UK Psychiatric Pharmacy Group
Developments in adult ADHD treatment
Current developments in adult attention deficit-hyperactivity disorder
were described by Gordon Bates, a child and adolescent psychiatrist responsible
for the regional ADHD clinic at Birmingham Children’s Hospital
and senior lecturer at the universities of Birmingham and Warwick.
There have been developments in the recognition and treatment of “adult
ADHD”, he said, which are that a lower treatment effect of stimulants
is seen with standard doses and a better effect observed with higher
doses. Furthermore, atomoxetine, tricyclic antidepressants and buproprion
are useful alternatives to stimulants.
He also touched on the recent changes in Controlled Drugs management
with reference to the removal of handwriting requirements for S2 and
S3 drugs. He suggested that this has had a positive impact on service
improvement allowing more automation of repeat prescriptions. Future
management and development options for adult ADHD were also discussed,
including treatment with long-acting dexamphetamine and modafanil.
Learning difficulties
Dave Branford, chief pharmacist, South Derbyshire Mental Health Trust,
gave a comprehensive therapeutic update in learning difficulties
(LD). He described challenging behaviour problems and suggested that
drugs
used to treat behavioural problems are treated like psychotropic
drugs, ie, that they are used within co-ordinated care plans striving
for
lowest optimal doses, that side effects are monitored using rating
instruments and that reviews are systematically and regularly performed.
However, he also stressed the need to avoid intra-class polypharmacy
and frequent drug and dose changes.
Priscilla Reed, a speech and language therapist from Lancashire,
continued the learning disabilities theme by considering communication
issues.
Particular problems that medical professionals come across among people
with learning disabilities include decision-making and hearing. She
told the meeting that accessible materials which may enhance the
understanding
and retention of information in this group of individuals are available
on various websites, including www.mencap.org.uk, www.easyinfo.org.uk,
and www.askaboutmedicines.org.
New services in mental health
Four pharmacists described their research and other practice developments
to the meeting.
Ciara Hallows, from Birmingham, presented her research on producing British
Sign Language drug information resources on psychotropic drugs for deaf
service users. She showed a video clip of a risperidone information resource,
with simultaneous British Sign Language, oral and visual explanations.
As a result of the popularity of the resources, Ms Hallows advised the
meeting that the facility is being progressed for potential national
distribution.
Wendy Broderick, associate director of pharmacy, Tees, Esk and Wear Valleys
NHS Trust, spoke on “Getting into bed with the private sector”.
She outlined the trials and tribulations in adopting an innovative approach
to outsourcing of medicines supply for a secondary care mental health
unit to a multinational corporation. The greatest challenges were around
changing the concept of mental health pharmacy and dissolution of service
level agreements with acute trust providers. She said that public-private
partnership is her trust’s direction of travel and that this model
fits within the Department of Health objectives.
Suzanne Robinson, from the Royal Glamorgan Hospital, Llantrisant, outlined
her experience as a non-medical prescriber in practice. She looked at
where supplementary prescribing fits in a mental health service and suggested
acute episodes of depression and treatment-resistant schizophrenia were
suitable candidates. She also described the challenges met in setting
up this new role.
Stephen Bazire, chief pharmacist, Norfolk and Waveney Mental Health Partnership
NHS Trust, and honorary professor at the School of Chemistry and Pharmacy,
University of East Anglia, described the implementation of an automated
dispensing machine at his hospital. He said that the advantage of an
automated tablet counting machine for mental health service providers
lie in the ability to produce individualised patient medicines sachets
in biodegradable strips. This allows complete flexibility in supplies,
he said. He described the planning, implementation and roll-out process
for his hospital’s automated system and highlighted the challenges
met along the way. These included “deblistering” of medicines
from patient packs and interfacing with the pharmacy computer system.
Is NICE too restrictive in the mental health medicines field?
The conference debate embraced the controversial theme of whether the
National Institute of Health and Clinical Excellence is too restrictive
in the field of mental health practice.
The debate centred around the provocative house belief that NICE guidance
is too evidence-based and pays too little attention to clinical experience.
Before the debate an informal vote suggested that the opinion of the
delegates was predominantly against NICE.
Roger Bullock, clinical lead in old age psychiatry, Avon and Wiltshire,
and director of the Kingshill Research Centre, spoke for the motion.
He suggested that people with free minds were like “Dr Who” characters,
and those that followed NICE guidelines were like “cybermen”.
Speaking against the motion, Steve Pilling, consultant clinical psychologist
and co-director of the National Collaborating Centre for Mental Health,
defended NICE by pointing out that it took a lot of care with its guidance
and
took the time to evaluate the evidence in a robust way.
Following the presentations, the informal vote shifted to a more balanced
view on NICE’s worth.
A patient’s view — learning to manage bipolar disorder
Mark Harnden was diagnosed with bipolar disorder in 1995. He presented
a talk entitled “Madness, medication, empowerment and the person” to
the meeting.
He described his experiences of psychosis, the side effects of medication
and a five-year battle to accept his bipolar illness. He outlined his
management programme, which provided a comprehensive understanding of
the concepts involved in learning to self-manage extreme mood swings
and went on to describe getting his life back on track. He described
his experiences as “11 bizarre years” and told the meeting
that he is thankful to have persevered with all the professionals with
whom he came into contact.
Correction
At the UK Psychiatric Pharmacy Group meeting Mark Harnden said that he was glad the professionals with whom he came into contact had persevered with him, rather than that he was grateful that he had persevered with the professionals.
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The
Pharmaceutical Journal