Bipolar4LifeSupport

Questions to ask the psychiatrist

Carers need information and psychiatrists are busy. Carers may not always find out what they need to know about the person they are caring for. This checklist is designed to help you get all the information you need about the diagnosis and treatment of the person you care for.

You may be able to get some of this information from other members of the clinical team involved, or from written information that they can provide.

If the person gives you permission, the psychiatrist will be able to give you information about their condition and care.

Although you may not want to ask all the questions listed, you may find that they help you in preparing to meet the psychiatrist and the mental health team. Not everyone will need all the answers to all these questions at the same time. You may have questions that are not covered in this leaflet. Even so, it should provide a helpful framework for deciding what you do need to know.

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About the illness
•What is the diagnosis or problem?
•If a diagnosis has not yet been made, what are the possibilities?
•Why has this happened to them?
•Will they recover?

If a diagnosis has been made
•What symptoms suggest this diagnosis/illness?
•What is known about the causes of this disorder/illness?
•What is likely to happen in the future? Will it get better or worse?
•Where can I get written information about this disorder?

About the assessment
•What assessments have already been done?
•Are there any other assessments that might be needed?
•Are there any physical problems that have been discovered? If so, what will need to be done?
•Have culture and background been considered?

Care Programme Approach (CPA)
•What is the CPA?
•What does the CPA mean?
•Is the person on the CPA? If not, why not?
•Will I be involved in the CPA?

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Who cares for the carers?

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About care and treatment
•What are the aims of the care and treatment?
•What is a care co-ordinator?
•What part will the care co-ordinator play in the person’s care?
•Who else will be involved in the treatment?
•What is your plan for treatment?
•For how long will they need treatment?
•Would talking treatments (eg, cognitive behavioural therapy, family therapy) be helpful? If so, are they available locally?
•What happens if they refuse treatment?

Sharing of information
•Have you asked them about how much information they are happy to share with me?
•Will I be informed about important meetings concerning their care and treatment?
•Can I see you on my own?
•Would you like to ask me for any other information about them or the family?
•Can I tell you things that will not be shared with the person or other members of staff?
•Are their views on confidentiality clearly marked in their notes?

Care and treatment
•What can I do to help?
•Are there any local self-help or carers’ groups that can help me understand the illness?
•How can I get advice and training in the day-to-day management of the illness?
•Are there any local groups that can provide support?

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Getting help
•How can I get in touch with you?
•How do I arrange to see you?
•Who do I contact if I’m worried about their behaviour?
•What do I do if I’m worried that they are becoming ill again?
•Who do I contact in an emergency?
•What help might be available?
•How can I get a second opinion?

Carers
•What is the difference between a carer, a nearest relative and a nominated person?
•I understand that, as a carer, I am entitled to an assessment and care plan of my own. Who should I speak to?
•If I have specific needs of my own, who should I ask?
•If I need help, to whom should I turn?

Medication
•What medication is to be used, and how?
•Is the lowest effective dose being prescribed?
•Can a low dose be taken at first and increased if necessary?
•How often will the medication be reviewed?
•Will I be involved in future discussions about the dose or type of medication?
•What should the benefits of this medication be? •In the short term
•In the long term

•What are the possible side-effects of this medication? •In the short term
•In the long term

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Managing the medication
•Why have you chosen this particular medication?
•How long will the medication have to be taken for?
•Are there any other medications that could be used if this one does not work?
•What symptoms might mean that the dose should be changed?

What should I do if they experience unpleasant side-effects?
•What will happen if they stop taking the medication?
•Do you have any written information about this medication to give me?

Hospital treatment
•Do they need to be admitted to hospital? If so, for how long?
•If they have to go into hospital, which one will it be?
•Will they be on a locked ward?
•If they get short-term leave from hospital, when and how will I be informed?
•How often will I be able to see them?

Discharge from hospital
•What arrangements will be made for their care and monitoring after discharge from hospital?
•If I am not able to look after the person when they are discharged, what will happen?
•Am I expected to help with anything, especially medication?
•Do you know of any self-help techniques that will help their recovery?

If not admitted to hospital
•Do they need to be admitted to hospital?
•Are there any alternatives to hospital admission?

Content used with permission from the Royal College of Psychiatrists website: A checklist for carers of people with mental health problems. Copyright for this leaflet is with the Royal College of Psychiatrists.

SSRI antidepressants are used to treat depression and some other conditions. They can take 2-4 weeks to build up their effect to work fully. A normal course of antidepressants lasts at least six months after symptoms have eased. Side-effects may occur, but are often minor. At the end of a course of treatment, you should gradually reduce the dose as directed by your doctor before stopping completely.

SSRI antidepressants are not just for depression

SSRI stands for selective serotonin reuptake inhibitor. They are a group of antidepressant medicines that are used to treat depression. They are also used to treat some other conditions such as bulimia nervosa, panic disorder, and obsessive-compulsive disorder.

How do SSRI antidepressants work?

Antidepressants alter the balance of some of the chemicals in the brain (neurotransmitters). SSRI antidepressants mainly affect a neurotransmitter called serotonin.

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How effective are SSRI antidepressants?

About 5-7 in 10 people with moderate or severe depression have an improvement in symptoms within a few weeks of starting treatment with an antidepressant. However, up to 3 in 10 people improve with dummy tablets (placebos), as some people would have improved in this time naturally. So, if you have depression, you are roughly twice as likely to improve with an antidepressant compared with taking no treatment. But, they do not work in everybody. As a rule, the more severe the depression, the greater the chance that an antidepressant will work well.

Note: antidepressants do not necessarily make sad people happy. The word ‘depressed’ is often used when people really mean sad, fed-up, or unhappy. True depression is different to unhappiness and has persistent symptoms (which often include persistent sadness). See separate leaflet called Depression for more information about this condition.

The success rate of SSRI antidepressants can vary when used to treat the other conditions listed above (bulimia, panic disorder and obsessive-compulsive disorder).

How quickly do SSRI antidepressants work?

Some people notice an improvement within a few days of starting treatment. However, an antidepressant often takes 2-4 weeks to build up its effect and work fully. Some people stop treatment after a week or so thinking it is not helping. It is best to wait for 3-4 weeks before deciding if treatment with an SSRI is helping or not.

If you find that the treatment is helpful after 3-4 weeks, it is usual to continue. A normal course of antidepressants lasts at least six months after symptoms have eased. If you stop the medicine too soon, your symptoms may rapidly return. Some people with recurrent depression are advised to take longer courses of treatment (up to two years or longer).

When you are taking SSRI antidepressants

It is important to take the medication each day at the dose prescribed. Do not stop taking an SSRI medicine abruptly. This is because you may develop some withdrawal symptoms. The dose is usually gradually reduced before stopping completely at the end of a course of treatment. But don’t do this yourself – your doctor will advise on dosage reduction when the time comes. It is best not to stop treatment or change the dose without consulting a doctor.

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Are there different types of SSRI antidepressants?

There are several different types. They include citalopram, escitalopram, fluoxetine, paroxetine and sertraline. Each of these comes in different brand names. There is no best type that suits everyone. If the one chosen does not suit, it is sometimes necessary to change the dose, or change the preparation. Your doctor will advise. Also, if SSRI antidepressants do not help then another type of antidepressant may be advised.

What about side-effects and risks?

Most people have either minor, or no, side-effects. Possible side-effects vary between different preparations. The leaflet that comes in the medicine packet gives a full list of possible side-effects. You should read this before you start taking the medicine. It is beyond the scope of this leaflet to list all side-effects, but the following highlights some of the more common or serious ones.

As a rule, tell your doctor if a side-effect persists or is troublesome. Your doctor can advise on the best course of action – for example, to stop the medication, a switch to a different medicine, etc.

The most common side-effects

These include diarrhoea, feeling sick (nauseated), vomiting (being sick), and headaches. It is worth keeping on with treatment if these side-effects are mild at first as they may wear off after a week or so.

A possible sedating effect

SSRIs can cause drowsiness (a sedating effect) in some people. This side-effect is not common, and is not as much of a problem as with some other types of antidepressants. However, you must be aware of the possibility, especially if you are a driver, as it may impair your ability to drive safely. Any sedative effect is likely to be greatest in the first month of starting treatment, or on increasing the dose. The Driver and Vehicle Licensing Agency (DVLA) advises that you should not drive during this time if you feel that you are drowsy or sedated at all.

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Bleeding into the gut

Some research has suggested that SSRIs may be associated with a small increased risk of bleeding into the gut, but the evidence is inconclusive. This is especially in older people and in people taking other medicines that have the potential to damage the lining of the gut or interfere with clotting. Therefore, ideally, SSRIs should be avoided if you take aspirin, warfarin, novel anticoagulants (such as dabigatran, apixaban and rivoraxaban) or non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. If no suitable alternative to an SSRI can be found and you have an increased risk of bleeding, your doctor may advise that you take an additional medicine. This will help to protect the lining of the gut.

Small increased risk of fractures

Research studies suggest that there is a small increased risk of fractures in people taking an SSRI. However, the reason for this increased risk is not clear.

Nervous system side-effects

Dizziness, agitation, anxiety, difficulty sleeping, and tremor have all been reported as possible side-effects.

Sexual problems

Problems with sexual function are a common symptom of depression. However, in addition to this, all antidepressants may cause some problems with sexual function. For example, problems getting an erection, vaginal dryness and decreased sex drive have been reported as side-effects in some people.

Antidepressants and suicidal behaviour

In recent years there have been some case reports which claim a link between taking antidepressants and feeling suicidal, particularly in teenagers and young adults. This may be more a risk in the first few weeks of starting medication or after a dose increase. It is debatable whether this possible risk is due to the medicine or to the depression. If it is due to the medication then the risk remains very small. And, overall, the most effective way to prevent suicidal thoughts and acts is to treat depression. However, because of this possible link, see your doctor promptly if you become increasingly restless, anxious or agitated, or if you have any suicidal thoughts. In particular, you should speak with your doctor if these develop in the early stages of treatment or following an increase in dose.

Are SSRI antidepressants addictive?

SSRIs are not tranquillisers, and are not thought to be addictive. Most people can stop an SSRI without any problem. At the end of a course of treatment you should reduce the dose gradually over about four weeks before finally stopping. This is because some people develop withdrawal symptoms if the medication is stopped abruptly. If you have withdrawal symptoms it does not mean that you are addicted to the the medicine, as other features of addiction such as cravings for the medicine do not occur.

Withdrawal symptoms that may occur include:
•Dizziness
•Anxiety and agitation
•Sleep disturbance
•Flu-like symptoms
•Diarrhoea
•Tummy (abdominal) cramps
•Pins and needles
•Mood swings
•Feeling sick (nauseated)
•Low mood

These symptoms are unlikely to occur if you reduce the dose gradually. If withdrawal symptoms do occur, they will usually last less than two weeks. An option if they do occur is to restart the drug and reduce the dose even more slowly.

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How to use the Yellow Card Scheme

If you think you have had a side-effect to one of your medicines you can report this on the Yellow Card Scheme. You can do this online at the following web address: http://www.mhra.gov.uk/yellowcard.

The Yellow Card Scheme is used to make pharmacists, doctors and nurses aware of any new side-effects that medicines may have caused. If you wish to report a side-effect, you will need to provide basic information about:
•The side-effect.
•The name of the medicine which you think caused it.
•Information about the person who had the side-effect.
•Your contact details as the reporter of the side-effect.

It is helpful if you have your medication – and/or the leaflet that came with it – with you while you fill out the report.

Antipsychotics are medicines that are mainly used to treat schizophrenia or mania caused by bipolar disorder. There are two main types of antipsychotics: atypical antipsychotics and older antipsychotics. Both types are thought to work as well as each other. Side-effects are common with antipsychotics. You will need regular tests to monitor for side-effects while you take theses medicines.

What are antipsychotics?

Antipsychotics are a group of medicines that are mainly used to treat mental health illnesses such as schizophrenia, or mania (where you feel high or elated) caused by bipolar disorder. They can also be used to treat severe depression and severe anxiety. Antipsychotics are sometimes also called major tranquillisers.

There are two main types of antipsychotics:
•Newer or atypical antipsychotics. These are sometimes called second-generation antipsychotics and include: amisulpride, aripiprazole, clozapine, olanzapine, quetiapine, risperidone and sertindole.
•Older typical well-established antipsychotics. These are sometimes called first-generation antipsychotics and include: chlorpromazine, flupentixol, haloperidol, levomepromazine, pericyazine, perphenazine, pimozide, sulpiride, trifluoperazine, and zuclopenthixol.

Antipsychotics are available as tablets, capsules, liquids, and depot injections (long-acting). They come in various different brand names.

Older antipsychotics have been used since the 1950s and are still prescribed today. Newer antipsychotics were developed in the 1970s onwards. It was originally thought that these medicines would have fewer side-effects than the older type of antipsychotics. However, we now know that they can also cause quite a few side-effects.

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How do antipsychotics work?

Antipsychotics are thought to work by altering the effect of certain chemicals in the brain, called dopamine, serotonin, noradrenaline and acetylcholine. These chemicals have the effect of changing your behaviour, mood and emotions. Dopamine is the main chemical that these medicines have an effect on.

By altering the effects of these chemicals in the brain they can suppress or prevent you from experiencing:
•Hallucinations (such as hearing voices).
•Delusions (having ideas not based on reality).
•Thought disorder.
•Extreme mood swings that are associated with bipolar disorder.

When are antipsychotics usually prescribed?

As discussed above, antipsychotics are usually prescribed to help to ease the symptoms of schizophrenia, mania (caused by bipolar disorder), severe depression or severe anxiety. Normally they are started by a specialist in psychiatry, or your GP will ask a specialist for advice on when to start them.

Also, for many years antipsychotics were used to calm elderly people who had dementia, but this use is no longer recommended. This is because these medicines are thought to increase the risk of stroke and early death – by a small amount. Risperidone is the only antipsychotic recommended for use in these people. Even then, it should only be used for short period of time (less than six weeks) and for severe symptoms.

Which antipsychotic is usually prescribed?

The choice of antipsychotic prescribed depends upon what is being treated, how severe your symptoms are, and if you have any other health problems. There are a number of differences between the various antipsychotic medicines. For example, some are more sedating than others. Therefore, one may be better for one individual than for another. A specialist in psychiatry usually advises on which to use in each case. It is difficult to tell which antipsychotic will work well for you. If one does not work so well, a different one is often tried and may work well. Your doctor will advise.

It is thought that the older and newer types of antipsychotics work as well as each other. The exception to this is clozapine – it is the only antipsychotic that is thought to work better than the others. Unfortunately, clozapine has a number of possible serious side-effects, especially on your blood cells. This means that people who take clozapine have to have regular blood tests.

In some cases, an injection of a long-acting antipsychotic medicine (depot injection) is used once symptoms have eased. The medicine from a depot injection is slowly released into the body and is given every 2-4 weeks. This aims to prevent relapses (recurrences of symptoms). The main advantage of depot injections is that you do not have to remember to take tablets every day.

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6
Schizophrenia
How well do antipsychotics work?

It is thought that for every 10 people who take these medicines, 8 will experience an improvement in their symptoms. Unfortunately, antipsychotics do not always make the symptoms go away completely, or for ever. A lot people need to take them in the long term even if they feel well. This is in order to stop their symptoms from coming back. Even if you take these medicines on a long-term basis and they are helping, sometimes your symptoms can come back.

Symptoms may take 2-4 weeks to ease after starting medication, and it can take several weeks for full improvement. The dose of the medicine is usually built up gradually to help to prevent side-effects (including weight gain).

What is the usual length of treatment?

This depends on various things. Some people may only need to take them for a few weeks, but others may need to take them long-term (for example, for schizophrenia). Even when symptoms ease, antipsychotic medication is normally continued long-term if you have schizophrenia. This aims to prevent relapses, or to limit the number and severity of relapses. However, if you only have one episode of symptoms of schizophrenia that clears completely with treatment, one option is to try coming off medication after 1-2 years. Your doctor will advise.

Stopping antipsychotics

If you want to stop taking an antipsychotic you should always talk to your doctor first. This is in order to help you decide if stopping is the best thing for you, and how you should stop taking your medicine. These medicines are usually stopped slowly over a number of weeks. If you stop taking an antipsychotic medicine suddenly, you may become unwell quite quickly. Your doctor will usually advise you to reduce the dose slowly to see what effect the lower dose has on your symptoms.

Support groups e

Hearing Voices Network
Rethink Mental Illness

Find support near you ▶

What about side-effects from antipsychotics?

Side-effects can sometimes be troublesome. There is often a trade-off between easing symptoms and having to put up with some side-effects from treatment. The different antipsychotic medicines can have different types of side-effects. Also, sometimes one medicine causes side-effects in some people and not in others. Therefore, it is not unusual to try two or more different medicines before one is found that is best suited to an individual.

The following are the main side-effects that sometimes occur. However, you should read the information leaflet that comes in each medicine packet for a full list of possible side-effects.

Common side-effects include:
•Dry mouth, blurred vision, flushing and constipation. These may ease off when you get used to the medicine.
•Drowsiness (sedation), which is also common but may be an indication that the dose is too high. A reduced dose may be an option.
•Weight gain which some people develop. Weight gain may increase the risk of developing diabetes and heart problems in the longer term. This appears to be a particular problem with the atypical antipsychotics – notably, clozapine and olanzapine.
•Movement disorders which develop in some cases. These include: •Parkinsonism – this can cause symptoms similar to those that occur in people with Parkinson’s disease – for example, tremor and muscle stiffness.
•Akathisia – this is like a restlessness of the legs.
•Dystonia – this means abnormal movements of the face and body.
•Tardive dyskinesia (TD) – this is a movement disorder that can occur if you take antipsychotics for several years. It causes rhythmical, involuntary movements. These are usually lip-smacking and tongue-rotating movements, although it can affect the arms and legs too. About 1 in 5 people treated with typical antipsychotics eventually develops TD.

Atypical antipsychotic medicines are thought to be less likely to cause movement disorder side-effects than typical antipsychotic medicines. This reduced incidence of movement disorder is the main reason why an atypical antipsychotic is often used first-line. Atypicals do, however, have their own risks – in particular, the risk of weight gain. If movement disorder side-effects occur then other medicines may be used to try to counteract them.

Will I need any tests while taking an antipsychotic?

Your doctor will want to monitor you regularly for side-effects if you take an antipsychotic. The tests needed and how often you will need to have them depend on which antipsychotic you are taking.

In general, your doctor will take a sample of blood for certain tests before you start treatment. The tests look at how many blood cells you have, how well your kidneys and liver are working, how much lipid (fat) is in your blood, and if you have diabetes. These tests may be repeated in the first 3 or 4 months of treatment. After this they are normally done every year. However, your doctor may advise you to have these tests more often.

Your weight and blood pressure are usually measured before you start treatment and every few weeks after this for the first few months. After this they are normally measured every year.

The blood level of prolactin (a hormone) may also be measured before starting treatment and six months later. Usually it is then measured every year after this. The prolactin level is measured because sometimes antipsychotics can make you produce too much of this hormone. If you make too much prolactin it can lead to your breasts growing bigger and breast milk being produced.

Note: people taking clozapine need weekly blood tests for the first six months and two-weekly blood tests after that. This is because it can have a serious effect on how many blood cells you make.

Who cannot take antipsychotics?

Antipsychotics are usually not prescribed for people who are comatose (in a coma), have depression of their central nervous system, and who have phaeochromocytoma (tumour on the adrenal gland).

Can I buy antipsychotics?

No – they are only available from your pharmacist, with a doctor’s prescription.

How to use the Yellow Card Scheme

If you think you have had a side-effect to one of your medicines, you can report this on the Yellow Card Scheme. You can do this online at the following web address: http://www.mhra.gov.uk/yellowcard.

The Yellow Card Scheme is used to make pharmacists, doctors and nurses aware of any new side-effects that your medicines may have caused. If you wish to report a side-effect, you will need to provide basic information about:
•The side-effect.
•The name of the medicine which you think caused it.
•Information about the person who had the side-effect.
•Your contact details as the reporter of the side-effect.

It is helpful if you have your medication and/or the leaflet that came with it with you while you fill out the report.

Antipsychotics are medicines that are mainly used to treat schizophrenia or mania caused by bipolar disorder. There are two main types of antipsychotics: atypical antipsychotics and older antipsychotics. Both types are thought to work as well as each other. Side-effects are common with antipsychotics. You will need regular tests to monitor for side-effects while you take theses medicines.

What are antipsychotics?

Antipsychotics are a group of medicines that are mainly used to treat mental health illnesses such as schizophrenia, or mania (where you feel high or elated) caused by bipolar disorder. They can also be used to treat severe depression and severe anxiety. Antipsychotics are sometimes also called major tranquillisers.

There are two main types of antipsychotics:
•Newer or atypical antipsychotics. These are sometimes called second-generation antipsychotics and include: amisulpride, aripiprazole, clozapine, olanzapine, quetiapine, risperidone and sertindole.
•Older typical well-established antipsychotics. These are sometimes called first-generation antipsychotics and include: chlorpromazine, flupentixol, haloperidol, levomepromazine, pericyazine, perphenazine, pimozide, sulpiride, trifluoperazine, and zuclopenthixol.

Antipsychotics are available as tablets, capsules, liquids, and depot injections (long-acting). They come in various different brand names.

Older antipsychotics have been used since the 1950s and are still prescribed today. Newer antipsychotics were developed in the 1970s onwards. It was originally thought that these medicines would have fewer side-effects than the older type of antipsychotics. However, we now know that they can also cause quite a few side-effects.

Related articles q

Schizophrenia
Hearing Voices – A Self Help Guide
Bipolar Disorder

How do antipsychotics work?

Antipsychotics are thought to work by altering the effect of certain chemicals in the brain, called dopamine, serotonin, noradrenaline and acetylcholine. These chemicals have the effect of changing your behaviour, mood and emotions. Dopamine is the main chemical that these medicines have an effect on.

By altering the effects of these chemicals in the brain they can suppress or prevent you from experiencing:
•Hallucinations (such as hearing voices).
•Delusions (having ideas not based on reality).
•Thought disorder.
•Extreme mood swings that are associated with bipolar disorder.

When are antipsychotics usually prescribed?

As discussed above, antipsychotics are usually prescribed to help to ease the symptoms of schizophrenia, mania (caused by bipolar disorder), severe depression or severe anxiety. Normally they are started by a specialist in psychiatry, or your GP will ask a specialist for advice on when to start them.

Also, for many years antipsychotics were used to calm elderly people who had dementia, but this use is no longer recommended. This is because these medicines are thought to increase the risk of stroke and early death – by a small amount. Risperidone is the only antipsychotic recommended for use in these people. Even then, it should only be used for short period of time (less than six weeks) and for severe symptoms.

Which antipsychotic is usually prescribed?

The choice of antipsychotic prescribed depends upon what is being treated, how severe your symptoms are, and if you have any other health problems. There are a number of differences between the various antipsychotic medicines. For example, some are more sedating than others. Therefore, one may be better for one individual than for another. A specialist in psychiatry usually advises on which to use in each case. It is difficult to tell which antipsychotic will work well for you. If one does not work so well, a different one is often tried and may work well. Your doctor will advise.

It is thought that the older and newer types of antipsychotics work as well as each other. The exception to this is clozapine – it is the only antipsychotic that is thought to work better than the others. Unfortunately, clozapine has a number of possible serious side-effects, especially on your blood cells. This means that people who take clozapine have to have regular blood tests.

In some cases, an injection of a long-acting antipsychotic medicine (depot injection) is used once symptoms have eased. The medicine from a depot injection is slowly released into the body and is given every 2-4 weeks. This aims to prevent relapses (recurrences of symptoms). The main advantage of depot injections is that you do not have to remember to take tablets every day.

p

6
Schizophrenia
How well do antipsychotics work?

It is thought that for every 10 people who take these medicines, 8 will experience an improvement in their symptoms. Unfortunately, antipsychotics do not always make the symptoms go away completely, or for ever. A lot people need to take them in the long term even if they feel well. This is in order to stop their symptoms from coming back. Even if you take these medicines on a long-term basis and they are helping, sometimes your symptoms can come back.

Symptoms may take 2-4 weeks to ease after starting medication, and it can take several weeks for full improvement. The dose of the medicine is usually built up gradually to help to prevent side-effects (including weight gain).

What is the usual length of treatment?

This depends on various things. Some people may only need to take them for a few weeks, but others may need to take them long-term (for example, for schizophrenia). Even when symptoms ease, antipsychotic medication is normally continued long-term if you have schizophrenia. This aims to prevent relapses, or to limit the number and severity of relapses. However, if you only have one episode of symptoms of schizophrenia that clears completely with treatment, one option is to try coming off medication after 1-2 years. Your doctor will advise.

Stopping antipsychotics

If you want to stop taking an antipsychotic you should always talk to your doctor first. This is in order to help you decide if stopping is the best thing for you, and how you should stop taking your medicine. These medicines are usually stopped slowly over a number of weeks. If you stop taking an antipsychotic medicine suddenly, you may become unwell quite quickly. Your doctor will usually advise you to reduce the dose slowly to see what effect the lower dose has on your symptoms.

Support groups e

Hearing Voices Network
Rethink Mental Illness

Find support near you ▶

What about side-effects from antipsychotics?

Side-effects can sometimes be troublesome. There is often a trade-off between easing symptoms and having to put up with some side-effects from treatment. The different antipsychotic medicines can have different types of side-effects. Also, sometimes one medicine causes side-effects in some people and not in others. Therefore, it is not unusual to try two or more different medicines before one is found that is best suited to an individual.

The following are the main side-effects that sometimes occur. However, you should read the information leaflet that comes in each medicine packet for a full list of possible side-effects.

Common side-effects include:
•Dry mouth, blurred vision, flushing and constipation. These may ease off when you get used to the medicine.
•Drowsiness (sedation), which is also common but may be an indication that the dose is too high. A reduced dose may be an option.
•Weight gain which some people develop. Weight gain may increase the risk of developing diabetes and heart problems in the longer term. This appears to be a particular problem with the atypical antipsychotics – notably, clozapine and olanzapine.
•Movement disorders which develop in some cases. These include: •Parkinsonism – this can cause symptoms similar to those that occur in people with Parkinson’s disease – for example, tremor and muscle stiffness.
•Akathisia – this is like a restlessness of the legs.
•Dystonia – this means abnormal movements of the face and body.
•Tardive dyskinesia (TD) – this is a movement disorder that can occur if you take antipsychotics for several years. It causes rhythmical, involuntary movements. These are usually lip-smacking and tongue-rotating movements, although it can affect the arms and legs too. About 1 in 5 people treated with typical antipsychotics eventually develops TD.

Atypical antipsychotic medicines are thought to be less likely to cause movement disorder side-effects than typical antipsychotic medicines. This reduced incidence of movement disorder is the main reason why an atypical antipsychotic is often used first-line. Atypicals do, however, have their own risks – in particular, the risk of weight gain. If movement disorder side-effects occur then other medicines may be used to try to counteract them.

Will I need any tests while taking an antipsychotic?

Your doctor will want to monitor you regularly for side-effects if you take an antipsychotic. The tests needed and how often you will need to have them depend on which antipsychotic you are taking.

In general, your doctor will take a sample of blood for certain tests before you start treatment. The tests look at how many blood cells you have, how well your kidneys and liver are working, how much lipid (fat) is in your blood, and if you have diabetes. These tests may be repeated in the first 3 or 4 months of treatment. After this they are normally done every year. However, your doctor may advise you to have these tests more often.

Your weight and blood pressure are usually measured before you start treatment and every few weeks after this for the first few months. After this they are normally measured every year.

The blood level of prolactin (a hormone) may also be measured before starting treatment and six months later. Usually it is then measured every year after this. The prolactin level is measured because sometimes antipsychotics can make you produce too much of this hormone. If you make too much prolactin it can lead to your breasts growing bigger and breast milk being produced.

Note: people taking clozapine need weekly blood tests for the first six months and two-weekly blood tests after that. This is because it can have a serious effect on how many blood cells you make.

Who cannot take antipsychotics?

Antipsychotics are usually not prescribed for people who are comatose (in a coma), have depression of their central nervous system, and who have phaeochromocytoma (tumour on the adrenal gland).

Can I buy antipsychotics?

No – they are only available from your pharmacist, with a doctor’s prescription.

How to use the Yellow Card Scheme

If you think you have had a side-effect to one of your medicines, you can report this on the Yellow Card Scheme. You can do this online at the following web address: http://www.mhra.gov.uk/yellowcard.

The Yellow Card Scheme is used to make pharmacists, doctors and nurses aware of any new side-effects that your medicines may have caused. If you wish to report a side-effect, you will need to provide basic information about:
•The side-effect.
•The name of the medicine which you think caused it.
•Information about the person who had the side-effect.
•Your contact details as the reporter of the side-effect.

It is helpful if you have your medication and/or the leaflet that came with it with you while you fill out the report.

What is anorexia nervosa?

Anorexia nervosa (just called anorexia from now on) is an eating disorder. Anorexia is a serious condition which affects all sorts of people. Anorexia is very common – about 1 in 20 teenagers has it. However, it affects people of all ages and has become more common in boys and men in recent years.

People with anorexia often find that they do not allow themselves to feel full after eating. This means that they restrict the amount they eat and drink. People with anorexia are underweight. Sometimes, the weight becomes so low that it is dangerous to health.

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How do I know if I have an eating disorder?

If you answer yes to two or more of these questions then you may have an eating disorder and you should see your doctor:
•Do you make yourself sick because you are uncomfortably full?
•Do you worry that you’ve lost control over how much you eat?
•Have you recently lost more than 6 kg (about one stone) in the past three months?
•Do you believe you’re fat when others think you are thin?
•Would you say that food dominates your life?

What are the symptoms of anorexia nervosa?

Deliberate weight loss

This is the main symptom. You lose weight by avoiding fattening foods or even any foods. People with anorexia limit the amount they eat and drink, in order to control how their body looks. You may often pretend to other people that you are eating far more than you actually are. You may be using other ways of staying thin such as exercising too much. You may also have made yourself vomit, take laxatives, or even take appetite suppressant medicines or diuretics (water tablets).

People with anorexia typically weigh 15% or more below the expected weight for their age, sex and height. The body mass index (BMI) is calculated by your weight (in kilograms) divided by the square of your height (in metres). For example, if you weigh 66 kg and are 1.7 m tall then your BMI would be 66/(1.7 x 1.7) = 22.8. A normal BMI for an adult is 20-25. Above that you are overweight, and below that you are underweight. Adults with anorexia have a BMI below 17.5.

With anorexia, you feel very in control of your bodyweight and shape. However, with time, anorexia can take control of you. After some time it can become very difficult to make healthy, normal choices about the amount and types of food you eat.

A wrong idea of body size

People with anorexia think that they are fat when they are actually very thin. Although other people see you as thin or underweight, it is very difficult for you to see this. You are likely to have a severe dread (like a phobia) of gaining weight. People with anorexia will do their utmost to avoid putting on weight.

Other features

It is common for people with anorexia to:
•Vomit secretly after eating.
•Try hard to hide their thinness – for example, by wearing baggy clothes.
•Tend not to be truthful about how much they eat and everything to do with food.
•Like food and feel hungry. However, it is the consequences of eating that frighten them.

People with anorexia may also become obsessed with what other people are eating.

People with anorexia often restrict themselves to certain types of food. Eating food may even become like a ritual. For example, each time you eat, you have to cut your food into very small pieces. You may think frequently about your weight and even weigh yourself most days or even several times a day. It is also common to feel cold most of the time and to have irregular sleeping patterns. You might also find yourself having poor concentration.

What are the health risks with anorexia nervosa?

Health risks are caused by undereating (starvation) and by the methods used to get rid of eaten food (vomiting, excess laxatives, etc). Problems that may occur include the following:

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Irregular periods

Many women with anorexia have irregular periods, as hormone levels can be affected by poor diet. Their periods may even stop altogether or they may find that their periods have never started, especially if they started having eating problems when they were younger. Some women with anorexia may be infertile (unable to have a baby).

Chemical imbalances in the body

These are caused either by repeated vomiting or by excess use of laxatives – for example, a low potassium level which may cause tiredness, weakness, abnormal heart rhythms, kidney damage and convulsions. Low calcium levels can lead to tetany (muscle spasms).

Thinning of the bones (osteoporosis)

This is caused by a lack of calcium and vitamin D and can lead to easily fractured bones. In addition, the risk of getting osteoporosis increases if you are a woman and your periods have stopped. This is because oestrogen in your body protects your bones from osteoporosis and the levels of oestrogen in your body reduce when your periods stop.

Bowel problems

These may occur if you take a lot of laxatives. Laxatives can damage the bowel muscle and nerve endings. This may eventually result in permanent constipation and also sometimes abdominal pains.

Swelling of hands, feet and face

This is usually due to fluid disturbances in the body.

Teeth problems

These can be caused by the acid from the stomach rotting away the enamel with repeated vomiting.

Anaemia

Having a diet low in iron can lead to anaemia. This can make you feel weaker and more tired than normal. Dizzy spells and feeling faint can also occur.

Depression

It is common to feel low when you have anorexia. Some people develop clinical depression, which can respond well to treatment. It is important to talk to your doctor about any symptoms of depression you may have. Many people find they become more moody or irritable.

Hair and skin problems

You may find you have downy hair on your body and also the hair on your head becomes thinner. Many people with anorexia also have dry, rough skin.

What is the cause of anorexia nervosa?

The exact cause is not fully understood. Part of the cause is a fear of getting fat but it is not just as simple as that. Different causes possibly work together to bring on the condition. These may include the following:
•The pressure from society and the media to be thin is thought to play a part. This is probably why anorexia is much more common in westernised countries.
•Personality and family environment probably play a role too. People with anorexia often have poor self-esteem (not much self-confidence) and commonly feel that they have to be perfectionists. Often there are disturbed family relationships. All sorts of emotions, feelings and attitudes may contribute to causing anorexia.
•There may be some genetic factor. We know this from studies of families with identical twins. If one twin has anorexia then the other has a 1 in 2 chance of getting it. This tells us that the condition may have a genetic part. However, because not every twin gets it, there are other factors too.

Are any tests needed?

Although there is no test to diagnose anorexia, your doctor may wish to do some tests. These may include blood tests to check for complications of anorexia – for example, anaemia, potassium levels, kidney or liver problems or a low glucose level. An ECG hear tracing (electrocardiography) may be advised to check for an irregular heart rhythm.

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Bulimia nervosa
What is the treatment for anorexia nervosa?

The aim of treatment is to:
•Reduce risk of harm (and death) which can be caused by anorexia.
•Encourage weight gain and healthy eating.
•Reduce other related symptoms and problems.
•Help people become both physically and mentally stronger.

You are likely to be referred to a specialist mental health team which includes psychiatrists, psychologists, nurses, dietitians and other professionals. If you have more severe anorexia, you may be referred to a specialist eating disorder unit.

The sort of treatments that may be offered include the following:

Help with eating

Having regular meals is better. Even if you only eat small meals it is beneficial to the body to eat at least three times a day. You should try to be honest (with yourself and other people) about the amount of food you are actually eating. You should reduce the number of times you weigh yourself; try to weigh yourself only once a week. It may be useful to keep an eating diary to write down all the food that you eat.

Psychological (talking) treatments

For example, cognitive behavioural therapy (CBT), cognitive analytic therapy (CAT), interpersonal psychotherapy (IPT) and focal psychodynamic therapy. Talking treatments help to look at the reasons why you may have developed anorexia, and aim to change any false beliefs that you may have about your weight and body, and to help show you how to identify and deal with emotional issues. Talking treatments take time and usually require regular sessions over several months. Treatment may also involve other members of your family going to meetings to discuss any family issues.

Antidepressant medication

This may be advised in addition to talking treatments if you also develop depression. These are not always recommended if you are younger than 18 years old.

Treatment of any physical or teeth problems that may occur

This may include taking potassium supplements, having dental care and trying not to use laxatives or water tablets. You may be recommend to take hormones (for example, the oral contraceptive pill) to increase levels of oestrogen in your body to help strengthen your bones.

Self-help measures may be of benefit

There are a number of self-help books and guides available. These provide methods on how to cope with and overcome anorexia. (Beat – the Eating Disorders Association listed at the end – may be able to suggest current titles.) They are not suitable for everyone, particularly if your anorexia is severe.

Some people with more severe anorexia may need to have a short stay in hospital.

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What is the outlook (prognosis)?

With treatment, anorexia can take weeks or even many months to improve. It can take several years for people with anorexia to become completely better. Many people find they still have issues with food, even after treatment, but they are more in control and can lead happier, more fulfilled lives.

Unfortunately, some people with anorexia die from causes related to anorexia. Causes of death include infections, dehydration, blood chemical imbalances (such as low potassium levels) and even suicide.