Preview

Mental Health

Better Essays
Open Document
Open Document
6145 Words
Grammar
Grammar
Plagiarism
Plagiarism
Writing
Writing
Score
Score
Mental Health
Australian and New Zealand Journal of Mental Health Nursing (2000) 9, 166–176

F EATURE A RTICLE

The use of the Liverpool University neuroleptic side-effect rating scale (LUNSERS) in clinical practice
Paul Morrison,1 Deanne Gaskill,2 Tom Meehan,2 Paul Lunney,2 Gayle Lawrence2 and Paul Collings2
1

School of Nursing, University of Canberra, ACT 2601 and 2Centre for Nursing Research, Queensland University of Technology, Kelvin Grove Campus, Brisbane, Qld 4509, Australia

ABSTRACT: Forty-four mental health clients completed the Liverpool University Neuroleptic Side-Effect Rating Scale (LUNSERS)—a self-rating scale to assess the prevalence and intensity of neuroleptic side-effects. In the month prior to the study, 50% of the clients surveyed had experienced more than half of the side-effects outlined on the 41-item scale. A prevalence profile allowed us to rank the frequency of individual side-effects across the sample. Some side-effects such as ‘difficulty concentrating’, ‘difficulty remembering’, ‘tiredness’ and ‘restlessness’ were experienced by most of the clients in the study while ‘unusual skin marks’, ‘difficulty passing water’, ‘rashes’ were experienced by a few. A prevalence profile may be a useful guide in developing strategies for managing side-effects more effectively in small groups of clients. In addition, the use of the LUNSERS in clinical practice would enable case managers to establish baseline measures for individual clients and evaluate changes in medication and other non-medical strategies for reducing unwanted side-effects. The identification and assessment of antipsychotic side-effects is an important area for client and professional carer education. KEY WORDS: antipsychotic medication, case manager, LUNSERS, side-effects.

INTRODUCTION
The aim of this paper is to describe how the Liverpool University Neuroleptic Side-Effect

Correspondence: Paul Morrison, School of Nursing, University of Canberra, ACT 2601, Australia. Email:



References: Abbott, R. J. & Loizou, L. A. (1986). Neuroleptic malignant syndrome. British Journal of Psychiatry 148, 47–51. Awad, A. G. (1993). Subjective response to neuroleptics in schizophrenia. Schizophrenia Bulletin 19, 609–618. Bebbington, P. E. (1995). The content and context of compliance. Int. Clin. Psychopharmacol. 9 (Supplement 5), 41–50 (Abstract only). Bech, P., Malt, U. F., Dencker, S. J. et al. eds. (1993). Scales for assessment of diagnosis and severity of mental disorders. Acta Psychiatrica Scandinavica 87 (Supplementum 372), 55–56. Bennett, J. (1991). Drugs and the CPN. Nursing Times 44, 38–40. Bennett, J., Done, J., Harrison-Read, P. & Hunt, B. (1995b). Development of a rating scale/checklist to assess the side effects of antipsychotics by community psychiatric nurses. In: C. Brooker & E. White (Eds) Community Psychiatric Nursing. A Research Perspective, Vol. 3 (pp. 1–19). London: Chapman & Hall. Bennett, J., Done, J. & Hunt, B. (1995a). Assessing the side effects of antipsychotic drugs: A survey of CPN practice. Journal of Psychiatric and Mental Health Nursing 2, 177–182. Bostrom, A. C. (1988). Assessment scales for tardive dyskinesia. Journal of Psychosocial Nursing 26, 9–12. Bowling, A. (1995). Measuring Disease. Oxford: Oxford University Press. ASSESSMENT OF ANTIPSYCHOTIC MEDICATION SIDE-EFFECTS Finn, S. E., Bailey, J. M., Schultz, R. T. & Faber, R. (1990). Subjective utility ratings of neuroleptics in treating schizophrenia. Psychological Medicine 20, 843–848. Gardiner-Caldwell Communications Ltd (1993). Extrapyramidal Symptoms: Current Concepts and Future Prospects. Macclesfield, Cheshire: GardinerCaldwell. Gray, R. & Howard, A. (1997). The Maudsley medication review clinic. Journal of Psychiatric and Mental Health Nursing 4, 225–226. Green, J. H. (1988). Frequent rehospitalization and non-compliance with treatment. Hospital and Community Psychiatry 39, 963–966. Hindmarch, I. (1994). Neuroleptic-induced deficit syndrome: Behavioural toxicity of neuroleptics in man. In: R. Ancill (Ed.), Schizophrenia: Exploring the Spectrum of Psychosis (pp. 305–320). London: John Wiley & Sons. Hirsch, S., Bowen, J., Emami, J. et al. (1996). A one year prospective study of the effects of life events and medication in the aetiology of schizophrenic relapse. British Journal of Psychiatry 168, 49–56. Hogan, T. P., Awad, A. G. & Eastwood, R. (1983). A self-report scale predictive of drug compliance in schizophrenics: Reliability and discriminative validity. Psychological Medicine 13, 177–183. Jablensky, A., McGrath, J., Herrman, H. et al. (1999). People Living with Psychotic Illness: An Australian Study 1997–98. An Overview. Canberra: Commonwealth Department of Health and Aged Care. Keks, N. (1996). Minimising the non-extrapyramidial side-effects of antipsychotics. Acta Psychiatrica Scandinavica 94, 18–24. Kellam, A. M. P. (1987). The neuroleptic syndrome, so-called: A survey of the world literature. British Journal of Psychiatry 150, 752–759. Kopala, L. C. (1996). Spontaneous and drug-induced movement disorders in schizophrenia. Acta Psychiatrica Scandinavica 94, 12–17. Lingjærde, O., Ahlfors, U. G., Bech, P., Dencker, S. J. & Elgen, K. (1987). The UKU side effect rating scale. Acta Psychiatrica Scandinavica 76 (Supplementum 334), 1–100. Littrell, K. H. (1996). Beyond compliance: Evaluating antipsychotic efficacy. Journal of the American Psychiatric Nurses Association 2, 186–190. Loewenthal, K. M. (1996). An Introduction to Psychological Tests and Scales. London: UCL Press. Lund, V. E. & Frank, D. I. (1991). Helping the medicine go down. Journal of Psychosocial Nursing 29, 6–9. 175 Michaels, R. A. & Mumford, K. (1989). Identifying akinesia and akathisia: The relationship between patient’s self-report and nurse’s assessment. Archives of Psychiatric Nursing 3, 97–101. Mitchell. J. E. & Popkin, M. K. (1982). Antipsychotic drug therapy and sexual dysfunction in men. American Journal of Psychiatry 139, 633–637. Morrison, P., Gaskill, D., Meehan, T. & Collings, P. (1998). Community Nursing Assessments of the Side-Effects of Antipsychotic Medication. Brisbane: Centre for Nursing Research, Queensland University of Technology. Morrison, P., Meehan, T., Gaskill, D., Lunney, P. & Collings, P. (in press) Enhancing case managers’ skills in the assessment and management of antipsychotic medication side-effects. Australian and New Zealand Journal of Psychiatry. Munetz, M. R. & Benjamin, S. (1988). How to examine patients using the abnormal involuntary movement scale. Hospital and Community Psychiatry 39, 1172–1177. Munetz, M. R. & Roth, L. H. (1985). Informing patients about tardive dyskinesia. Archives of General Psychiatry 42, 866–871. Myers, E. D. & Calvert, E. J. (1973). The effect of forewarning on the occurrence of side effects and discontinuance of medication on patients on amitriptyline. British Journal of Psychiatry 122, 461–464. Rogers, A., Pilgrim, D. & Lacey, R. (1993). Experiencing Psychiatry. Users’ Views of Services. London: Macmillan/MIND. Ryan, P., Ford. R. & Clifford, P. (1991). Case Management and Community Care. London: Research and Development for Psychiatry. Sane Australia (1997). Antipsychotic Medications Education Project. Final report to the Department of Health and Family Services, Pharmaceuticals Benefits Branch, Canberra. Schwarz, H. I., Vingrano, W. & Bezirgowan, P. (1988). Autonomy and the right to refuse treatment: Patient attitudes after involuntary medication. Hospital and Community Psychiatry 39, 1049–1054. Sullivan, G., Wells, K. B. & Leake, B. (1992). Clinical factors associated with better quality of life in a seriously mentally ill population. Hospital and Community Psychiatry 43, 794–799. Wade, T. & Weir, D. (1995). Consumer, Carer and Prescriber Strategies to Enhance Consumer Compliance with Psychotropic Medication for Severe Mental Illness. Canberra: Research Project 176 funded by the Pharmaceutical Education Program, Commonwealth Department of Human Services and Health. Warner, R. (1994). Recovery from Schizophrenia: Psychiatry and Political Economy, 2nd edn. London: Routledge. Weiden, P. J., Scheifler, P. L., Diamond, R. J. & Ross, P. MORRISON ET AL. R. (1999). Breakthroughs in Antipsychotic Medications. a Guide for Consumers, Families, and Clinicians. New York: W.W. Norton & Company. Wyatt, R. J. (1991). Early intervention with neuroleptics may decrease the long-term morbidity of schizophrenia. Schizophrenia Research 5, 201–202.

You May Also Find These Documents Helpful

  • Better Essays

    Typical antipsychotic drugs (neuroleptics) work by reducing dopamine within schizophrenia sufferers. Common forms of neuroleptics include drugs such as Thorazine, Prolixin and Haldol. These drugs actually block the activity of the dopamine neurotransmitter, the drugs take effect within 48 hours but it can be several weeks before a noticeable difference is seen with symptom reduction. Barondes’s (1993) research looked into balancing the dosage of the drug, lowering the drug dosage reduced the side effects but also reduced the effectiveness of the drug meaning it wouldn’t necessarily be a successful or quick recovery compared to high dosages of the neuroleptics. Although this showed clear evidence for the effectiveness of neuroleptics in combating schizophrenia, emphasized when changing the dosage changes the effectiveness of the neuroleptics.…

    • 1606 Words
    • 7 Pages
    Better Essays
  • Good Essays

    Background: We aimed to explore relations between symptomatic remission and functionality evaluation in schizophrenia patients treated with paliperidone extended-release (ER), as seen in a normal day-to-day practice, using flexible dosing regimens of paliperidone ER. We explored symptomatic remission rate in patients treated with flexibly dosed paliperidone ER by 8 items of Positive and Negative Syndrome Scale (PANSS) and change of Personal and Social Performance (PSP) scale. Method: This was a 12-week multicenter, open-label, prospective clinical study conducted in in-patient and outpatient populations. Flexible dosing in the range 3-12 mg/day was used throughout the study. All subjects attended clinic visits on weeks 0, 4, 8, and 12 as usual clinical practice for the 12-week observation period. Data were summarized with respect to demographic and baseline characteristics, efficacy measurement with PANSS scale, PSP, and social functioning score, and safety observations. Descriptive statistics were performed to identify the retention rate at each visit as well as the symptomatic remission rate. Summary statistics of average doses the subjects received were based on all subjects participating in the study. Results: A total of 480 patients were enrolled. Among them, 426 patients (88.8%) had evaluation at week 4 and 350 (72.9%) completed the 12-week evaluation. Patients with at least moderate severity of schizophrenia were evaluated as “mild” or better on PANSS scale by all 8 items after 12 weeks of treatment with paliperidone ER. There was significant…

    • 5271 Words
    • 22 Pages
    Good Essays
  • Good Essays

    Education on the patient’s medication management, as well as psychotherapy management would be of utmost importance. Ensuring that the patient is aware of the importance of psychotherapy and medication management should be the first nursing intervention. This is due to the fact that should he not be compliant with medication and therapy, mania will most definitely recur and lead to more complications for the patient.…

    • 980 Words
    • 4 Pages
    Good Essays
  • Better Essays

    One way to test the effectiveness of conventional drugs is to compare the relapse rate of placebo. Davis use meta-analysis and found relapse occurred in 55% of p[patients whose drugs were replaced by placebo’s compared with a 19% relapse rate for those who stayed on antipsychotics. Davis did find that environment also play a role in relapse rate of treatment. Relapse rate of patient who stayed in a hostility and criticism family on medication were 53% compared to 92% for those under the placebo condition, whereas those living in supportive home environments there was no significant difference between the medication and placebo group.…

    • 1592 Words
    • 7 Pages
    Better Essays
  • Good Essays

    The development and use of Antipsychotic drugs to treat schizophrenia support the dopamine hypothesis. The drugs work by blocking activity of dopamine and have been shown to alleviate symptoms of schizophrenia, such as hallucinations, delusions and thinking problems associated with the disorder. This is because by reducing dopamine activity helps to maintain a constant level in guiding attention, leading to a decrease in key schizophrenic symptoms of hallucinations and delusions because they can be caused by being overly attentive. Statistics increase the reliability of the biological explanation of the dopamine hypothesis for explaining schizophrenia; as they show Antipsychotics have a 60% success rate. Therefore, this shows a link between high levels of dopamine activity and schizophrenia, as antipsychotics work by blocking the dopamine activity. This has led to more…

    • 1149 Words
    • 5 Pages
    Good Essays
  • Powerful Essays

    Antipsychotic agents are most commonly used to treat bipolar disorder and schizophrenia however when prescribed at lower doses, it has been found to be quite useful in the treatment of BPD, especially for all or nothing thinking, suspiciousness, paranoia, cognitive perceptual symptoms and dissociative episodes. The implementation of antipsychotic medication and with the addition of another medications from the class of mood stabilizers may be indicated reduce symptoms of impulsivity, anger, anxiety, depressed mood, and general level of functioning. The stabilizers do not reduce suspiciousness, split thinking, dissociative episodes, and paranoia. When these symptoms persist after others improve with mood stabilizers an addition of an antipsychotic agent is…

    • 1552 Words
    • 7 Pages
    Powerful Essays
  • Satisfactory Essays

    3.Elaine Zablocki (2004).” Atypical antipsychotic drugs cut negative symptoms, side effects: the second generation of treatment for schizophrenia and other psychotic disorders offers fewer side effects, but costs are much higher”. Managed Healthcare Executive. 14.3 p48.…

    • 95 Words
    • 1 Page
    Satisfactory Essays
  • Powerful Essays

    Crisp, J., Taylor, C., Douglas, C. & Rebeiro, G. (2013). Potter & Perry’s fundamentals of nursing (4th ed.). Chatswood, NSW: Mosby Elsevier…

    • 2001 Words
    • 9 Pages
    Powerful Essays
  • Powerful Essays

    The early psychosocial treatments of first episode psychosis is of crucial importance in the improvement of the prognosis of the illness. When ensuring successful care, timely maintenance of treatment response is optimal in regards to better long term outcomes. The appropriate use of psychotherapeutic drugs to suit each individual can be a difficult task as the side effects of the medication can impact on adherence to treatment. Psycho-education in regard to illness and medication. The treatment of more established schizophrenia has significant differences compared to first episode psychosis. Treatment options and medications can differ as can dosages of antipsychotic medication.…

    • 1240 Words
    • 5 Pages
    Powerful Essays
  • Good Essays

    The effectiveness of atypical antipsychotic medication was analysed by Leucht et al (1999). The meta-analysis of studies showed the superiority of these drugs compared to conventional drugs. However the analysis showed that two of the new drugs tested were only ‘slightly’ more effective than conventional drugs, and the…

    • 432 Words
    • 2 Pages
    Good Essays
  • Powerful Essays

    Antipsychotics differ in side effects, however; these differences are the very reason why there should be a hierarchal model of some sort that can classify antipsychotic medication according to which is the most efficient. Antipsychotic medication has been separated into two categories. They are first generation antipsychotics (FGA) and second generation antipsychotics (SGA). First generation antipsychotics include the following: Chlorpromazine (Thoarzine), fluphenazine (Prolixin), haloperidol (Haldol), loxapine (Loxapine), perphenazine (Trilafon), and Thiothixene (Navane). Second generation antipsychotics include the following: Zeprasidone, Risperidone, Olanzapine, Clozapine, Aripiprazole, and Iloperidone. Classification of various antipsychotic medications into first and second generation subgroups is not adequate enough to help Schizophrenic patients with comorbid alcohol or substance abuse. Comparatively, studies have shown results that show mixed results but more studies favor second generation antipsychotics over first generation…

    • 1285 Words
    • 6 Pages
    Powerful Essays
  • Good Essays

    There is a lack of information regarding the long-term effects of taking atypical anti-psychotic drugs. Meanwhile, doctors continue to prescribe the medication and parents continue to give it to their children in hopes of controlling their mental illness. There is no evidence that these drugs are effective. These drugs are slowly affecting our children's brains and their developing bodies. (“Opponents Stress” par. 2) Therefore, pharmaceutical companies and the FDA need to conduct extensive research on these drugs to determine what the long-term effects are.…

    • 467 Words
    • 2 Pages
    Good Essays
  • Better Essays

    Schitzophrenia

    • 1544 Words
    • 7 Pages

    Approximately one percent of the population develops schizophrenia during their lifetime, and more than two million Americans suffer from the illness in a given year. (Lundy, 1990).…

    • 1544 Words
    • 7 Pages
    Better Essays
  • Better Essays

    Drug Attitude Inventory

    • 1280 Words
    • 6 Pages

    The Drug Attitude Inventory-(DAI-30) was created to assess the effectiveness of medication used to treat people hospitalized with Schizophrenia (Lin et al., 2013). This model was based upon 30 questions and yielded a true or false response. For each question resulting in a true response the number 1 assigned. False responses yielded a -1 response. At the end of the assessment scores totaling were referenced to as subjective and negative referred to as negative subjective (Lin et al., 2013). It was used to evaluate the ways patients felt about the medication they were prescribed, personal beliefs in relation to their mental health and well being (Lin et al., 2013). This showed some improvements in symptoms, however, findings were not significant…

    • 1280 Words
    • 6 Pages
    Better Essays
  • Powerful Essays

    The assignment will discuss the importance of assessment in Mental Health nursing, focusing on a 54 year old lady suffering from major depression. The Department of Health (DoH, 2010) pointed out that depression is a disorder of mood and may be characterised by low mood and feelings of unhappiness, exhaustion, self blame and suicidal thoughts. The assessment scale called Health of the Nations Outcome Scales (HONOS) (see appendix B) and the rational for using this scale will be explored. A brief profile of the patient and the practice setting will be discussed. The scale will be used on the patient and the details of the patient and the hospital will not be disclosed to protect the patient’s identity according to the Nursing and Midwifery code of conduct (NMC, 2008), hence the name used will be fictitious. The process of the assessment and the involvement of the service user, family, carer and contribution of the multi-professional team will be highlighted in relation to the patient’s future care planning needs. The good and drawbacks of the scale will be explored. A summary of the experience of using the assessment scale will be written.…

    • 22424 Words
    • 90 Pages
    Powerful Essays