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Issue 3 February 2007 - Contents Other issues

The first issue of ‘best practice’ for 2007 focuses on some psychoactive drugs, which are often initiated in specialist practice, but managed in primary care. We concerntrate on three areas of prescribing: stimulant medications, lithium and antipsychotic medications.

The bpacnz team

Primary care plays a key role in the management of ADHD Select
Although the diagnosis and management of ADHD is primarily the responsibility of specialist multidisciplinary teams, primary care clinicians play important roles in improving outcomes for people with ADHD.
These roles include: making a provisional diagnosis and referring appropriately, assisting patients and their families to reach decisions on management options, facilitating and encouraging adherence to treatment regimens, monitoring for adverse effects and response to treatment, and discussing the future.
Monitoring for metabolic disorders in patients taking antipsychotic drugs Select
Individuals with serious mental illness have markedly increased rates of metabolic disturbances, including obesity, diabetes and lipid disorders. Treatment with antipsychotics can contribute to these problems along with lifestyle issues associated with severe illness. Concurrent medical illness is also common in this group, leading to increased morbidity and mortality particularly due to cardiovascular disease. The GP plays a key role in a multidisciplinary approach to patient management by ensuring on-going monitoring and advice to improve health outcomes. Many people taking antipsychotic drugs in the community will see their GP regularly in between specialist visits. Antipsychotics
Lithium in General Practice Select
Lithium remains a mainstay of treatment for bipolar disorder but dose individualisation, measurement of serum drug concentrations and monitoring for adverse reactions are vital in order to maximise therapeutic response. Lithium has a narrow therapeutic index. Drug interactions, changes in diet and fluid intake, illness and compliance can all markedly affect serum drug concentrations, reducing therapeutic response or causing toxicity. In most cases lithium will be started by a specialist but the General Practitioner has an important role to play to ensure optimal management. Lithium
Essentials Select