![]() ![]() The LUNSERS, although patient-rated, is cumbersome. Among the general scales, the UKU and SAFTEE are time-consuming and require the clinician to conduct a semi-structured interview (a patient-completed version of the UKU is available). Many of the other scales are impractical for use in routine clinical practice. It is patient-completed, relatively short (21 items for men and women), global in its coverage, and rates both the frequency and distress of each item. Some scales are clinician-completed and some are patient-completed.Īmong current scales, the GASS is one of the most practical for clinical use ( Waddell and Taylor, 2008). For example, the Glasgow Antipsychotics Side-Effect Scale (GASS) covers 22 items ( Waddell and Taylor, 2008), the Udvalg for Kliniske Undersøgelser (UKU) evaluates 48 possible side effects, the Liverpool University Neuroleptic Side-Effect Rating Scale (LUNSERS) includes 41 items, plus 10 ‘red herring’ items and the Systematic Assessment For Treatment Emergent Events (SAFTEE) has over 70 event terms. Other rating scales assess a range of side effects. Some rating scales are designed to assess specific antipsychotic side effects, for example, the Simpson Angus rating Scale (SAS) assesses parkinsonism, the Barnes Akathisia Scale (BAS) evaluates akathisia and the Abnormal Involuntary Movement Scale (AIMS) assesses tardive dyskinesia. The proportion declined during a postaudit improvement programme but was still 18% in a repeat audit in 2011. ![]() ![]() A UK national audit of nearly 6000 patients prescribed depot antipsychotic medication in 2008 showed that 35% had no documented assessment of side effects in the previous 12 months. However, in clinical practice monitoring for antipsychotic side effects is often haphazard. Several schizophrenia guidelines have highlighted the advantage of a systematic approach to monitoring for example, the National Institute for Health and Care Excellence (NICE) guidelines state that antipsychotic side effects should be monitored and recorded ‘regularly and systematically throughout treatment, but especially during titration’ and the Clinical Standards Board for Scotland guidelines state that it is ‘desirable’ for antipsychotic side effects to be ‘assessed using standardised methods and validated rating scales’. Patients may be reluctant to discuss some side effects or to report nonadherence with medications because of side effects. The latter may include dose reduction of the antipsychotic, switching to an alternative antipsychotic or starting a treatment specifically tailored to counter the side effect in question, for example, prescribing an anticholinergic agent for antipsychotic induced parkinsonism.Ī systematic approach to side effect monitoring is necessary otherwise side effects can be missed. Treatment options will depend on the side effect, its impact on the patient and a careful assessment of both the benefits and drawbacks of continuing the current medication versus other strategies. If these are detected, their impact on the patient can be explored and potential avenues for treatment can be openly discussed in the clinical consultation. To prevent these outcomes it is important that patients treated with antipsychotics are monitored for potential side effects. For example, postural hypotension can lead to a fall and injury, hyperprolactinaemia may lead to osteoporosis, and weight gain contributes to type II diabetes, heart disease and stroke. In addition, some side effects can cause secondary physical morbidity and mortality. Side effects are clinically important as they can cause suffering, impair quality of life, be stigmatising and can lead to nonadherence with antipsychotic medication, which may lead to relapse of the underlying psychiatric disorder. Antipsychotic drugs can cause a wide range of potential side effects including extrapyramidal symptoms, sedation, weight gain, metabolic disturbance, sexual dysfunction, urinary symptoms, gastrointestinal symptoms, and symptoms that reflect raised prolactin, for example, menstrual irregularities and galactorrhoea. The side effect profiles of different antipsychotics vary greatly and individual patients also show considerable variation in their susceptibility to develop specific side effects. ![]()
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