). Given the larger choice of
drugs available now, it is imperative that those choosing treatment understand
the differences between the available drugs — especially their
side effect profile and propensity to increase patient risk (of, for
example, cardiovascular disease).
A common and long-standing cause for concern in prescribing in mental
health has been the inappropriate use of high-dose antipsychotics. Once
a patient is discharged from secondary care, medication changes may not
be made for fear of “rocking the boat” and there is potential
for relapse and readmission to hospital. I do not dispute that these
fears are real, but they need to be taken into context and the risk versus
benefit ratio carefully evaluated. For many, changing medication to decrease
morbidity may improve their quality of life and social functioning for
the rest of their lives, which in turn could lead to an improvement in
compliance. Because of this, I would challenge decisions not to change
medication for fear of relapse.
Medication switches, when planned and managed carefully, can be done
to minimise the risk of relapse. This can be done on inpatient wards
under the care of the multidisciplinary team or in the community through
the community mental health team.
As health care professionals we need constantly to ask ourselves: “Are
we really doing our best?” In our trust we have extended pharmacists’ roles
to medication review of those with enduring mental illness. Pharmacists
in our trust may also undertake physical health checks and advise secondary
care psychiatrists or general practitioners as appropriate.
Shameem Mir
Chief Pharmacist
East London and City Mental Health Trust
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The
Pharmaceutical Journal