Survey of Depot Antipsychotic Prescribing in Southern Adelaide

2005 ◽  
Vol 13 (3) ◽  
pp. 253-257 ◽  
Author(s):  
Peter Herriot ◽  
Kamran Kheirani
Keyword(s):  
Mental Health ◽  
Blood Glucose ◽  
Community Mental Health ◽  
Dose Reduction ◽  
Involuntary Movement ◽  
Dose Interval ◽  
Community Mental Health Service ◽  
The Past ◽  
Administration Interval ◽  
Depot Antipsychotic

Objective: Depot antipsychotic medication (DAP) is widely used in the treatment of schizophrenia and related disorders. The objectives of this study were to (i) determine whether DAP was being prescribed in accordance with established guidelines in terms of dose, interval of administration and indications; and (ii) assess the quality of the assessment and documentation of tardive dyskinesia (TD) as well as blood glucose and lipid abnormalities. Methods: The survey was carried out between April and June 2003 at all three public hospital affiliated community mental health centres located in the southern region of Adelaide. Data were extracted from three sources: depot prescription charts, community mental health service case notes and hospital case notes. Results: Two hundred and sixty-one patients were receiving DAP. The majority (89%) had a diagnosis of schizophrenia or schizoaffective disorder. The DAP prescribed most frequently was zuclopenthixol decanoate (57%) at a modal dose of 200 mg and a modal administration interval of 2weeks. Fifty-three per cent of patients had at least one dose reduction during the course of treatment. Four per cent of patients had a case note documented diagnosis of TD. Fifty-seven per cent of patients had at least one blood glucose test in the past year, with nearly half showing high results. Forty-seven per cent of patients had at least one lipid study in the past year, with more than half having high total cholesterol and 22% having high triglycerides. Conclusion: The results of this study indicate that DAP is being used mostly for the treatment of schizophrenia and related disorders, which is in agreement with established evidence-based guidelines. The finding of at least one documented attempt at DAP dose reduction or extension of interval of administration in approximately half of the patients receiving DAP is encouraging and may have an impact on reducing the likelihood of TD. A formal TD surveillance programme using a screening tool such as the Abnormal Involuntary Movement Scale is recommended. In addition, more frequent evaluation of blood glucose and lipid levels is needed.

Audit on Prescribing Practice of Depot Antipsychotic Injections in the Adult Community Mental Health Service

2017 ◽  
Vol 41 (S1) ◽  
pp. S277-S277
Author(s):  
M. Ray ◽  
S. Rao
Keyword(s):  
Mental Health ◽  
Side Effects ◽  
Community Mental Health ◽  
Practice Guidelines ◽  
Best Practice ◽  
Community Mental Health Service ◽  
Dose Frequency ◽  
Depot Antipsychotic ◽  
Prescribing Practice ◽  
Good Standard

IntroductionThere are a number of good standard practices available for prescribing long acting antipsychotics. Adherence to these guidelines will minimise any harm to the service users.AimsTo compare depot antipsychotic prescribing practice with good standard practice guidelines of BNF, Trust and Maudsley guidelines.ObjectivesTo compare practice with standards in the areas of:– licensed indication;– dose/frequency range;– avoiding poly-pharmacy;– regular review of clinical and side effects.MethodsCase notes of a randomly selected sample of 30 patients from the depot clinic at the City East Adult Community Mental Health Team Leicester, UK were retrospectively investigated. The data collected was analysed and the results were produced. Compliance with the best practice guidelines was calculated and recommendations made based on the findings.ResultsOne hundred percent compliance was noticed in licensed indications and dose/frequency within BNF range. However, 14% patients received poly-pharmacotherapy, 86% had regular outpatient review, but only 46% had review of side effects.ConclusionsBetter quality of documentations by the clinicians, improvised technology to elicit automatic review reminders, introduction of checklist for clinics to include review of all clinically important information, wider dissemination of the findings of this investigation, and re-auditing practice to explore impact of this investigation was recommended.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Patient-controlled benzodiazepine dose reduction in a community mental health service

2005 ◽  
Vol 22 (2) ◽  
pp. 42-45 ◽  
Author(s):  
Bangaru Raju ◽  
David Meagher
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Community Mental Health ◽  
Health Service ◽  
Dose Reduction ◽  
Community Mental Health Service ◽  
Anxiety Management ◽  
Valuable Adjunct ◽  
Benzodiazepine Use

AbstactObjectives: We report a patient-controlled benzodiazepine discontinuation programme in a generic multidisciplinary community mental health service.Method: A prescribing audit identified suboptimal benzodiazepine use which stimulated a discontinuation programme [prescribing policy, psychoeducation, anxiety management] to encourage benzodiazepine cessation. Benzodiazepine status was re-assessed at 12 and 24 month follow-ups.Results: 158 patients were receiving benzodiazepines at study onset. At 12 month follow-up, 68 of these were still receiving benodiazepines. This was due to discontinuation (n = 32), dose reduction (n = 26) and service dropout (n = 71). Benzodiazepine status at follow-up was predicted by attendance at anxiety management sessions (p = 0.01) and shorter duration of benzodiazepine use (p = 0.005). Patients attending anxiety management sessions were 2.5 times more likely to reduce use. Discontinuation followed four patterns: (a) rapid and complete discontinuation (n = 19); (b) total discontinuation in a gradual manner (n = 13); (c) partial dose reduction without total discontinuation (n = 18) and (d) almost total discontinuation with continued low-dose use (n = 8). The patients that achieved total discontinuation were younger (p = 0.01) and in receipt of benzodiazepine agents for a shorter duration (p = 0.009). At 24 month follow-up only three patients had relapsed into benzodiazepine use and a further 13 had achieved total discontinuation.Conclusions: Many chronic benzodiazepine users can achieve lasting discontinuation with patient-controlled dose tapering. Patient refusal and service dropout are common during discontinuation programmes. Anxiety management is a valuable adjunct to discontinuation.

scholarly journals The Greek Hybrid Version of the Assertive Community Treatment Model: A Perspective View between Challenges and Limitations

Psych ◽  
2021 ◽  
Vol 3 (4) ◽  
pp. 792-799
Author(s):  
Vaios Peritogiannis ◽  
Fotini Tsoli
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Community Mental Health ◽  
Health Services ◽  
Mental Health Professionals ◽  
Assertive Community Treatment ◽  
Rural Areas ◽  
Community Treatment ◽  
Community Mental Health Service ◽  
Perspective View

The Assertive Community Treatment (ACT) model of care has been long considered to be effective in the management of patients with severe mental illness (SMI) in most Western countries. The implementation of the original ACT model may be particularly challenging in rural and remote communities with small and dispersed populations and lack of adequate mental health services. Rural programs may have to adapt the model and modify the ACT fidelity standards to accommodate these limitations, and this is the rationale for the introduction of more flexible, hybrid ACT models. In rural Greece, the so called Mobile Mental Health Units (MMHUs) are well-established community mental health services. For patients with SMI that have difficulties engaging with treatment services, the new hybrid ACT model has been recently launched. The objective of this manuscript is to present the recently launched hybrid ACT model in rural areas in Greece and to explore the challenges and limitations in its implementation from the experience of a team of mental health professionals with ACT experience. Referral criteria have not been strictly set, but the number of previous relapses and hospitalizations is taken under consideration, as well as the history of poor treatment adherence and disengagement from mental health services. The main limitation in the implementation of the hybrid ACT service is that it has been introduced in several areas in the absence of a pre-existing community mental health service. This may impact referrals and limit focus on the difficult cases of patients with SMI, thus making the evaluation of the model inapplicable.

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