Home' Australian Pharmacist : Australian Pharmacist June 2015 Contents Australian Pharmacist June 2015 I ©Pharmaceutical Society of Australia Ltd.
CONTINUING PROFESSIONAL DEVELOPMENT
COUNSELLING IN PRACTICE
As poor concordance is a significant
issue with antipsychotic therapy,
counselling skills should be tailored
accordingly, with a focus on achieving
concordance for the consumer.
Matt has presented with a prescription
for lithium and should be provided with
specific information about this therapy.
Revisiting the above, the following
information should be communicated
He has been prescribed a medicine
called lithium carbonate.
Lithium is used for maintenance
treatment of bipolar disorder when
the patient has had two or more
previous episodes of either mania
or depression. Lithium has the most
extensive evidence for maintenance
treatment of bipolar disorder.
Lithium should be taken twice daily
(once in the morning and once at
night) for two weeks at which time
Matt’s GP will review how the therapy
is going as well as the level of lithium
in the blood to ensure the levels
He may need to take lithium for
3–5 years however, in some people
treatment is indefinite. The duration of
treatment will depend on the nature of
his condition and how he responds to
and tolerates the treatment.
Lithium should not be ceased
abruptly as this may lead to a relapse
of depression or mania.
Lithium has been associated with
several adverse effects including shifts
in thyroid hormone levels as well as
other hormones in the body, which will
be monitored closely by the GP, fine
tremor and less commonly muscular
weakness and extrapyramidal
features such as slurred speech and
He will need tests (at initiation of
therapy and every 3–6 months
thereafter) to monitor his lithium
levels and ensure levels do not exceed
the recommended therapeutic range.
Initial signs of elevated lithium levels
include confusion, unsteadiness,
nausea, diarrhoea and tremor.
He should report any adverse effects
to his GP or pharmacist as early
as possible to avoid blood levels
reaching toxic concentrations which
may cause more serious adverse
effects such as vomiting, coarse
tremor and impaired consciousness.
Lithium may interact with other
medicines that affect the kidneys as
the kidneys are used to clear lithium
from the body (e.g. NSAIDs and
diuretics). He should always check
with his GP or pharmacist before
using other medicines.
How would you communicate
these to a patient taking
Before any counselling is carried out, the
pharmacist should take steps to identify
the type and amount of education
desired. This may help to lead to the
conversation. Verbal information can
be reinforced by provision of written
information that may help the patient
to recall information once they have left
Medicine counselling should be
provided in a semi‐private, or private
area away from other people. This may
be particularly important for medicines
used for mental health illnesses due to
the nature of the condition. Privacy also
allows greater opportunity for the
consumer to ask questions that they
may be hesitant to ask in public.
Why are patient-specific
communication skills needed?
Given the poor concordance of people
experiencing mental illness, counselling
is particularly important. It is recognised
that provision of medicines information
to the consumer is one of the most
important factors influencing adherence
to medicine.6 Relapse rates have
been shown to be five times higher in
people with mental illness who choose
not to take antipsychotic medicine,
compared with people who adhere to
their prescribed therapy.
antipsychotics come with complex
side effect profiles and some studies
have shown a significant relationship
between various adverse effects
Every patient is different and
counselling should be tailored to the
individual. Not all patients can be
expected to respond to counselling in
the same way. Therefore, knowledge,
insight and perceptions of therapy
need to be assessed in this population.
Attitudes towards therapy may be
assessed using a validated scale such
the Morisky Medication Adherence Scale,
a 4‐item questionnaire that explores
a consumer’s likelihood of medicine
compliance. The questionnaire includes
questions such as whether a consumer
would stop taking a medicine when
they feel better or experience an
“EVERY PATIENT IS DIFFERENT AND COUNSELLING SHOULD
BE TAILORED TO THE INDIVIDUAL.”
Links Archive Australian Pharmacist May 2015 Australian Pharmacist July 2015 Navigation Previous Page Next Page