Improving physical health for people taking antipsychotic medication in the Community Learning Disabilities Service

Abstract

Adherence with antipsychotic monitoring guidelines is notoriously low nationally. Without active monitoring and measures to improve metabolic abnormalities, more patients may develop related morbidity and mortality. An audit highlighted antipsychotic monitoring in this learning disability service in London did not match guideline recommendations. People with intellectual disability also experience health inequalities. Psychiatrists are well placed to provide advice and assistance that is suitable for those with complex communication, behaviour, and social needs.The QI team tested ideas to increase rates of antipsychotic reviews. The focus was the follow up monitoring of all universal measures recommended by NICE 2014, collected at 2-weekly intervals. We trialled interventions in four broad categories; Intervention 1: to make monitoring more structured and planned; Intervention 2: to increase staff and patient awareness of healthy eating and exercise programs; Intervention 3: to increase the collection of diet and exercise histories from patients; Intervention 4: to improve the uptake of blood tests.The interventions created an improvement in monitoring. There are lessons in the methodology for others carrying out similar projects.

Physical Activity, Exercise and Sport Programs as Effective Therapeutic Tools in Psychosocial Rehabilitation

“…schizophrenia, major depressive and bipolar disorders) have a 20-years shorter lifespan due to chronic somatic comorbidities, such as diabetes, overweight, obesity, cardiovascular and dysmetabolic diseases, also including to the long-term consequences of the side-effects of antipsychotic drugs [ 2 - 4 ]. Persons with severe psychosocial disabilities are also significantly more sedentary and show lower levels of physical activity than healthy persons [ 4 , 5 ], factors which can contribute to their shorter lifespan, because of the greater cardiovascular risk that these unhealthy habits entail. It must be emphasized that sedentary behavior and low physical activity levels are independent yet modifiable risk.…”

“…It must be emphasized that sedentary behavior and low physical activity levels are independent yet modifiable risk. It must be emphasized that sedentary behavior and low physical physical activity levels are independent yet modifiable risk factors for premature mortality of these people [ 4 - 6 ]. For this reason, the interest in the integration of sport, physical activity and exercise programs as a component of treatment and rehabilitation for this population has been growing over the last decades.…”

Audit of physical health monitoring in children and adolescents receiving antipsychotics in neurodevelopmental clinics in Northumberland

“…A similar audit carried out recently in an inpatient setting in United Kingdom on children and adolescents prescribed antipsychotics demonstrated adherence rates of 20%-60% on different parameters[ 16 ]. In comparison, an audit of similar parameters in a community based setting focusing on adult patient’s demonstrated partial adherence to guidelines in around half the patients[ 17 ]. Both the above audits were carried out with standards set by NICE as the reference.…”

“…Some published literature on quality improvement projects in this regard demonstrated simple methods like a visual prompt questionnaire tool along with review paperwork, new formatting of clinical letters to general practitioners, psychoeducation of both clinical practitioners and patients, easy read leaflets and posters which did produce a significant improvement in adherence to clinical guidelines[ 16 , 17 ]. On a larger scale, in Europe, the Therapeutic Drug Monitoring (TDM) run by the German-Austrian Swiss “Competence Network on TDM in Child and Adolescent Psychiatry” and the Paediatric Atypical Antipsychotic Monitoring Safety Study (PAMS) in the United Kingdom have been developed as pharmacovigilance projects[ 19 , 20 ].…”

The Effects of “VelaMente?!” Project on Social Functioning of People With Severe Psychosocial Disabilities

“…Furthermore, they often show a difficult adherence to treatments, worsened also by the stigmatization about their disability [ 5 , 6 ]. Overall, patients with severe psychosocial disability often show a complex mixture of clinical conditions strongly related to their lifestyles and social needs [ 3 , 7 ].…”