Deena Ashoorian

Construction and validation of the My Medicines and Me Questionnaire for assessment of the self-reported side effects of psychotropic medication

We aimed to construct and assess the psychometric properties of the My Medicines and Me Questionnaire (M3Q), a self-report side-effect questionnaire for mental health patients. Thirty individuals taking a psychotropic medication completed the M3Q side-effect checklist along with the Liverpool University Neuroleptic Side Effect Rating Scale. Thirty healthy comparison individuals also completed the M3Q checklist. Data were analyzed using factorial analysis. Psychometric evaluations including validity and reliability testing were carried out on the questionnaire’s checklist. The original 54-item checklist of the M3Q was shortened to include only those items found to be significant in the factorial analysis. The revised 32-item checklist of the M3Q was found to be valid and reliable. The M3Q is a simple, valid and reliable questionnaire that can be used routinely in clinical practice for detecting bothersome side effects of a range of psychotropic medications. This will provide a platform for improved communication between the clinician and the patient.

The use of Enhancing Quality Use of Medication Self-Reported Questionniare (EQUIM-SRQ) among mental health consumers: a pilot study

Objective: To assess the applicability, interpretability and potential limitations of an adverse event screening questionnaire (the Enhancing Quality Use of Medication Self-Reported Questionnaire [EQUIM-SRQ]) in an Australian mental health outpatient population. Method: Questionnaires were distributed amongst two Australian adult mental health clinics for completion either at the clinic (onsite), or externally (postal option), during March – May 2011. Assistance was offered to participants completing the questionnaire onsite. Clients who were visited in their homes by clinic staff were invited to participate as external participants. Results: Of 160 questionnaires distributed, 29 (18%) were completed. Of those, 22 were completed onsite, and seven were completed externally. Of the questionnaires completed onsite, 11 were fully completed, with 4 participants requiring assistance. A further 11 questionnaires were partially completed, with 2 participants requiring assistance. Of the questionnaires completed externally, 5 were fully completed. Conclusion: Although the response rate was low, the EQUIM-SRQ was applicable, interpretable and acceptable when completed or partially completed questionnaires were assessed. The potential exists to apply the EQUIM-SRQ in further research, and thereafter, clinical practice.

Development of the My Medicines and Me (M3Q) side effect questionnaire for mental health patients: a qualitative study

Objective: The objective of this study was to assess the acceptability, content validity and usability of the My Medicines and Me (M3Q) self-report side effect questionnaire. Methods: Eight focus groups consisting of mental health patients, carers, general practitioners, psychiatrists, mental health nurses and pharmacists were conducted, involving 78 participants. Two researchers independently examined the transcriptions and analysed the data thematically using an inductive method. Results: The findings supported changes to the formatting, length and phrasing of questions in the original version of the questionnaire. Although the groups provided differing views on the usability of the M3Q in clinical practice, the patient and carer groups were unconditionally in favour of such a tool to be used systematically to describe patients’ subjective experiences with side effects. Conclusion: The differing contribution made by all groups involved in the administration and completion of the M3Q assisted with content validity of the questionnaire. The acceptability and usability of this novel side effect questionnaire was also explored, with many participants agreeing it was a necessary tool for a patient centred approach to treatment. Following implementation of the changes to the current format of the questionnaire, investigation into the uptake and use in clinical practice should be carried out.

Re: Antipsychotic medication side effect assessment tools: A systematic review:

Australian & New Zealand Journal of Psychiatry, 51(2) on long-term side effects and ideal HT formulations remain limited. In recent years, HT prescription timing has gained more importance. For example, delaying puberty for a girl with gender dysphoria (GD) may help increase height, building positive body image and self-perception. However, some specialists hesitate before prescribing HT, despite growing consensus that HT could be an appropriate intervention for youth with GD (Milrod, 2014). Additionally, cultural differences might have underestimated influences on HT prescriptions. We present a case with HT delay possibly caused by long-standing stigma of seemingly unorthodox HT for individuals with GD and show how cultural differences influenced decision-making on HT. Mr F, a 20-year-old Asian man with male-to-female (MtF) GD, far taller than average and large-framed, was transferred from another hospital with transgender healthcare program to our hospital for one major reason: a second opinion on HT due to concerns about limited response based on the client’s positive masculinity. According to the World Professional Association for Transgender Health, 7th version (Coleman et al., 2011), there are no contraindications for HT receipt. Therefore, we prescribed HT and continued to help the client with psychosocial problems. One year after prescription, the client was living in a female role and appeared sure of ‘herself’. ‘Why did we not try HT earlier?’ the client asked. The client greatly benefited from HT to relieve the distress caused by growing masculinity. Therefore, the timing of HT prescription is worth a rethink. The reasons for the client’s immediate need for HT and the postponement of HT may have been the same—the client’s typically masculine body. The client and the first hospital team seemed to have been trapped in a dilemma by cognitive appraisal of body image deeply influenced by the cultural context. Therefore, cultural differences and their influences on body image may explain the first team’s hesitation to prescribe HT. Few reports have explored such impact of cultural differences on decision-making in HT prescription in GD. An epidemiological study in Japan indicated the timing of HT in MtF individuals was earlier than female-to-male (FtM) individuals, which may strengthen our argument in the case report (Nakatsuka, 2011). In conclusion, the importance of earlier HT use in MtF individuals might be underestimated, especially in Eastern cultures. Therefore, specialists involved in transgender healthcare should be aware of the role of cultural differences in decisionmaking and timing for HT prescription.