Pharmacy and mental health care

Assignment 1:
1 Main types of mental illness
Main types of mental illness and their symptoms are summarised below using
the categorisation system in Diagnostic and Statistical Manual of Mental Disorders
Fourth Edition (DSM-IV):

1.1 Mood disorders

Under this category is a collection of conditions involves disturbance in mood.
This can be presented as inappropriate, elevated or limited expression of feelings.
Major depressive disorder is defined as lowered mood state and a lack of
interest in activities that are normally enjoyable (Andrews and Jenkins 1999). Other
symptoms include a reduction in energy level, difficulty concentrating, reduced
libido and thoughts of suicide. In bipolar disorder patients experience episodes of
mania, depression or mixed episodes, usually separated by periods of remission. It
can be further divided to Type I or Type II disorder depends on the pattern of
outbreak (Heffner 2007).

1.2 Anxiety disorders

This is an umbrella category encompasses a number of conditions that suggests
abnormal or pathological anxiety. Symptoms of anxiety include increased heart rate,
tensed muscles, dizziness, difficulty sleeping and restlessness. They are primarily
the flight-or-fight response in the absence of appropriate stimulus (Heffner 2007).
Generalised Anxiety Disorder (GAD) is the chronic persistent anxiety that is not
focused on any particular situation. Acute stress disorder refers to the period of
intense fear, disorientation and withdrawal following a traumatic event. In
Obsessive-compulsive disorder (OCD) patients experience obsessive and
distressing thoughts which lead to uncontrollable compulsions.

1.3 Substance-related Disorders

Substance related disorders refer to abuse or dependence on a substance.
Alcohol abuse is most common but misuse of any drug is also included. In
substance abuse individual may experience failure to fulfil routine obligations,
physical and mental damage due to recurrent use and social isolation. Abuse is part
of substance dependence in which the later also include increase in tolerance
and withdrawal symptoms.

1.4 Psychotic disorders

The major symptoms in this category are delusion and hallucination. Delusions
are false beliefs while hallucinations are false perceptions in the absence of
stimulus. They can occur in any sensory modality auditory, visual, olfactory, etc.
Schizophrenia is the most common presentation in which patients demonstrate
disorganised speech and thinking. There are positive symptoms include thought
disorders, delusions and hallucinations. Negative symptoms include tiredness, loss
of concentration, and lack of energy. The later is longer lasting and maybe
exacerbated by side-effects of drugs for treatment of positive symptoms (Mental
Health Foundation 2003).

1.5 Delirium, dementia, and amnesia and other cognitive

disorders
The main feature of this class of disorders is a significant impairment of
cognition. Dementia is the most prevalent condition which is the progressive
decline of several cognitive abilities beyond the scope of normal aging. It is
presented as memory loss, difficulty problem-solving and poor concentration and
perception. People may also be confused, restless and irritable (Heffner 2007).
Alzheimiers disease is the most common form of dementia which has a pathogenic
source. Delirium and amnesia refer to short-term decline in cognition and memory
disturbance in the absence of other cognitive impairments respectively.

1.6 Other mental disorders

In personality disorders symptoms are enduring and begin by early
adulthood: unstable relationships, low self-esteem and problems with impulsive
behaviour. Eating disorders refer to disturbance in eating behaviour that
negatively affects ones health. In anorexia nervosa people dont eat too enough
resulting in abnormally low body weight, amenorrhea in females and incense fear of
gaining weight. In bulimia nervosa people fail to stick with a healthy eating
pattern and symptoms include self-recrimination, crash dieting and over-exercising.
Sleep disorders can either be related to the timing and quality of sleep
(Dyssomnias) or about abnormal behaviours during sleep (Parasomnias). Some
common symptoms are inability to fall asleep, easy disruption of sleep, anxiety and
lack of concentration.

2 My role in mental health care

2.1 As a pharmacist
As a prospective pharmacist I have an important role in mental health care.
Pharmacists contribution to the specialty covers every part of the patient journey

from admission to discharge. They are not only focused on pharmaceutical care
delivery but are also involved in psychological and behavioural management (Figure
1). In hospitals pharmacists are vital in advising and implementing
psychopharmacological treatments in multidisciplinary team ward round or meeting.
They provide medication screening of side effects in doctors consultation. They also
involve in non-psychiatric treatment for patients with mental illness. Before and
after discharge pharmacists will have to liaise with doctors and community nurses /
pharmacists to set up a concordance plan (Davies 2008). In community settings we
have supervised
administration of Controlled Drugs (CDs) and Medicines Use
Review (MUR) to ensure the effectiveness of treatments. It has been reported that
independent prescribing of CDs will allow pharmacists to further their role in
management of chronic drug abusers as they have more experience in working with
addicts under the current pharmacy contract (Boenneken, et al. 2006).

Figure 1 Overview of pharmacist input to mental health care

Promotion of pharmacists input to mental health care is backed by the UK

Psychiatric Pharmacy Group (UKPPG). It provides clinical resources of prescribing
guidelines and drug directory, and as a platform for pharmacists with an interest in
psychiatry to collaborate and network. Commissioned by the UKPPG, the College of
Mental Health Pharmacists (CMH) accredits specialist mental health pharmacists
based on a range of clinical and intellectual competencies. I should consider
advanced training of the above organisations to delivery up-to-date quality care to
patients.

2.2 As a healthcare professional

Apart from the pharmacists perspective I should also be aware of my role as a
healthcare professional. Radical reform has been taking place to transform the
traditional medic-centred practice to a modern competence-based approach in the
area of mental health service. This is outlined in New ways of working for
everyone (NWW) by the National Institute for Mental Health in England (NIMHE)
National Workforce Programme (NWP) where responsibility is shared and individual
role is reshaped (Department of Health 2007). This allows more flexible and personcentred service provision in a cost-effective manner. NIMHE is working beyond the
NHS to provide support to clinical staff to implement mental health policies under
the National Service Framework (NSF) and the NHS plan. As part of the clinical team
we need to fully understand and safeguard the service requirements outlined by the
NSF and adopt the practical working style of NWW.

2.3 As a citizen
Even though I am not yet practicing there are many ways for me to get involved.
There are many organisations in the country that are focused on mental health
issues, including Mind, Mental Health Foundation and Alzheimiers Society. Besides
making donations we can also help to raise fund by joining their challenge events or
even leave a legacy. As a student we can utilise our spare time by volunteering in
related community works. We should spread out the message to our family, friends
and colleagues to get them involved as well. And finally for those we know with
mental illness we should tell them the available ways of getting help and
assistance.

3 Conclusion
Different mental disorders have different but often overlapping symptoms, and
they could be caused by or leading to general medical conditions. This is a
complicated issue affects every aspect of the society and we need people of
different profession to work together for a better care to our patients.

Bibliography

Andrews, Gavin, and Rachel Jenkins, . Management of Mental Disorders. Sydney:

World Health Organization Collaborating Centre for Mental Health and Substance
Abuse, 1999.
Boenneken, Inga, John Gallagher, Mohammed Sessay, Colin O'Gara, and Jason Luty.
Independent prescribing of CDs to addicts by pharmacists is long overdue. The
Pharmaceutical Journal 276 (2006): 164.

Davies, Wendy. Working in mental health pharmacy. The Pharmaceutical Journal

280 (2008): 102.
Department of Health. Mental health: New ways of working for everyone.
Publications policy and guidance, Department of Health, 2007.
Heffner, Chris. 2007. http://allpsych.com/disorders/index.html.
Mental
Health
Foundation.
Schizophrenia.
2003.
http://www.mentalhealth.org.uk/information/mental-health-a-z/schizophrenia.