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Read J, Williams J. Positive and Negative Effects of Antipsychotic Medication: An International Online Survey of 832 Recipients. Curr Drug Saf 2020; 14:173-181. [PMID: 30827259 PMCID: PMC6864560 DOI: 10.2174/1574886314666190301152734] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 02/16/2019] [Accepted: 02/22/2019] [Indexed: 12/22/2022]
Abstract
Background: Antipsychotic medication is currently the treatment of choice for psychosis, but few studies directly survey the first-hand experience of recipients. Objective: To ascertain the experiences and opinions of an international sample of users of antipsychotic drugs, regarding positive and negative effects. Methods: An online direct-to-consumer questionnaire was completed by 832 users of antipsychotics, from 30 countries – predominantly USA, UK and Australia. This is the largest such sample to date. Results: Over half (56%) thought, the drugs reduced the problems they were prescribed for, but 27% thought they made them worse. Slightly less people found the drugs generally ‘helpful’ (41%) than found them ‘unhelpful’ (43%). While 35% reported that their ‘quality of life’ was ‘improved’, 54% reported that it was made ‘worse’. The average number of adverse effects reported was 11, with an average of five at the ‘severe’ level. Fourteen effects were reported by 57% or more participants, most commonly: ‘Drowsiness, feeling tired, sedation’ (92%), ‘Loss of motivation’ (86%), ‘Slowed thoughts’ (86%), and ‘Emotional numbing’ (85%). Suicidality was reported to be a side effect by 58%. Older people reported particularly poor outcomes and high levels of adverse effects. Duration of treatment was unrelated to positive outcomes but significantly related to negative outcomes. Most respondents (70%) had tried to stop taking the drugs. The most common reasons people wanted to stop were the side effects (64%) and worries about long-term physical health (52%). Most (70%) did not recall being told anything at all about side effects. Conclusion: Clinical implications are discussed, with a particular focus on the principles of informed consent, and involving patients in decision making about their own lives.
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Affiliation(s)
- John Read
- School of Psychology, University of East London, London, United Kingdom
| | - James Williams
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
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Valdovinos MG, Schieber E, McMahon M, Beard L, Wilkinson A, Carpenter J. Adverse Side Effects of Psychotropic Medication and Challenging Behavior: Pilot Work Assessing Impact. JOURNAL OF DEVELOPMENTAL AND PHYSICAL DISABILITIES 2017; 29:969-982. [PMID: 29398883 PMCID: PMC5791745 DOI: 10.1007/s10882-017-9570-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Psychotropic medications are often prescribed to reduce challenging behavior in individuals with intellectual and developmental disabilities (IDD). Functional analyses (FAs) have demonstrated utility in assessing medication impact on behavior; however, the impact of adverse side effects (ASE) on challenging behavior is under-assessed. The purpose of this study was to develop a methodology, similar to FAs, to explore potential medication ASE impact on challenging behavior in seven individuals with IDD. Results revealed response rate differences in designed ASE conditions for most participants. Outcomes support further development and use of this methodology to assess the presence and impact of ASEs.
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Affiliation(s)
| | | | | | - Lisa Beard
- University of Maryland, Baltimore County
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Wykes T, Evans J, Paton C, Barnes TRE, Taylor D, Bentall R, Dalton B, Ruffell T, Rose D, Vitoratou S. What side effects are problematic for patients prescribed antipsychotic medication? The Maudsley Side Effects (MSE) measure for antipsychotic medication. Psychol Med 2017; 47:2369-2378. [PMID: 28420450 PMCID: PMC5820531 DOI: 10.1017/s0033291717000903] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 03/15/2017] [Accepted: 03/16/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Capturing service users' perspectives can highlight additional and different concerns to those of clinicians, but there are no up to date, self-report psychometrically sound measures of side effects of antipsychotic medications. Aim To develop a psychometrically sound measure to identify antipsychotic side effects important to service users, the Maudsley Side Effects (MSE) measure. METHOD An initial item bank was subjected to a Delphi exercise (n = 9) with psychiatrists and pharmacists, followed by service user focus groups and expert panels (n = 15) to determine item relevance and language. Feasibility and comprehensive psychometric properties were established in two samples (N43 and N50). We investigated whether we could predict the three most important side effects for individuals from their frequency, severity and life impact. RESULTS MSE is a 53-item measure with good reliability and validity. Poorer mental and physical health, but not psychotic symptoms, was related to side-effect burden. Seventy-nine percent of items were chosen as one of the three most important effects. Severity, impact and distress only predicted 'putting on weight' which was more distressing, more severe and had more life impact in those for whom it was most important. CONCLUSIONS MSE is a self-report questionnaire that identifies reliably the side-effect burden as experienced by patients. Identifying key side effects important to patients can act as a starting point for joint decision making on the type and the dose of medication.
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Affiliation(s)
- T. Wykes
- Psychology Department,
Institute of Psychiatry, Psychology, and Neuroscience, King's College
London, London, UK
- South London and Maudsley NHS Foundation
Trust, London UK
| | - J. Evans
- NIHR Biomedical Research Centre, South London and
Maudsley NHS Foundation Trust and Institute of Psychiatry, Psychology, and Neuroscience,
King's College London, London, UK
| | - C. Paton
- Chief Pharmacist, Oxleas NHS
Foundation Trust, Dartford, UK
| | | | - D. Taylor
- Pharmacy and Pathology, South
London and Maudsley NHS Foundation Trust, London,
UK
- Institute of Pharmaceutical Science, King's
College London, London, UK
| | - R. Bentall
- Department of Psychological Sciences,
University of Liverpool, UK
| | - B. Dalton
- Department for Psychological Medicine,
Institute of Psychiatry, Psychology, and Neuroscience, King's College
London, London, UK
| | - T. Ruffell
- Health Service & Population
Research, Centre for Implementation Science,
Institute of Psychiatry, Psychology, and Neuroscience, King's College
London, London, UK
| | - D. Rose
- Health Service & Population
Research, Centre for Implementation Science,
Institute of Psychiatry, Psychology, and Neuroscience, King's College
London, London, UK
| | - S. Vitoratou
- Health Service & Population
Research, Centre for Implementation Science,
Institute of Psychiatry, Psychology, and Neuroscience, King's College
London, London, UK
- Psychometrics and Measurement Lab,
Biostatistics and Health Informatics, Institute of
Psychiatry, Psychology, and Neuroscience, King's College London,
London, UK
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Jordan S, Gabe-Walters ME, Watkins A, Humphreys I, Newson L, Snelgrove S, Dennis MS. Nurse-Led Medicines' Monitoring for Patients with Dementia in Care Homes: A Pragmatic Cohort Stepped Wedge Cluster Randomised Trial. PLoS One 2015; 10:e0140203. [PMID: 26461064 PMCID: PMC4603896 DOI: 10.1371/journal.pone.0140203] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 09/21/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND People with dementia are susceptible to adverse drug reactions (ADRs). However, they are not always closely monitored for potential problems relating to their medicines: structured nurse-led ADR Profiles have the potential to address this care gap. We aimed to assess the number and nature of clinical problems identified and addressed and changes in prescribing following introduction of nurse-led medicines' monitoring. DESIGN Pragmatic cohort stepped-wedge cluster Randomised Controlled Trial (RCT) of structured nurse-led medicines' monitoring versus usual care. SETTING Five UK private sector care homes. PARTICIPANTS 41 service users, taking at least one antipsychotic, antidepressant or anti-epileptic medicine. INTERVENTION Nurses completed the West Wales ADR (WWADR) Profile for Mental Health Medicines with each participant according to trial step. OUTCOMES Problems addressed and changes in medicines prescribed. DATA COLLECTION AND ANALYSIS Information was collected from participants' notes before randomisation and after each of five monthly trial steps. The impact of the Profile on problems found, actions taken and reduction in mental health medicines was explored in multivariate analyses, accounting for data collection step and site. RESULTS Five of 10 sites and 43 of 49 service users approached participated. Profile administration increased the number of problems addressed from a mean of 6.02 [SD 2.92] to 9.86 [4.48], effect size 3.84, 95% CI 2.57-4.11, P <0.001. For example, pain was more likely to be treated (adjusted Odds Ratio [aOR] 3.84, 1.78-8.30), and more patients attended dentists and opticians (aOR 52.76 [11.80-235.90] and 5.12 [1.45-18.03] respectively). Profile use was associated with reduction in mental health medicines (aOR 4.45, 1.15-17.22). CONCLUSION The WWADR Profile for Mental Health Medicines can improve the quality and safety of care, and warrants further investigation as a strategy to mitigate the known adverse effects of prescribed medicines. TRIAL REGISTRATION ISRCTN 48133332.
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Affiliation(s)
- Susan Jordan
- College of Human and Health Sciences, Swansea University, Swansea, Wales
| | | | - Alan Watkins
- College of Medicine, Swansea University, Swansea, Wales
| | - Ioan Humphreys
- College of Human and Health Sciences, Swansea University, Swansea, Wales
| | - Louise Newson
- College of Human and Health Sciences, Swansea University, Swansea, Wales
| | - Sherrill Snelgrove
- College of Human and Health Sciences, Swansea University, Swansea, Wales
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Medication monitoring in a nurse-led respiratory outpatient clinic: pragmatic randomised trial of the West Wales Adverse Drug Reaction Profile. PLoS One 2014; 9:e96682. [PMID: 24798210 PMCID: PMC4010491 DOI: 10.1371/journal.pone.0096682] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 04/04/2014] [Indexed: 11/29/2022] Open
Abstract
Objective To assess the clinical effect of medication monitoring using the West Wales Adverse Drug Reaction (ADR) Profile for Respiratory Medicine. Design Single-site parallel-arm pragmatic trial using stratified randomisation. Setting Nurse-led respiratory outpatient clinic in general hospital in South Wales. Participants 54 patients with chronic respiratory disease receiving bronchodilators, corticosteroids or leukotriene receptor antagonists. Intervention Following initial observation of usual nursing care, we allocated participants at random to receive at follow up: either the West Wales ADR Profile for Respiratory Medicine in addition to usual care (‘intervention arm’ with 26 participants); or usual care alone (‘control arm’ with 28 participants). Main Outcome Measures Problems reported and actions taken. Results We followed up all randomised participants, and analysed data in accordance with treatment allocated. The increase in numbers of problems per participant identified at follow up was significantly higher in the intervention arm, where the median increase was 20.5 [inter-quartile range (IQR) 13–26], while that in the control arm was −1 [−3 to +2] [Mann-Whitney U test: z = 6.28, p<0.001]. The increase in numbers of actions per participant taken at follow up was also significantly higher in the intervention arm, where the median increase was 2.5 [1]–[4] while that in the control arm was 0 [−1.75 to +1] [Mann-Whitney U test: z = 4.40, p<0.001]. Conclusion When added to usual nursing care, the West Wales ADR Profile identified more problems and prompted more nursing actions. Our ADR Profile warrants further investigation as a strategy to optimise medication management. Trial Registration Controlled-trials.com ISRCTN10386209
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Jordan S, Gabe M, Newson L, Snelgrove S, Panes G, Picek A, Russell IT, Dennis M. Medication monitoring for people with dementia in care homes: the feasibility and clinical impact of nurse-led monitoring. ScientificWorldJournal 2014; 2014:843621. [PMID: 24707218 PMCID: PMC3951004 DOI: 10.1155/2014/843621] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 01/06/2014] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES People with dementia are susceptible to adverse effects of medicines. However, they are not always closely monitored. We explored (1) feasibility and (2) clinical impact of nurse-led medication monitoring. DESIGN Feasibility "before-and-after" intervention study. SETTING Three care homes in Wales. PARTICIPANTS Eleven service users diagnosed with dementia, taking at least one antipsychotic, antidepressant, or antiepileptic medicine. INTERVENTION West Wales Adverse Drug Reaction (ADR) Profile for Mental Health Medicines. OUTCOME MEASURES (1) Feasibility: recruitment, retention, and implementation. (2) Clinical impact: previously undocumented problems identified and ameliorated, as recorded in participants' records before and after introduction of the profile, and one month later. RESULTS Nurses recruited and retained 11 of 29 eligible service users. The profile took 20-25 minutes to implement, caused no harm, and supplemented usual care. Initially, the profile identified previously undocumented problems for all participants (mean 12.7 (SD 4.7)). One month later, some problems had been ameliorated (mean 4.9 (3.6)). Clinical gains included new prescriptions to manage pain (2 participants), psoriasis (1), Parkinsonian symptoms (1), rash (1), dose reduction of benzodiazepines (1), new care plans for oral hygiene, skin problems, and constipation. CONCLUSIONS Participants benefited from structured nurse-led medication monitoring. Clinical trials of our ADR Profile are feasible and necessary.
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Affiliation(s)
- Sue Jordan
- Department of Nursing, The College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, Wales SA2 8PP, UK
| | - Marie Gabe
- Department of Nursing, The College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, Wales SA2 8PP, UK
| | - Louise Newson
- Department of Nursing, The College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, Wales SA2 8PP, UK
| | - Sherrill Snelgrove
- Department of Nursing, The College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, Wales SA2 8PP, UK
| | - Gerwyn Panes
- Department of Nursing, The College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, Wales SA2 8PP, UK
| | - Aldo Picek
- Fieldbay Ltd., Chestnut House, Tawe Business Village, Swansea Enterprise Park, Swansea SA7 9LA, UK
| | - Ian T. Russell
- The College of Medicine, Swansea University, Singleton Park, Swansea SA2 8PP, UK
| | - Michael Dennis
- The College of Medicine, Swansea University, Singleton Park, Swansea SA2 8PP, UK
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