Prescribing for the Long-term Mentally Ill

F. Holloway

doi:10.1192/bjp.152.4.511

Prescribing for the Long-term Mentally Ill

The British Journal of Psychiatry ◽

10.1192/bjp.152.4.511 ◽

1988 ◽

Vol 152 (4) ◽

pp. 511-515 ◽

Cited By ~ 28

Author(s):

F. Holloway

Keyword(s):

Drug Treatment ◽

Clinical Review ◽

General Practitioners ◽

Mentally Ill ◽

Psychiatric Illness ◽

Antipsychotic Drugs ◽

Psychiatric Service ◽

Treatment Practices

A survey of the drug treatment of long-term mentally ill users of a district psychiatric service is described. The appropriateness of prescriptions was assessed against standard criteria after a detailed clinical review of each patient. Overprescribing, particularly of sedative/hypnotic and of anticholinergic and antipsychotic drugs, was common. Junior psychiatrists and general practitioners are in need of improved training in the management of chronic psychiatric illness: a review of treatment practices might be an appropriate medium for this training.

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Acute Lithium-Induced Tremor

The British Journal of Psychiatry ◽

10.1192/bjp.143.1.40 ◽

1983 ◽

Vol 143 (1) ◽

pp. 40-41 ◽

Cited By ~ 5

Author(s):

S. Pullinger ◽

P. Tyrer

Keyword(s):

Drug Treatment ◽

Antipsychotic Drugs ◽

Signs And Symptoms ◽

Lithium Therapy ◽

Physiological Tremor ◽

Antiparkinsonian Drug ◽

Extrapyramidal Signs ◽

Extrapyramidal Effects ◽

Acute Lithium

It has recently been found that tremor in patients on long-term lithium therapy has a lower frequency than that of normal physiological tremor and is likely to have an extrapyramidal component (Tyrer et al, 1981). Other extrapyramidal signs and symptoms have been found with chronic lithium therapy (Shopsin and Gershon, 1975; Baastrup et al, 1976; Branchey et al, 1976; Asnis et al, 1979). These extrapyramidal effects differ from the pseudoparkinsonism produced by antipsychotic drugs in that they do not respond to antiparkinsonian drug treatment (Schou, 1970; Tyrer et al, 1980).

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Role of General Practitioners in Care of Long-Term Mentally Ill Patients

The British Journal of Psychiatry ◽

10.1192/bjp.159.5.703 ◽

1991 ◽

Vol 159 (5) ◽

pp. 703-706 ◽

Cited By ~ 4

Author(s):

Amanda Poynton ◽

Peter Higgins

Keyword(s):

General Practitioners ◽

Mentally Ill ◽

Postal Questionnaire ◽

Care Plan ◽

Physical Problems ◽

Community Psychiatric ◽

Specific Practice ◽

General Practices ◽

Key Worker

“Objective – To assess general practitioners' involvement with long term mentally ill patients and attitudes towards their care.Design – Postal questionnaire survey.Setting – General practices in South West Thames region.Subjects – 507 general practitioners, 369 (73%) of whom returned the questionnaire.Main outcome measures – The number of adult long term mentally ill patients whom general practitioners estimate they have on their lists and general practitioners' willingness to take responsibility for them.Results – 110 respondents had noticed an effect of the discharge of adult long term mentally ill patients on their practices. Most (225) respondents estimated that they had 10 or fewer such patients each on their lists. Having higher numbers was significantly associated with practising in Greater London or within three miles of a large mental hospital and having contact with a psychiatrist visiting the practice. 333 general practitioners would agree to share the care of long term mentally ill patients with the psychiatrist by taking responsibility for the patients' physical problems. Only 59 would agree to act as a key worker, 308 preferring the community psychiatric nurse to do it. Only nine had specific practice policies for looking after long term mentally ill patients and 287 agreed that such patients often come to their general practitioner's attention only when there is a crisis.Conclusions – The uneven distribution of long term mentally ill patients suggests that community psychiatric resources might be better targeted at those practices with higher numbers of such patients. Most general practitioners seem to be receptive to a shared care plan where the consultant takes responsibility for monitoring psychiatric health with the community nurse as key worker. The lack of practice policies for reviewing the care of long term mentally ill patients must limit general practitioners' ability to prevent crises developing in their care.”

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