Monday, 31 December 2012

Sexual side effects of medication

A shockwave went through my family the day my cousin Anna opened a chic erotic shop in town. Some people, like my aunt, tried to cover it up by saying Anna and her husband had " become franchisers ". That wasn't a lie but not exactly the whole truth either. It all became clear to everyone the day the invitations for the opening hit the doormats with a figurative loud bang.
I was pleasantly surprised, I often like it when things are a bit "different". So I took some friends and colleagues to the opening festivities and met quite a few family members there. Some shy , giggly or clearly uncomfortable. Others unexpectedly interested and curious and going through the shelving as if it were an exclusive exhibition in a trendy museum.
I observed Anna selling her products and listened to her talking in detail about sex and erotic equipment with ease as if she was Nigella Lawson in person promoting her cooking and favorite kitchen utensils.
Lots could be learned for  mental health care from the openness of my cousin. She inspired me to get the topic of sexual side effects of medication higher on the agenda.
Back at work my colleagues and I made a checklist for physical health to be used at care evaluations. Sexual side effects of medication was one of the topics and now much harder to neglect . And we encouraged colleagues to talk about it more.

There are many different types of psychotropic medications and they may cause a range of sexual side effects like decreased libido, erectile- or ejaculation dysfunction for men and decreased lubrication for women. For both men and women, the quality  of sensation may be less and the time it takes to reach an orgasm can be prolonged or completely impossible . Some medications are less likely to cause trouble. And some people may not experience any of the sexual side effects at all..
Sexual side effects can have a negative impact on lives and relationships. That makes it important to encourage and enable patients to speak about it.

People who are well informed about these side effects are often better prepared and more likely to comply with treatment. They know that side effects often decrease in time. But if not , a medication change,adjustment or additional medication can help to overcome these troubles. 

It's important that mental health professionals learn to discuss this subject more. It may take courage to overcome our own shyness. But there are many cases in which a solution can be found and lives  can be improved. That’s definitely worth the effort .

Wednesday, 29 August 2012

How to improve dental care in psychiatry

Dental care is poor and a disregarded health issue among people with serious mental illness. They are on a higher risk than average for tooth decay,inflamed gums and denture problems. Medication combined with reduced self care is an important cause. 
Poor dental health can increase the risk for social stigmatization / isolation and serious physical health problems. 
There is a causal link between poor oral health and cardiovascular disease and even stroke.Considering that people with serious mental illness like schizophrenia die 15-20 years earlier on average than the general population we have have enough reasons to take dental health seriously.

According to Danish research only 31% of schizophrenia patients complied with a regular annual dental check-up visit , compared to 68% in the general adult Danish population. 
Huge risks for poor dental care are: substance abuse diagnosis ,living in an institution or admission to a psychiatric facility for a minimum of 30 days  and male sex.
However Clozapine treatment, at least monthly outpatient visits , and age 50+ were associated with a lower risk for inappropriate dental care.


 Psychotropic meds can cause shortage or too much saliva or a change in acidity. Combined with poor oral health  this can make tooth decay occur faster. 
Many patients smoke. This increases the risk for gum disease : one of the leading causes of tooth loss in adults.
Smoking also slows down healing after oral surgery. It can damage gum tissue and receding gums leaving the roots of the teeth exposed. This can increase the risk of tooth decay and cause hot/cold sensitivity.

To improve the level of dental health we can help patients to

- Use less sugar and acidic products like carbonated drinks
- brush 2x a day preferably with an electrical toothbrush , they are much more efficient than ordinary brushes
- use fluoride toothpaste
- use floss or interdental cleaning brushes twice a day
- visit a dentist and support the visit if needed. We may ask the dentist about screening for the rate of salivation to see if the amount and acidity of the saliva is within limits.
- decrease smoking 
- Use 4 - 7 xylitol chewing gums or lozenges devided over the day. It needs to be 100% xylitol, no other sugar substitutes.This reduces dental    plaque. It stimulates the production of anti-bacterial saliva and remineralization of the teeth. And it partially replaces sugars in the diet (satisfies the ‘sweet tooth’) Using Xylitol chewing gum or rinse can decrease tooth decay with 60 %. For those who cant use gum or lozenges xylitol mouth water may be an option.
 In high amounts xylitol can have a laxative effect and cause flatulence.
- Inform patients that they should avoid to consume acidic products one hour before brushing  teeth. The surface of teeth is softened by the acid and can be damaged.

Let's make dental care a priority in psychiatry. After all it is basic care, not luxury .

Saturday, 21 April 2012

The importance of family support

Fourteen years ago, after working  11 years at mental hospital wards  I started working as a community psychiatric nurse. A month later I had to take my partner to a psychiatrist because he was psychotic. An unexpected  experience.

It started on a Saturday. We decided to wait till tuesday  so we could see the GP we knew. Monday was a bank holiday.Things got worse over the  weekend  and I had no idea where it would end. Although I was familiar with psychosis it was like getting hit by an avalanche in mid summer. We only just met a year and a half earlier.

On tuesday the GP referred us to an office for mental health that same day. We were welcomed very friendly by a  CPN who knew I was a colleague from another hospital. He took us to an office. A few minutes later he introduced us to the psychiatrist who seemed  unpleasantly surprised . His words: “ It is not usual that family comes along unannounced” . Then he shook my hand reluctantly.
That is not the best way to introduce yourself  to a highly stressed person with an adrenaline level way beyond that of the average marathon runner. I can’t imagine a doctor of an emergency room would have said the same if my partner would have had a heart problem or an accident. This was an emergency  as well. A psychiatric one. 

During the visit my partner only told about 40 %  of what had happened - being distracted and paranoid. After some time I added a few things to the conversation but I was being ignored  by the psychiatrist.  And when he finally asked me: “Do you have any idea what psychosis is?“ I was so mad that I answered very calm : “ I have read some about it a while ago”   
He wrote a prescription for an anti-psychotic  and handed us the piece of paper. I asked him to add Biperiden in case of side effects.  I guess he had not expected that because he looked a bit confused. He wrote it down and wanted to say something but I felt too reared for further conversations. I felt like yelling  , throwing things around or burst into tears and I didn’t want to do either one of them. If you come for help the last thing  you need is people who make you feel  worse. A few minutes after we got home the phone rang: the  psychiatrist. He asked me if I could come long next time.  I asked him if he would  have called if I had not been a CPN. Later on we talked and things went better. He learned from the experience. 
And so did I. Although I always had a focus on family support : really knowing the despair, fear and frustration helps to keep it on top of the “to do”- list and encourage others to do so. This was just a bad experience, educational though. Many psychiatrists do an excellent job.

Family support is an important thing in mental health care. Ifcourse there are very dysfunctional families  and some people have caused problems our clients are facing now. No need to deny that and very important to take that into account. But most of them have good intentions and are willing to learn and help.And they usually know their ill family member better than we health professionals do. We shouldn't consider ourselves too important but see family members as team members. 

Psycho-educational family interventions and family support can reduce relapses, readmissions and suicide risk. An important part of our work because it benefits to the welbeing of our patients and a better future for them.

Many family members have felt left alone by mental health care in the past on more than one occasion.Imagine yourself in their shoes and do the best you can to make their next experience a better one.
If family  is visiting a hospital ward make them feel welcome and comfortable. That will make it easier for them to visit more often. For mental health workers a mental hospital ward might be an everyday thing but for visitors it’s often a very  unusual scary place to go , especially the inpredictable crisis wards. If possible give them a quiet place to talk and relax. Encourage family and friends to stay in touch. 
Loneliness is a huge problem for people with mental illness. And it is important to prevent that as much as we can.Giving good information and support to friends and family can make an important difference here.


Sunday, 8 April 2012

20 Commandments for Mental Health workers

  1. Thou shalt respect your patient and not judge
  2. Thou shalt increase the well-being, opportunities and happiness of your patient
  3. Thou shalt be in time for appointments and phone calls. It will show your patients that they matter
  4. Thou shalt have a well-chosen and well-timed sense of humour
  5. Thou shalt reconsider your ‘professional distance’ if it makes your patient feel he stands alone; show that you are a person too
  6. Thou shalt not let your bad mood or personal issues influence your professional attitude
  7. Thou shalt have an open conversation if your patient is suicidal and give good support and protection if necessary
  8. Thou shalt not hide behind a newspaper or smartphone on the ward or make any other unapproachable impression otherwise
  9. Thou shalt not hide and chat in the nurses’ offices but be with your patients as much as possible to create a safe and friendly environment
  10. Thou shalt consider family and good friends of your patient as team players (unless it’s impossible) and support them well in the interests of your patient
  11. Thou shalt inspire and support your colleagues to make mental healthcare as good and friendly as possible and ask and give feedback on a regular basis to become a ‘winning team’
  12. Thou shalt inform your patient well about side effects of medication, observe well and help to find solutions if needed
  13. Thou shalt not avoid the subject ‘sexual side effects of medication’
  14. Thou shalt help your patient to get good dental and physical care and support them on doctor and dentist visits if needed
  15. Thou shalt help and support your patient to exercise on a regular basis to increase their health and give support to decrease smoking.
  16. Thou shalt support your patient to overcome financial or housing problems and fight bureaucracy
  17. Thou shalt listen well to the patients' aspirations for their life and give support to achieve them
  18. Thou shalt stand up for the rights of your patient
  19. Thou shalt fight the stigma of mental illness at every opportunity
  20. Thou shalt help your patient to keep up hope

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