Papers by Denise McConnell
Acta Psychiatrica Scandinavica, 2000
Improving knowledge about the cytochrome p450 system means that potential drug interactions can b... more Improving knowledge about the cytochrome p450 system means that potential drug interactions can be predicted. Interactions involving warfarin may be thus avoidable. As many patients who have suffered from a stroke or other thromboembolic events may also develop psychiatric disorder, knowledge about possible interactions with psychotropics is essential for prescribers. A Medline and hand search of published literature was complemented by contacting manufacturers. The antidepressants citalopram, nefazodone and sertraline have relatively low interaction potential with warfarin; fluoxetine and fluvoxamine relatively high. Carbamazepine appears to reduce warfarin's anticoagulant effect. Other antipsychotics, antidepressants and anxiolytics have only a theoretical risk of interaction. Lithium, gabapentin, sulpiride and amisulpride are predominantly renally excreted and so are not likely to interact with warfarin. Many psychotropics are involved in predictable interactions with warfarin. Drugs with a known low interaction potential should be chosen instead of those known or predicted to interact.
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Acta Psychiatrica Scandinavica, 2000
Improving knowledge about the cytochrome p450 system means that potential drug interactions can b... more Improving knowledge about the cytochrome p450 system means that potential drug interactions can be predicted. Interactions involving warfarin may be thus avoidable. As many patients who have suffered from a stroke or other thromboembolic events may also develop psychiatric disorder, knowledge about possible interactions with psychotropics is essential for prescribers. A Medline and hand search of published literature was complemented by contacting manufacturers. The antidepressants citalopram, nefazodone and sertraline have relatively low interaction potential with warfarin; fluoxetine and fluvoxamine relatively high. Carbamazepine appears to reduce warfarin's anticoagulant effect. Other antipsychotics, antidepressants and anxiolytics have only a theoretical risk of interaction. Lithium, gabapentin, sulpiride and amisulpride are predominantly renally excreted and so are not likely to interact with warfarin. Many psychotropics are involved in predictable interactions with warfarin. Drugs with a known low interaction potential should be chosen instead of those known or predicted to interact.
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Psychiatric Bulletin, 1996
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Psychiatric Bulletin, 1995
Seizures are a serious adverse effect of many antidepressants: most, if not all, tricyclics (TCAs... more Seizures are a serious adverse effect of many antidepressants: most, if not all, tricyclics (TCAs) lower the seizure threshold, some atypicals (e.g. maprotiline) are known to cause convulsions and seizures have been reported to occur with all selective serotonin reuptake inhibitors (SSRIs). Opinions vary on which is the safest antidepressant to use in epilepsy.
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Psychiatric Bulletin, 1995
Prolactin, a protein hormone synthesised and released by the anterior pituitary, promotes mammary... more Prolactin, a protein hormone synthesised and released by the anterior pituitary, promotes mammary tissue development and lactation and suppresses gonadotrophin secretion. Dopamine is the natural inhibitor of prolactin release and so standard antipsychotics, which block dopamine receptors, will cause prolactin levels to rise. This hyperprolactinaemia can lead to gynaecomastia, galactorrhoea, menstrual disturbances, a reduction in sperm count, erectile dysfunction, failure of ejaculation and reduced libido. Prolactin-related adverse effects are frequently encountered in patients on antipsychotics and are a cause of substantial morbidity.
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Psychiatric Bulletin, 1995
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Psychiatric Bulletin, 1996
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Psychiatric Bulletin, 1998
Aims and methodThe study aimed to assess the available data on the use of lamotrigine as a mood s... more Aims and methodThe study aimed to assess the available data on the use of lamotrigine as a mood stabilising agent. We reviewed all published and unpublished data available to us through a Medline search from 1987–1998 and from our own files, which include reference materials presented at conferences as well as published reports.ResultsMost of the data found were derived from case reports or open trials. We could find no published double-blind, placebo-controlled studies. The data from initial open trials suggest that lamotrigine may be effective in bipolar disorder, but futher data are required before specific treatment recommendations can be made.Clinical implicationsAt this early stage, there are too few data to recommend lamotrigine for first or second line therapy in bipolar disorder. However, initial reports are very promising and this agent may eventually be unequivocally shown to be useful in treating mania, hypomania, depression, rapid cycling and mixed affective states in p...
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Psychiatric Bulletin, 1997
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Psychiatric Bulletin, 1996
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Psychiatric Bulletin, 1995
As postpartum depression can occur in up to 10% of mothers, antidepressants will often be require... more As postpartum depression can occur in up to 10% of mothers, antidepressants will often be required in mothers who are breast-feeding. The judicious use of antidepressants is important since all psychotropic drugs cross into the breast milk. Drug excretion into breast milk occurs primarily by passive diffusion. Small, highly lipid soluble, unionised drugs diffuse more rapidly than other drugs. It must be remembered, however, that for those drugs with a high volume of distribution, such as the highly lipid soluble drugs, most of the drug is outside the plasma compartment, leaving only a small proportion free to transport from plasma to milk. Also, most lipophilic drugs are concentrated in hind milk which is richer in fat than fore milk. All of the antidepressants are highly lipid soluble with large volumes of distribution.
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Journal of Psychopharmacology, 2000
Treatment resistant or refractory schizophrenia is a difficult to define condition of largely unk... more Treatment resistant or refractory schizophrenia is a difficult to define condition of largely unknown prevalence. For 10 years, clozapine has been the standard treatment in this condition and is recognized unequivocally as being effective. However, clozapine is sometimes poorly tolerated and has the potential for severe toxicity. Partly as a result of this, other atypicals have recently been evaluated as treatments for refractory schizophrenia. In order to evaluate the evidence base relating to the drug treatment of refractory schizophrenia, we developed a refractoriness rating based on previous work. Using this rating, we assessed all trials of atypicals in schizophrenia unresponsive to at least one drug. Overall, clozapine was consistently shown to be effective in refractory schizophrenia, even when stringently defined. Data relating to olanzapine and risperidone are equivocal at best, and there is some evidence to suggest that they are less effective than clozapine. There is esse...
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Journal of Mental Health, 2003
Background: Anti-psychotic drugs are the cornerstone of the management of psychotic disorders but... more Background: Anti-psychotic drugs are the cornerstone of the management of psychotic disorders but despite their ubiquity in clinical practice, many psychiatric patients lack knowledge about the medication that is prescribed to them. Education for out-patients does improve knowledge but these patients are relatively stable. In response to calls from users on a psychiatric intensive care unit (PICU), a medication education group was provided. Aims: To explore the effectiveness of a medication education group on knowledge about drug treatment, insight and treatment adherence. Method: Fifteen patients with psychotic disorders according to DSM-111-R criteria recruited from a psychiatric intensive care unit, received two sessions of medication education. Changes post education were compared to 15 comparison patients, who did not attend a medication education group but were individually matched for primary treatment team, age, sex, number of admissions and length of illness. Results: The experimental group improved significantly over time compared with the comparison group on knowledge about drug treatment. Sessions of education also led to an increase in insight, but there were no effects on compliance or attitudinal/behavioural factors that influence medication compliance. Symptom change did not account for the improved knowledge. Conclusions: Group education on drug issues was successful in increasing knowledge of medication and insight even in an acutely ill group. Declaration of interest: TW occasional sponsorship to conference and lectures for a variety of pharmaceutical companies.
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Psychiatric Bulletin, 1996
The alcohol withdrawal syndrome is characterised by symptoms such as anxiety, insomnia, anorexia,... more The alcohol withdrawal syndrome is characterised by symptoms such as anxiety, insomnia, anorexia, nausea, tremor, sweating and disturbances in coordination. These symptoms tend to occur within 6 to 12 hours of alcohol-dependent patients stopping or reducing their alcohol intake. Less frequently, convulsions, hallucinosis and delirium tremens can occur. Delirium tremens (disturbed orientation, visual and auditory hallucinations, paranoid ideation and tremulousness) is the most serious complication of alcohol withdrawal and occurs in up to 5% of patients withdrawing from alcohol. If it is severe or poorly treated, death can occur. In the UK some clinicians use chlormethiazole while others favour chlordiazepoxide. This article will examine and compare the use of these two drugs.
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Psychiatric Bulletin, 1997
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Psychiatric Bulletin, 1995
Clozapine is well known to be an effective treatment for neuroleptic-resistant schizophrenia. How... more Clozapine is well known to be an effective treatment for neuroleptic-resistant schizophrenia. However, its use is complicated by a variable and delayed response and by a range of troublesome adverse effects. Current practice is usually to increase the dose initially to around 450 mg/day and then by small increments to a maximum of 900 mg/day according to response and tolerability. While this method is often successful, it has been suggested that a better way of optimising the dose of clozapine might be to monitor plasma concentrations of the drug.
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Psychiatric Bulletin, 1997
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Psychiatric Bulletin, 2003
EW has received lecture fees from Eli Lilly and Zanofisynolab, DD-M. has received funds from Eli ... more EW has received lecture fees from Eli Lilly and Zanofisynolab, DD-M. has received funds from Eli Lilly and AstraZeneca, TW has received unrelated and unrestricted charitable grants and lecture fees from Novartis, AstraZeneca and Janssen Pharmaceuticals, NW is now ...
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Papers by Denise McConnell