Digest

News NHS spends £1 billion on recession depression Prescribing for anxiety or depression since the onset of the economic recession has cost the NHS in England about £1 billion, a survey by the Co‐operative Pharmacy has revealed ( www.co‐operative.coop ). Freedom of Information requests to 150 PCTs show that total antidepressant and anxiolytic prescribing increased from 39.5 million items in 2007/08 to 49.8 million in 2010/11, although annual spending fell from £291 million to £258 million. Citalopram (12.1 million items prescribed in 2010/11) and amitriptyline (8.8 million) were the most popular antidepressants whereas fluoxetine accounted for 5.2 million items. Diazepam was the most widely prescribed anxiolytic, with 1.5 million items. Prescribing was highest in the North‐West of England. Room to improve, says CQC There were a total of 45 248 admissions and detentions under the Mental Health Act in 2010/11 and a total of 3834 uses of community treatment orders (CTOs) in the NHS and independent sector, according to the annual report of the Care Quality Commission ( www.cqc.org.uk ). The number of people subject to a CTO increased by 29 per cent so that, overall, the number of people subject to the Act increased by 5 per cent to 20 938 by 31 March 2011. Despite some examples of good practice, the CQC says there is still ‘significant scope for improvement’ in some hospitals in obtaining consent to treatment. It recommends that providers ensure that staff take refresher courses on consent to treatment, with training provided in a range of formats, and assessment in revalidation and appraisal programmes. Help to commission dementia services Guidance on commissioning dementia services in the new commissioning environment has been published by The Alzheimer's Society and the communications agency MHP Health Mandate ( www.endoflifecareforadults.nhs.uk ). The recommendations for the Government and the NHS on providing dementia services in Common and Complex were developed in a policy workshop for eminent stakeholders. They include developing models of integrated care, improving data monitoring and utilisation, improving funding flows, and incorporating quality assessment and user involvement. Resources for autism The Department of Health has funded a series of online training resources and booklets to improve awareness and understanding of autism. Developed jointly with professional societies, the resources are intended for nurses, GPs, psychiatrists and social care services. Further information is available at www.dh.gov.uk/health/2011/12/autism‐training‐resources . NICE guideline for service users NICE has published a clinical guideline on improving the experience of people who use adult NHS mental health services ( www.nice.org.uk ). Service user experience in adult mental health: improving the experience of care for people using adult NHS mental health services (CG136) promotes person‐centred care, taking account of the needs, preferences and strengths of service users. NICE says that service users should be able to make informed decisions about their care and treatment in partnership with health and social care professionals. The guideline is supported by a NICE quality standard on NHS service user experience in adult mental health. Help for vulnerable children and adults Development of NICE guidance on social and emotional wellbeing for vulnerable children under five years old was paused while new policy was being formulated. Following publication of Supporting Families in the Foundation Years from the Departments for Education and Health in July 2011, the project has restarted, with guidance expected in October. Meanwhile, the Department of Health has published guidance and a toolkit to provide support and interventions for vulnerable individuals. Building Partnerships, Staying Safe ( www.dh.gov.uk/health/2011/12/guidancevulnerable‐adults ) describes policies and procedures for good governance for workers and organisations. Further information is available from the Strategic Health Authority's regional prevent co‐ordinator or by emailing the Department of Health central prevent team at: prevent@dh.gsi.gov.uk. Teriflunomide for MS reviewed The National Prescribing Centre has published a review and commentary on the TEMSO trial of teri flunomide in the treatment of multiple sclerosis ( www.npc.nhs.uk/rapidreview/?p=4775 ). An application for marketing authorisation is expected in the first half of this year. Teriflunomide, which blocks T and B lymphocyte proliferation and function, showed efficacy comparable to interferon beta‐1a in the Phase III TENERE trial in relapse prevention, with fewer patients discontinuing treatment. Nalmefene goes to EMA for treatment of alcohol dependence Lundbeck has applied to the European Medicines Agency (EMA) for marketing authorisation of the opioid system modulator nalmefene for the treatment of alcohol dependence, developed jointly with innovator Biotie. Phase III clinical trials suggest that nalmefene, which is taken orally as needed, may more than halve the number of heavy drinking days and total alcohol consumption, with evidence that its effects are maintained after one year of treatment. National Audit Office criticises neurological services ‘Services for people with long‐term neurological conditions are not as good as they ought to be, despite a large increase in spending,’ according to the National Audit Office ( www.nao.org.uk ), adding ‘Progress in implementing the Department's strategy has been poor and local organisations lack incentives to improve the quality of services.’ Its report, Services for People with Neurological Conditions, is highly critical of the lack of progress since publication of the 2005 National Service Framework for Long‐term Conditions, saying spending has increased by 40 per cent over four years but the Department of Health does not know what has been achieved. There is significant variation in access to services, patients are not given enough information, on going care is fragmented and social and health services badly coordinated. US to get inhaled antipsychotic? The US Food and Drug Admin istration (FDA) has been advised to approve inhaled loxapine for the acute treatment of agitation associated with schizophrenia or bipolar disorder in adults. Inhaled loxapine (5mg and 10mg) reduced Positive and Negative Syndrome Scale (PANSS)Excited Component score within 10 minutes compared with placebo in 344 people with schizophrenia and acute agitation, with no unexpected adverse effects ( Br J Psychiatry 2011;198:51‐8). However, it may cause bronchial spasm and the FDA's Psycho pharmacologic Drugs Advisory Committee recommended approval on a slim majority vote subject to implementation of a risk mitigation plan for respiratory events and monitoring for one hour after treatment. Dementia care patchy, says RCPsych The first national audit of dementia care has found that care in general hospitals in England and Wales often falls short of the standards expected. The audit, available at www.rcpsych.ac.uk and conducted jointly by the Royal College of Psychiatrists, other professional societies and The Alzheimer's Society, found lack of leadership, poor record keeping, insufficient staff training, a poor physical environment and a lack of guidance for family involvement in many hospitals. Eighty‐nine per cent of eligible hospitals in England and Wales submitted data, making this the most reliable assessment of services available. Primhe Conference The Primhe Annual Conference – Integrated primary care mental health and wellbeing –‐ demystified – is being held on Thursday 28th June at Stafford University Campus. The purpose of the event is to: Explain the national wellbeing and prevention picture and the fit with primary care Have an opportunity to talk to, question and influence UK leaders in healthcare and wellbeing Learn powerful practical techniques you can use in your practice Share experience and knowledge in practical wellbeing Deliver an enjoyable conference that gives every delegate new knowledge and real‐world skills that can be applied in their roles as clinicians and teachers.Who should attend? GPs, commissioners, primary and community healthcare professionals, service users and their families and carers wishing to keep up to date with developments in well being policy nationally. Anyone with an interest in learning and using the latest proven wellbeing techniques to give patients practical and fast help.For further information and booking details, see page 5. Serotonin syndrome The Wessex Drug and Medicines Information Centre has published a review of serotonin syndrome, explaining the underlying mechanism and identifying which drugs are most likely to cause it. It explains how the syndrome is a form of poisoning rather than an idiosyncratic drug reaction. Copies can be downloaded from www.nelm.nhs.uk . Copyright © 2012 John Wiley & Sons, Ltd.