An audit of psychiatric
case notes in relation to
antipsychotic
medication and
information giving
N. Bowler
Susanna Moss
Mark Winston and
M. Coleman
The psychoses
The psychoses are characterised by severe
symptoms: delusions, hallucinations and lack
of insight. Although being an infrequent
referral from general practitioners (Tredget
and Bowler, 2000), these illnesses have
increasingly become the core target of mental
health services over the past decade due to
their ``refocusing'' on individuals suffering
from severe and recurring mental illness
(Coleman and Jenkins, 1998). The Audit
Commission (1994) use psychotic diagnosis
as a factor within their definition of ``serious
mental illness''. Following one psychotic
episode approximately 25 per cent of
individuals make a full recovery, 50 per cent
experience a recurring illness and the
remaining 25 per cent experience an
unremitting illness (NHS Centre for Reviews
and Dissemination, 1999).
Schizophrenia is the most common form of
psychosis occurring in between 0.5 per cent
and 1 per cent of population (NHS Centre for
Reviews and Dissemination, 1999), usually
presenting in early adulthood characterised by
``positive'' symptoms such as hallucinations,
delusions, disorganised behaviour, thought
disorders or inappropriate emotions. These
are accompanied by intrinsic ``negative''
symptoms such as poverty of thought and
speech, depression, apathy and social
withdrawal. Individuals with a severe and
enduring illness often require hospitalisation,
followed by periods during which intrinsic
negative symptoms compromise life quality
(NHS Centre for Reviews and Dissemination,
1999).
Clinical management
Seriously mentally ill people are now routinely
managed in the community. Injectable long
acting depot preparations of ``typical'' anti-
psychotic medications, such as Flupenthixol
(Depixol) and Fluphenazine (Modecate)
form a central aspect of treatment, used
alongside a range of psychological and social
support for patient and carers (Imlah, 1981;
Drug and Therapeutics Bulletin, 1995).
Although effective at managing positive
symptoms, depot preparations are less
successful at controlling the long term and
disabling negative symptoms, thus
compromising their overall efficacy.
The authors
N. Bowler is a Lecturer, School of Health Science,
University of Wales, Swansea, UK.
Susanna Moss is an Assistant Research Psychologist,
Public Health and Policy, Bro Taf Health Authority,
Cardiff, UK.
Mark Winston is a Consultant Psychiatrist, St Tydfil's
Hospital, North Glamorgan NHS Trust, Merthyr Tydfil,
Mid Glamorgan, UK.
M. Coleman is a Programme Manager (Mental Health),
School of Health Science, University of Wales,
Swansea, UK.
Keywords
Psychiatry, Schizophrenia, Clinical effectiveness,
Mental health, Nurses
Abstract
This paper reports upon a Welsh Office funded ``clinical
effectiveness'' project. The project aimed to produce
evidence-based practice guidelines for depot neuroleptic
medication. An audit was conducted to establish current
practice regarding the provision of illness and treatment
specific information to out-patients and their informal
carers. Sixty-five patients' case-notes, under the care of a
single community mental health team were examined for
evidence of the type, nature and frequency of information
given to patients receiving typical depot neuroleptic
medications. Service guidelines were produced and are
presented.
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Original papers
212
Clinical Performance and Quality Health Care
Volume 8
.
Number 4
.
2000
.
pp. 212±216
# MCB University Press
.
ISSN 1063-0279