Psychiatric Patients - General Monitoring and Care
Description Recommendations for Specific Medicines Description Nursing staff are required to monitor users with serious mental illness between medical or psychiatric doctor visits. Regular monitoring with documented nursing notes in the file should occur monthly to 6- monthly depending on the severity of the illness and the risk of relapse, aggression, absconding or poor adherence, with referral
Recommendations for Specific Medicines
Description
Nursing staff are required to monitor users with serious mental illness between medical or psychiatric doctor visits.
Regular monitoring with documented nursing notes in the file should occur monthly to 6- monthly depending on the severity of the illness and the risk of relapse, aggression, absconding or poor adherence, with referral as required.
Monitoring includes:
- A mental state enquiry and examination.
- A brief psychosocial assessment.
- A risk assessment for harm to self or others with referral if deemed high risk.
- Adherence support.
- Women: family planning, pregnancy counselling, supportive home visits in childcare.
- General health: screen at baseline and annually - weight and body mass index, blood pressure (See: Hypertension), finger-prick blood glucose test for diabetes (See: Type 2 Diabetes Mellitus, Adults), HIV (See: HIV and AIDS), and tuberculosis (See: Pulmonary Tuberculosis (TB)).
- Lifestyle advice for obesity, smoking, alcohol, other substances, and high-risk sexual behaviour or victim of abuse.
Recommendations for Specific Medicines include
- Antipsychotic medicines:
- Examples: haloperidol, risperidone, flupenthixol decanoate, zuclopenthixol decanoate.
- If metabolic effects (e.g., weight gain, hyperglycaemia, hyperlipidaemia) occur, refer to a dietician and encourage regular exercise. If needed, manage dyslipidaemia (See: Prevention of ischaemic heart disease and atherosclerosis).
- Lithium:
- The therapeutic range is 0.8–1.0 mmol/L in acute mania, 0.6–0.8 mmol/l for prevention of mania and 0.4–0.8 mmol/l for prevention of depressive relapse.
- Monitor lithium concentration and eGFR every 6 months (3-monthly in elderly or those with medical comorbidity).
- Monitor TSH and calcium concentrations annually.
- Women of childbearing potential must be on family planning; refer all pregnant women on lithium immediately (See caution on lithium in Adult Hospital Level STGs: Mental Health Conditions and Substance Misuse - Bipolar And Related Disorders).
- Valproic acid and carbamazepine: Avoid in women of childbearing potential.
- If alternate treatment cannot be recommended and these agents are required, give:
- Folic acid, oral, 5 mg daily; and ensure reliable contraception.
- If alternate treatment cannot be recommended and these agents are required, give:
CAUTION
Valproic acid is teratogenic, and children born to women taking valproic acid during pregnancy are at significant risk of birth defects (10%) and persistent developmental disorders (40%). Valproic acid is contra-indicated during pregnancy and in women of child-bearing potential and should be avoided. If no alternative, acknowledgment of risk must be signed: https://www.sahpra.org.za/wp-content/uploads/2022/08/GLF-CEM-PV-S01_v1-Valproate-Annual-Risk-Acknowledgement-Form
Click here for the Valproate Annual Risk Acknowledgement form pdf
Standard Treatment Guidelines and Essential Medicines List for South Africa Primary Healthcare Level_Chapter 16: Mental Health Conditions_NEMLC Recommendations for Medicine Amendments 2020_2023