Celia Feetam

Lack of a clinically important interaction between warfarin and ascorbic acid

Abstract The effect of high doses of ascorbic acid on anticoagulant control with warfarin sodium has been investigated using patient volunteers. Total plasma warfarin concentrations as well as prothrombin times were measured before, during, and after 7-day periods, when doses of 3, 5, and 10 g ascorbic acid were taken daily with warfarin sodium. It is concluded that no clinically significant antagonism of the hypoprothrombinemic action of warfarin occurs even when high doses of ascorbic acid are taken concurrently, although a fall in total plasma warfarin (2–40% mean 17.5%) was observed.

What one hand giveth the other taketh away: some unpredicted effects of enantiomers in psychopharmacology

It is well known that many medicines are a mixture of two enantiomers, or mirror-image molecules. Two enantiomers occur when a molecule has a single chiral centre and the two mirror images, called S or L (left handed) and R or D (right handed), are usually found in equal amounts in the parent (racemic) mixture. While for many compounds used in clinical practice the active moiety is found in one of the two enantiomers with the other being seen as an unnecessary and redundant component of the racemic mixture, the difference between enantiomers can mean a difference between therapeutic and adverse effects, as well as in beneficial pharmacological effect and potency.

Glasgow Antipsychotic Side-effects Scale for Clozapine — Development and validation of a clozapine-specific side-effects scale

OBJECTIVE The authors developed and validated a clozapine-specific side-effects scale capable of eliciting the subjectively unpleasant side-effects of clozapine. METHODS Questions from the original Glasgow Antipsychotic Side-effects Scale (GASS) were compared to a list of the most commonly reported clozapine side-effects and those with a significant subjective burden were included in the GASS for Clozapine (GASS-C). The original authors of the GASS and a group of mental health professionals from the UK and Ireland were enlisted to comment on the questions in the GASS-C based on their clinical experience. 110 clozapine outpatients from two sites completed the GASS-C, the original GASS and a repeat GASS-C. Statistical analyses were performed using SPSS for Windows version 19. RESULTS The GASS-C was shown to have construct validity, in that Spearmans correlation coefficient was 0.816 (p<0.001) with the original GASS, whilst Cohens kappa coefficient was >0.77 (p<0.001) for one question and >0.81 (p<0.001) for remaining relevant questions. GASS-C was also shown to have strong test-retest reliability, in that Cronbachs alpha coefficient was >0.907 (p<0.001), whilst Cohens kappa coefficient was >0.81 (p<0.001) for 12 questions and >0.61 (p<0.001) for the remaining four questions. CONCLUSION The GASS-C is a valid and reliable clinical tool to enable a systematic assessment of the subjectively unpleasant side-effects of clozapine. Future research should focus on how the scale can be utilised as a clinical tool to improve real-world outcomes such as adherence to clozapine therapy and quality of life.

Managing bipolar depression: a therapeutic challenge?

Most people with bipolar disorder first seek treatment for depressive rather than manic symptoms. However, effective management of bipolar depression remains a challenge. In this review, Celia Feetam highlights how bipolar depression differs from unipolar depression both in its characteristics and in the approach to its treatment. Copyright

The UK Psychiatric Pharmacy Group - A Specialist Group Working in Mental Health

In 1970, a small group of pharmacists working in some of the large mental institutions of the time, before the advent of Caring for People (Department of Health et al, 1989), met on a Saturday afternoon in Hertfordshire. They were concerned that pharmacy services to in-patients suffering from serious mental illness were, at that time, generally provided by unsupported, under-resourced staff frequently working in isolation with no peer support and with no opportunity for further training in mental health or personal development. Later an informal group was set up which held similar meetings in Birmingham, Leeds, Derby, Wales and Scotland. From that small beginning over 20 years ago grew the United Kingdom Psychiatric Pharmacy Group (UKPPG), which now numbers some 400 members mostly working in secondary care. The group is selffinancing from membership fees and the proceeds of various educational activities and is organised on a voluntary basis by an active committee. It produces a quarterly bulletin, runs an email discussion group, maintains an extensive website and organises an annual international conference which attracts speakers and delegates from all over the world, as well as supporting further training and education for both pharmacists and technicians working in mental health. Full membership is open to all pharmacists in the UK with associate membership being available to any nonpharmacist and those working abroad. The overall aim of the group is ‘to promote better pharmaceutical care for people with mental health needs through education, liaison and accreditation’. Its specific objectives are to: ■ promote the highest standards of pharmaceutical practice within the speciality of mental health and learning disabilities ■ promote the role of specialist mental health pharmacists in optimising treatment with medicines, through communication, mentorship, support and dissemination of good practice ■ lead, promote and encourage research into and development of drug treatments within mental health ■ be the forum for all pharmacists with an interest in mental health ■ inform and guide the Royal Pharmaceutical Society of Great Britain about the pharmaceutical needs of patients with a mental health problem or learning disability ■ encourage and promote specialist postgraduate and other education of pharmacists to facilitate improved practice ■ develop the College of Mental Health Pharmacists as the accreditation body for specialist mental health pharmacists ■ work in partnership with other groups, including users and carers, on matters relating to mental health practice ■ develop and monitor standards of pharmaceutical practice in mental health ■ promote the role of pharmacists in mental health care.