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Depression is a mood disorder that may increase risk for the development of insulin resistance (IR) and type 2 diabetes (T2D), and vice versa. However, the mechanistic pathway linking depression and T2D is not fully elucidated. The aim of this narrative review, therefore, was to discuss the possible link between depression and T2D. The coexistence of T2D and depression is twice as great compared to the occurrence of either condition independently. Hyperglycaemia and dyslipidaemia promote the incidence of depression by enhancing inflammation and reducing brain serotonin (5‐hydroxytryptamine [5HT]). Dysregulation of insulin signalling in T2D impairs brain 5HT signalling, leading to the development of depression. Furthermore, depression is associated with the development of hyperglycaemia and poor glycaemic control. Psychological stress and depression promote the development of T2D. In conclusion, T2D could be a potential risk factor for the development of depression through the induction of inflammatory reactions and oxidative stress that affect brain neurotransmission. In addition, chronic stress in depression may induce the development of T2D through dysregulation of the hypothalamic–pituitary–adrenal axis and increase circulating cortisol levels, which triggers IR and T2D. [ABSTRACT FROM AUTHOR]

Aims: To examine the prevalence of potentially hazardous prescribing in the prison setting using prescribing safety indicators (PSIs) and explore their implementation and use in practice. Methods: PSIs were identified and reviewed by the project team following a literature review and a nominal group discussion. Pharmacists at 2 prison sites deployed the PSIs using search protocols within their electronic health record. Prevalence rates and 95% confidence intervals (CIs) were generated for each indicator. Semi‐structured interviews with 20 prison healthcare staff across England and Wales were conducted to explore the feasibility of deploying and using PSIs in prison settings. Results: Thirteen PSIs were successfully deployed mostly comprising drug–drug interactions (n = 9). Five yielded elevated prevalence rates: use of anticholinergics if aged ≥65 years (Site B: 25.8% [95%CI: 10.4–41.2%]), lack of antipsychotic monitoring for >12 months (Site A: 39.1% [95%CI: 27.1–52.1%]; Site B: 28.6% [95%CI: 17.9–41.4%]), prolonged use of hypnotics (Site B: 46.3% [95%CI: 35.6–57.1%]), antiplatelets prescribed with nonsteroidal anti‐inflammatory drugs without gastrointestinal protection (Site A: 12.5% [95%CI: 0.0–35.4%]; Site B: 16.7% [95%CI: 0.4–64.1%]), and selective serotonin/norepinephrine reuptake inhibitors prescribed with nonsteroidal anti‐inflammatory drugs/antiplatelets without gastrointestinal protection (Site A: 39.6% [95%CI: 31.2–48.4%]; Site B: 33.3% [95%CI: 20.8–47.9%]). Prison healthcare staff supported the use of PSIs and identified key considerations to guide its successful implementation, including staff engagement and PSI 'champions'. To respond to PSI searches, stakeholders suggested contextualised patient support through intraprofessional collaboration. Conclusion: We successfully implemented a suite of PSIs into 2 prisons, identifying those with higher prevalence values as intervention targets. When appropriately resourced and integrated into staff workflow, PSI searches may support prescribing safety in prisons. [ABSTRACT FROM AUTHOR]

Aim: To develop a set of prescribing safety indicators related to mental health disorders and medications, and to estimate the risk of harm associated with each indicator. Method: A modified two‐stage electronic Delphi. The first stage consisted of two rounds in which 31 experts rated their agreement with a set of 101 potential mental health related prescribing safety indicators using a five‐point scale and given the opportunity to suggest other indicators. Indicators that achieved 80% agreement were accepted. The second stage comprised a single round in which 29 members estimated the risk of harm for each accepted indicator by assessing the occurrence likelihood and outcome severity using two five‐point scales. Indicators were considered high or extreme risk when at least 80% of participants rated each indicator as high or extreme. Results: Seventy‐five indicators were accepted in the first stage. Following the second stage, 42 (56%) were considered to be high or extreme risk for patient care. The 42 indicators comprised different types of hazardous prescribing, including drug‐disease interactions (n = 12), drug‐drug interactions (n = 9), inadequate monitoring (n = 5), inappropriate duration (n = 4), inappropriate dose (n = 4), omissions (n = 4), potentially inappropriate medications (n = 3) and polypharmacy (n = 1). These indicators also covered different mental health related medication classes, including antipsychotics (n = 14), mood stabilisers (n = 8), antidepressants (n = 6), sedative, hypnotics and anxiolytics (n = 6), anticholinergic (n = 6) and nonspecific psychotropics (n = 2). Conclusion: This study has developed the first suite of prescribing safety indicators related to mental health disorders and medications, which could inform the development of future safety improvement initiatives and interventional studies. [ABSTRACT FROM AUTHOR]