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
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.
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.