DESCRIPTION
Nursing staff are required to monitor users with serious mental illness between medical or psychiatric doctor visits.
Regular monitoring with documented nursing notes in the file should occur monthly to 6-monthly depending on the severity of the illness and the risk of relapse, aggression, absconding or poor adherence, with referral as required.
Monitoring includes:
- A mental state enquiry and examination.
- A brief psychosocial assessment.
- A risk assessment for harm to self or others with referral if deemed high risk
- Adherence support.
- In women: family planning and pregnancy counselling.
- General health: screen at baseline and annually - weight and BMI, blood pressure (see: Hypertension), finger-prick blood glucose test for diabetes (see: Type 2 Diabetes mellitus, adults), HIV (see: HIV and AIDS) and tuberculosis (see: Pulmonary tuberculosis (TB)).
- Lifestyle advice for obesity, smoking, alcohol, other substances and high- risk sexual behaviour or victim of abuse.
Recommendations for specific medicines include:
- Antipsychotic medicines e.g.: haloperidol, risperidone, flupenthixol decanoate, zuclopenthixol deconate: If metabolic effects (weight gain/ hyperglycaemia) occur, refer to a dietician and encourage regular exercise. If needed, manage lipids - See: Prevention of ischaemic heart disease and atherosclerosis.
- Valproic acid and carbamazepine: Avoid in women of childbearing potential.
- If alternate treatment cannot be recommended and these agents are required, give:
- Folic acid, oral, 5 mg daily; and ensure reliable contraception.
CAUTION
Children born to women taking valproic acid are at significant risk of birth defects (10%) and persistent developmental disorders (40%).
Valproic acid is contra-indicated and should be avoided in pregnancy and women of child-bearing potential.