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MENTAL HEALTH


lacking. It is understood however, that in many cases, treatment with drugs is not enough, and the use of combination therapies are often the most effective strategies.


Such combination therapies do include the use of drugs, but these are used alongside psychological therapies and community support programmes. This approach often works more effectively than the sum of its parts, providing the patient with a support structure, and hopefully, a long-term resolution to their problem via changing how they think and process their thoughts – something which pharmacological treatment may not be able to provide on its own.


Psychological treatment often consist of interaction between the patient, and a doctor, psychologist or other expert healthcare professional, whereby the patient’s thoughts and feelings are discussed, and techniques used to assist the patient in modifying these thoughts, removing negative factors. A good example of such a therapy is cognitive behavioural therapy (CBT), which is commonly used as a treatment strategy in anxiety and depression. CBT aims to break the patient’s problems down into fi ve main aspects – situations, thoughts, emotions, physical feelings and actions. It is known that these aspect are all linked to one another, and expert education during CBT seeks to minimise the potential for these aspects to form a vicious cycle, normally brought on by the presence of negative thoughts. CBT can bring about the alleviation of these so-called vicious cycles via devices such as exposure therapy and others, so that the patient can be “trained” to stop negative thoughts in their tracks, and prevent the initiation of a cycle7


.


In addition to CBT, there are a number of other approaches which are commonly used, such as psychotherapy, and pharmacists should be aware of these so that they can provide more information and advice to their patients on request8


. If


you’re unsure about which resources to start with, the NHS Choices website is a great place to start!


Of course, the use of pharmacological treatments is a vital tool in the armamentarium of those involved in the treatment of mental health conditions. A cursory glance in the BNF indicates that this is a particularly far-reaching area of therapeutics, and indicates that some effort is required


36 - SCOTTISH PHARMACIST


from pharmacists to ensure that we are up to speed on these treatments, and the associated vital information that we need to be able to pass on to our patients at a moment’s notice. Due to the vastness of this therapeutic area, it is again impossible to cover any particular area in detail within this article, but it is important that we pharmacists are aware of where to locate this information, and to ensure that we incorporate it into our continued learning. For example, Section 4 of BNF 68 details currently available drugs for the treatment of various mental health conditions, and this information should be complemented with the information provided by the individual manufacturers (e.g. summary of product characteristics, patient information leafl ets, etc.), as well as guidance provided by the appropriate bodies (NICE, APA, etc.).


One particular area that appears to plague the use of medicines for mental health conditions is that of their side effects, which is an area where pharmacists are required to be the experts. For example, selective serotonin reuptake inhibitors (SSRIs) such as citalopram, fl uoxetine, paroxetine and sertraline are known to often make symptoms worse during treatment initiation. In some cases, these drugs may even lead to an increased risk of patient suicide, as they can increase the motivation of the patient during initiation. As a result, it is critical that pharmacists


identify patients who have been started on such medications, and counsel them accordingly. This counseling should detail that the medications can worsen symptoms, and patients (and caregivers, if appropriate) need to monitor this closely, seeking medical advice immediately should these outcomes occur.


WHAT ELSE CAN WE DO? As pharmacists, it’s easy to fall into the trap of sticking to being the experts on drugs, leaving other aspects to other professionals. However, we should ensure that we fully utilise our skills, expertise, and position of trust within out communities to assist our patients in whichever way we can, in the hope that we can help, along with our fellow professionals, to bring about positive outcomes. So, what else could/should we be doing? Well, this can be as simple as taking a bit of extra time to speak to our patients (where possible) to provide advice, address concerns, or to signpost them on to someone else who can help. For example, the use of community support strategies could be very benefi cial for a patient struggling with their mental health - these support groups can supply information in the form of reading material or small group meetings, in addition to assistance with employment, training or education for those who are particularly affected. Such groups offer the potential for accelerated improvement in patients,


Table 2. Some common mental health conditions and common symptoms6 Anxiety Disorders


Extreme worry Panic attacks


Shaking Excessive sweating REFERENCES


1 NHS Scotland. Mental Health Strategy for Scotland 2012-15. 2014; Available at: http://www.healthscotland.com/mental-health- background.aspx. Accessed 07/13, 2015.


2 Mental Health Foundation. What are Mental Health Problems?. 2014; Available at: http://www.mentalhealth.org.uk/help-information/ an-introduction-to-mental-health/what-are-mental-health-problems/. Accessed 12/08, 2014.


3 Lasalvia A, Zoppei S, Van Bortel T, Bonetto C, Cristofalo D, Wahlbeck K, et al. Global pattern of experienced and anticipated discrimination reported by people with major depressive disorder: a cross-sectional survey. The Lancet 2013;381(9860):55-62.


4 Mathers C, Fat DM, Boerma J. The global burden of disease: 2004 update. : World Health Organization; 2008.


5 Scottish Parliament. SPICe Briefi ng Mental Health in Scotland. 2014; Available at: http://www.scottish.parliament.uk/ ResearchBriefi ngsAndFactsheets/S4/SB_14-36.pdf. Accessed 07/13, 2015.


6 Rethink Mental Illness. Mental Illness - Diagnosis and Treatment. 2014; Available at: http://www.rethink.org/diagnosis-treatment. Accessed 12/08, 2014.


7 NHS Choices. Cognitive behavioural therapy (CBT). 2014; Available at: http://www.nhs.uk/conditions/cognitive-behavioural-therapy/ Pages/Introduction.aspx. Accessed 12/08, 2014.


8 NHS Choices. Psychotherapy. 2015; Available at: http://www.nhs.uk/conditions/Psychotherapy/Pages/Introduction.aspx. Accessed 07/13, 2015.


Depression Low mood


Lack of interest in activities previously enjoyed


Change in eating/sleeping patterns


Loss of libido Eating Disorders


Avoiding food and meals Denial of hunger


Repeatedly checking body weight


Hiding food which was claimed to be eaten


. Psychosis


Hearing things that are not there Seeing things that are not there


Having unusual beliefs not shared by others


while also acting to remove social stigmas associated with mental health conditions, and as such offer an obvious benefi t – so it’s vital to make your community aware of them wherever possible.


In addition to these sort of activities, pharmacists should provide general advice to patients which can bring about improvements in general mental health, and the avoidance of problems. Some of these pieces of advice are detailed in Box 1, and should be mentioned to patients whenever it is deemed to be suitable. The promotion of mental health is critical to the health of our society from a number of aspects, and pharmacists should make use of their position within healthcare to highlight the benefi ts of good mental health, and all sources of assistance for those in need.


Box 1. General advice for good mental health.


Talking about your feelings Keeping active Eating a healthy, balanced diet Drink alcohol sensibly


Maintain contact with friends and loved ones


Not being afraid to ask for help Giving yourself a break Doing things you enjoy Caring for others Accept who you are


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