Prescribing in mental health

PRESCRIBING IN MENTAL HEALTH

As the duty doctor today, you are asked by the reception team to review and issue a patient’s prescription, as they are unable to re-issue it. After looking in the patient’s notes, you see that the patient has requested a repeat prescription of lithium for his bipolar disorder, initiated by the consultant psychiatrist 7 months ago. On reviewing recent investigations, you note that the patient’s last blood tests were carried out 6 months ago. He is also noted to have chronic kidney disease. The reception team have documented an attempt to telephone the patient to ask him to have a repeat blood test to monitor how he is responding to the new medication. The receptionist is leaving for the day and is keen to get this prescription as soon as possible.

  • Do you re-issue the prescription for the receptionist straight away?

  • How often and what do you need to monitor for patients’ being prescribed lithium?

  • How would you manage the non-attendance of the patient on a high-risk drug, not responding to monitoring requests?

 

Helpful links

  British National Formulary. www.bnf.org.
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  General Medical Council (2013) Good medical practice. Available at: www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/good-medical-practice (accessed 6 December 2019).
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  NHS (2009) National Patient Safety Agency. National Reporting and Learning Service: Patient Safety Alert (NPSA/2009/PSA005) Safer Lithium Therapy. Available at: www.sps.nhs.uk/wp-content/uploads/2018/02/2009-NRLS-0921-Safer-lithium-trt-2009.12.01-v1.pdf (accessed 10 December 2019).
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  NICE (2014) Bipolar disorder: Assessment and management. Available at: www.nice.org.uk/guidance/cg185 (accessed 6 December 2019).
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InnovAiT 10 Minutes scenarios highlight difficult areas of practice that GPs may struggle with and encourage discussion and debate. Summaries of previous discussions hosted on Doctors.net in partnership with the RCGP are available to view and download on the InnovAiT website: https://journals.sagepub.com/ino/tenminutescenarios

Conclusion: A brief 10 minute scenario looking at prescribing issues for patients on certain medication for a mental health condition.
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