Mental Health NHS Foundation Trust Research Articles

Obituary.

Chris Halek, director of nursing at Coventry and Warwickshire NHS Partnership Trust, died last month after a long illness. Ms Halek was appointed director of nursing in June 2007, having been deputy director of nursing in Birmingham and Solihull Mental Health NHS Foundation Trust. Ms Halek was well known for her pioneering work in eating disorders.

Pathological Gambling Associated With Modafinil

Back to table of contents Previous article Next article LETTERFull AccessPathological Gambling Associated With ModafinilN. Tarrant,A. E. Cavanna,H. Rickards,N. TarrantSearch for more papers by this author,A. E. CavannaSearch for more papers by this author,H. RickardsSearch for more papers by this author,Published Online:1 Jan 2010https://doi.org/10.1176/jnp.2010.22.1.123.e27AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Pathological gambling is defined by the DSM-IV-TR as a clinical condition characterized by persistent and maladaptive gambling behaviors; these are severe enough to disrupt the patient’s life and relationships and are not due to a manic episode. 1 Based on gambling behavior phenomenology, comorbid psychiatric conditions, family history, and demographics, it has been proposed that pathological gambling can present in three clinical subtypes: impulsive, obsessive-compulsive, and addictive. 2 Pathological gambling has been reported in association with dopamine agonists used in Parkinson’s disease, 3 restless legs syndrome, and endocrine disorders. The European Union Pharmacovigilance Working Party recommends that summaries of product characteristics for dopamine agonists carry a warning about pathological gambling as a side effect. To the best of our knowledge, there are currently no published reports of pathological gambling associated with modafinil, and there have been no Yellow Card reports submitted to the U.K. Commission on Human Medicines.Case ReportMr. C was referred to the neuropsychiatry clinic at the age of 39 with a 12-year history of narcolepsy (HLA-DBQ1*0602 positive) and associated cataplexy. He had no significant medical or psychiatric history and was being treated with modafinil, 300 mg daily in two divided doses. Initially there was a good response, but a developing tolerance prompted the referral. The patient had a prior history of minor gambling but reported a 10-fold increase in his slot-machine use, spending £20,000–£30,000 a year, since commencing modafinil. The patient was hesitant to increase the dose in case his gambling habit worsened.It was decided to withhold modafinil for a 2-month trial. At the next review, the patient complained of increased somnolence without the medication but reported that his gambling habit had considerably decreased. His somnolence had necessitated restarting modafinil, and his gambling had increased once again. He was started on clomipramine, 50 mg at night, with a view to titrating up to 150 mg/day to alleviate his compulsive behavior.Eighteen months later, he was taking clomipramine, 40 mg at night, and had discontinued modafinil. He reported that he was no longer gambling.DiscussionModafinil is currently licensed in the United Kingdom for the symptomatic relief of excessive sleepiness associated with narcolepsy, obstructive sleep apnea, and moderate to severe chronic shift-work sleep disorder. Its use is also under study for cocaine dependence and attention-deficit/hyperactivity disorder. In this patient, we observed a clear-cut temporal relationship between modafinil treatment and a gambling habit, with an improvement after withdrawal and worsening on rechallenge. The precise mechanism of action of modafinil is still unclear. 4 Modafinil is thought to increase wakefulness by blocking dopamine clearance through inhibition of the dopamine transporter and has been shown to increase cortical and caudate dopamine concentrations. 5 The effects of modafinil on impulsive/compulsive symptoms have been poorly investigated. A recent controlled study suggested that modafinil can have bidirectional effects on pathological gambling patients. Specifically, it has been shown to increase desire to gamble, disinhibition, and risky decision-making in low impulsivity subjects, while decreasing these indexes in high impulsivity subjects. 6 Overall, reward-seeking behavior, especially pathological gambling-compulsive/addictive subtype, may represent a possible adverse effect of modafinil via potentiation of the dopaminergic system in predisposed individuals. University of Birmingham Medical School, Birmingham, UKDepartment of Neuropsychiatry, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK Department of Neuropsychiatry, Institute of Neurology, London, UKDepartment of Neuropsychiatry, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK

How Non-Medical Prescribing may Impact on the Service Development of a Clozapine Clinic

The purpose of this article is to discuss the possible implications of applying non medical prescribing practices to a Clozapine clinic in the Rotherham, Doncaster and South Humber Mental Health NHS Foundation Trust (RDASH). To reflect on such issues the current working practices, and the way in which non medical prescribing may be used, will be considered, thus identifying the perceived need and evidence base for a non medical prescribing role to improve the quality of care for service users within the Clozapine clinic. The apparent expectations of non medical prescribing from clinic staff, colleagues and service users will be considered including the suggested benefits, barriers to effective working, fears, concerns and practical implications.

Rules of engagement: reaching out to communities

With the right form of engagement, so-called hard-to-reach communities can play vital roles in shaping and improving services. This article describes some of the innovative ways in which Birmingham and Solihull Mental Health NHS Foundation Trust engages with local communities and offers some advice to senior nurses and managers who want to make contact with people in their localities

Towards establishing the meaning of advanced practice nursing in a mental health care trust

This paper reports on a study undertaken in one mental health NHS foundation trust in the UK, which sought to examine to what extent advanced practice nursing could contribute to advancing new ways of working in the future. The literature on advanced nursing in the UK is critically discussed and where availability permits, reference is made to international literature. The findings of a survey of nurses with a Masters degree or acting at advanced level are reported and discussed. Though the data reported here are largely confirmed by similar studies, nevertheless the insights provided should alert organisations to the complexity of introducing new roles during a time of radical change in the health care system. Despite the efforts of a highly motivated trust, respondents identified barriers and obstacles that were of such significance that some were forced to rethink their readiness to embrace the role. It is hoped that the recommendations derived from this study may assist other organisations at a similar stage of implementing advanced nursing practice roles.