Monitoring antipsychotic side effects: a competed audit cycle conducted in a secure hospital
| Date | 08 August 2016 |
| DOI | https://doi.org/10.1108/JFP-06-2015-0034 |
| Published date | 08 August 2016 |
| Pages | 182-188 |
| Author | Camilla Haw,Ayesha Muthu-Veloe,Mark Suett,Oghodafetite Ibodor,Marco Picchioni |
| Subject Matter | Health & social care,Criminology & forensic psychology,Forensic practice |
Monitoring antipsychotic side effects:
a competed audit cycle conducted
in a secure hospital
Camilla Haw, Ayesha Muthu-Veloe, Mark Suett, Oghodafetite Ibodor and Marco Picchioni
Camilla Haw is a former
Consultant Psychiatrist at the
St Andrew’s Academic
Department,
St Andrew’s Healthcare,
Northampton, UK and an
Emeritus Professor in
Mental Health Care at the
School of Health,
University of Northampton,
Northampton, UK.
Ayesha Muthu-Veloe, Mark
Suett and Oghodafetite Ibodor
are former Associate
Specialists, all at the Men’s
Service, St Andrew’s
Healthcare, Northampton, UK.
Marco Picchioni is an Honorary
Consultant Forensic
Psychiatrist at the St Andrew’s
Academic Department,
St Andrew’s Healthcare,
Northampton, UK.
Abstract
Purpose –The purpose of this paper is to describe a completed audit cycle of the assessment and
documentation of antipsychotic side effects reported by patients in a secure hospital setting.
Design/methodology/approach –The initial audit was carried out in 2012. As a result of the findings
clinicians were recommended to use a brief structured side effect monitoring guide (the Glasgow
Antipsychotic Side-Effect Scale (GASS-m)). The audit was repeated in 2015.
Findings –Of the 41 patients notes included in the initial audit, for only one (2.4 per cent) was there evidence
of a systematic and structured approach to monitoring antipsychotic side effects. In the repeat audit this
figure (and use of the GASS-m) had increased to 21/45 (46.7 per cent). For all patients where the GASS-m
had been used (n ¼21) the overall severity of side effects was in the “mild”range (0-21).
Research limitations/implications –Sample size was modest and the study was conducted in an
independent secure hospital so may not be generalisable to the NHS.
Practical implications –Use of structured tools/guides to monitor patients’side effects is recommended
so that emergent side effects can be readily recognised, tracked and managed and, relapses made less likely
through improved compliance and thus patients’quality of life improved. This is very important for forensic
patients since relapses are likely to increase risk to others.
Originality/value –Previous audits have addressed physical health monitoring of patients on antipsychotics
but not by asking them about side effects.
Keywords Monitoring, Side effects, Audit, Secure care, Antipsychotics, GASS-m
Paper type Research paper
Introduction
In this study we consider the problem of antipsychotic side effects and the importance of
regularly and systematically questioning patients about these. We present the findings of a
completed audit cycle of side effect monitoring conducted in a forensic inpatient setting. We also
describe the implications for practice of our findings, particularly with respect to forensic patients.
All medicines produce side effects but those of antipsychotics can be particularly wide-ranging and
troublesome. While first generation agents commonly produce unpleasant and stigmatising
movement disorders, second-generation antipsychotics have an equally troubling but different
profile including weight gain and glucose intolerance as well as sedation. Some authors are highly
critical of current levels of antipsychotic usage and perceive these drugs as doing more harm than
good (Whitaker, 2004; Moncrieff et al., 2009). Both types of antipsychotic are known to cause sexual
dysfunction which psychiatrists underestimate and tend not to inquire about despite being of
considerable importance to many patients (Cutler, 2002; Dossenbach et al., 2005). When patients
Received 4 June 2015
Revised 29 July 2015
Accepted 29 July 2015
Conflict of interest: the authors
declare that they have no conflict
of interest.
PAGE182
j
JOURNAL OF FORENSIC PRACTICE
j
VOL. 18 NO. 3 2016, pp. 182-188, © Emerald Group Publishing Limited, ISSN 2050-8794 DOI 10.1108/JFP-06-2015-0034
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