Antipsychotic long-acting injections: Prescribing practice in the UK

BackgroundData from the USA, Australia and Europe suggest that the proportion of patients with schizophrenia prescribed an antipsychotic long-acting injection (LAI) varies from around a quarter to a third. Use of LAIs has been associated with male gender and younger age.AimsTo characterise the use of LAIs in people with schizophrenia in three clinical settings in the UK.MethodThe study used audit data from quality improvement programmes conducted by the Prescribing Observatory for Mental Health.ResultsLong-acting injections were found to be prescribed for between a quarter and a third of patients, depending on the clinical setting. Flupentixol, risperidone and zuclopenthixol were most commonly prescribed and were combined with an oral antipsychotic in half of cases, frequently constituting high-dose prescribing. The use of LAIs was not consistently associated with age, gender or ethnicity.ConclusionsAntipsychotic LAIs are commonly prescribed. We did not replicate previous findings with respect to demographic variables associated with their use.

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Antipsychotic and anticholinergic drug prescribing pattern in psychiatry:Implications for evidence - based practice

European Psychiatry ◽

10.1016/s0924-9338(11)72926-1 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 1221-1221

Author(s):

K.A.J. Al Khaja ◽

R.P. Sequeira ◽

M.K. Al-Haddad ◽

A.R. Al-Offi

Keyword(s):

Psychotic Disorders ◽

Anticholinergic Drug ◽

High Dose ◽

Evidence Based ◽

Prescribing Pattern ◽

Retrospective Audit ◽

Prescribing Practice ◽

Study Population ◽

Oral Antipsychotic ◽

Long Acting

ObjectivesTo determine the antipsychotic prescribing pattern and the prevalence of concurrent anticholinergic prescribing for patients with psychotic disorders.MethodsA retrospective audit of prescriptions issued for outpatients at the Psychiatric Hospital in Bahrain.ResultsAntipsychotic monotherapy was prescribed for 89.2% patients, whereas polytherapy with two- and three- drugs in 10.4 and 0.4%, respectively. Atypical antipsychotics were prescribed more often (67.7%) than typical antipsychotics. Risperidone and haloperidol were the most frequently prescribed antipsychotics. Majority of the study population (93.2%) were prescribed an oral antipsychotic, whereas 3.1% each were on depot preparation or on depot plus an oral antipsychotic. Long-acting risperidone injection was the only depot preparation prescribed. The mean antipsychotic dose expressed as chlorpromazine equivalents (CPZeq; mg/day) was 242 (220 for monotherapy and 414 for polytherapy). The prevalence of high dose antipsychotic (mean CPZeq>1000 mg/day) was 1.8%, prescribed at a mean CPZeq dose of 1531 (1925 for monotherapy and 1137 for polytherapy) mainly attributed to haloperidol. Anticholinergics were co-prescribed for almost two third of patients receiving antipsychotics, particularly for those on polytherapy (monotherapy 57.3%; polytherapy 87.5%). Antipsychotic polytherapy, high dose of antipsychotics and co-prescription of an oral with a depot antipsychotic preparation were strongly associated with concurrent prescription of anticholinergics. Procyclidine and orphenadrine were the most often prescribed anticholinergics.ConclusionAntipsychotic monotherapy is the common practice for outpatients with psychotic disorders. Some of the antipsychotic polytherapies, dosage strategies, and high prevalence of anticholinergic use are therapeutic issues that need to be addressed to foster evidence-based prescribing practice.

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No Going Back: Advantages of Ultrasound-Guided Upper Arm PICC Placement

Journal of the Association for Vascular Access ◽

10.2309/java.13-4-6 ◽

2008 ◽

Vol 13 (4) ◽

pp. 191-197 ◽

Cited By ~ 24

Author(s):

Liz Simcock

Keyword(s):

Success Rate ◽

Ultrasound Guided ◽

Upper Arm ◽

Exit Site Infection ◽

Catheter Migration ◽

Audit Data ◽

Change In Practice ◽

Before And After ◽

The Usa ◽

The Uk

Abstract Background, Method and Purpose: The use of peripherally inserted central catheters (PICCs) in the UK has been steadily increasing since they were first introduced in 1995. Ultrasound-guided upper arm placement - which has become prevalent in the USA over the last few years - is gradually attracting interest amongst PICC placers in the UK. The literature shows that upper arm placement improves insertion success rate (Hockley, Hamilton, Young, Chapman, Taylor, Creed et al, 2007; Hunter, 2007; Krstenic, Brealey, Gaikwad & Maraveyas, 2008) and patient satisfaction (Polak, Anderson, Hagspiel, & Mungovan, 1998; Sansivero, 2000; McMahon, 2002). Following a switch to upper arm placement at her institution, the author examined audit data from before and after the change in practice to see if there were other measurable clinical improvements. Results: Comparison of data from a four-year period shows that upper arm placement in our patient population increased insertion success rate and line longevity, while reducing exit site infection, thrombosis and catheter migration. Implications for Practice: This data shows that ultrasound-guided upper-arm placement improves patient outcomes. PICC placers still using the more traditional antecubital approach should consider a change in practice.

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Cessation and reduction in alcohol consumption and misuse after psychedelic use

Journal of Psychopharmacology ◽

10.1177/0269881119845793 ◽

2019 ◽

Vol 33 (9) ◽

pp. 1088-1101 ◽

Cited By ~ 19

Author(s):

Albert Garcia-Romeu ◽

Alan K Davis ◽

Fire Erowid ◽

Earth Erowid ◽

Roland R Griffiths ◽

...

Keyword(s):

Alcohol Consumption ◽

Alcohol Use ◽

Clinical Studies ◽

Online Survey ◽

Meta Analysis ◽

High Dose ◽

Clinical Settings ◽

Problematic Alcohol ◽

The Usa ◽

Problematic Alcohol Use

Background:Meta-analysis of randomized studies using lysergic acid diethylamide (LSD) for alcohol use disorder (AUD) showed large, significant effects for LSD efficacy compared to control conditions. Clinical studies suggest potential anti-addiction effects of LSD and mechanistically-related classic psychedelics for alcohol and other substance use disorders.Aims:To supplement clinical studies, reports of psychedelic use in naturalistic settings can provide further data regarding potential effects of psychedelics on alcohol use.Methods:An anonymous online survey of individuals with prior AUD reporting cessation or reduction in alcohol use following psychedelic use in non-clinical settings.Results:343 respondents, mostly White (89%), males (78%), in the USA (60%) completed the survey. Participants reported seven years of problematic alcohol use on average before the psychedelic experience to which they attributed reduced alcohol consumption, with 72% meeting retrospective criteria for severe AUD. Most reported taking a moderate or high dose of LSD (38%) or psilocybin (36%), followed by significant reduction in alcohol consumption. After the psychedelic experience 83% no longer met AUD criteria. Participants rated their psychedelic experience as highly meaningful and insightful, with 28% endorsing psychedelic-associated changes in life priorities or values as facilitating reduced alcohol misuse. Greater psychedelic dose, insight, mystical-type effects, and personal meaning of experiences were associated with a greater reduction in alcohol consumption, controlling for prior alcohol consumption and related distress.Conclusions:Although results cannot demonstrate causality, they suggest that naturalistic psychedelic use may lead to cessation or reduction in problematic alcohol use, supporting further investigation of psychedelic-assisted treatment for AUD.

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High-dose and combination antipsychotic prescribing in acute adult wards in the UK: The challenges posed by p.r.n. prescribing

The British Journal of Psychiatry ◽

10.1192/bjp.bp.107.042895 ◽

2008 ◽

Vol 192 (6) ◽

pp. 435-439 ◽

Cited By ~ 94

Author(s):

Carol Paton ◽

Thomas R. E. Barnes ◽

Mary-Rose Cavanagh ◽

David Taylor ◽

Paul Lelliott

Keyword(s):

Quality Improvement ◽

Clinical Practice ◽

Clinical Guidelines ◽

Standard Dose ◽

High Dose ◽

Quality Improvement Programme ◽

Prescribing Practice ◽

Improvement Programme ◽

Antipsychotic Prescribing ◽

The Uk

BackgroundClinical guidelines recommend the routine use of a single antipsychotic drug in a standard dose, but prescriptions for high-dose and combined antipsychotics are common in clinical practice.AimsTo evaluate the effectiveness of a quality improvement programme in reducing the prevalence of high-dose and combined antipsychotic prescribing in acute adult in-patient wards in the UK.MethodBaseline audit was followed by feedback of benchmarked data and delivery of a range of bespoke change interventions, and then by a further audit 1 year later.ResultsThirty-two services participated, submitting data for 3942 patients at baseline and 3271 patients at the 1-year audit. There was little change in the prevalence of high-dose (baseline 36%; re-audit 34%) or combined antipsychotic prescribing (baseline 43%; re-audit 39%). As required (‘p.r.n.’) prescriptions were the principal cause of both high-dose and combined antipsychotic prescribing on both occasions.ConclusionsThe quality improvement programme did not have a demonstrable impact on prescribing practice in the majority of services. Future efforts to align practice with clinical guidelines need to specifically target the culture and practice of p.r.n. prescribing.

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Inhaled corticosteroid use and risk COVID-19 related death among 966,461 patients with COPD or asthma: an OpenSAFELY analysis

10.1101/2020.06.19.20135491 ◽

2020 ◽

Cited By ~ 2

Author(s):

◽

Anna Schultze ◽

Alex J Walker ◽

Brian MacKenna ◽

Caroline E Morton ◽

...

Keyword(s):

Inhaled Corticosteroids ◽

Beta Agonist ◽

High Dose ◽

Unmeasured Confounder ◽

Risk Of Death ◽

Increased Risk ◽

Analyse Data ◽

Long Acting ◽

The Uk ◽

Primary Care Practices

AbstractBackgroundEarly descriptions of the coronavirus outbreak showed a lower prevalence of asthma and COPD than was expected for people diagnosed with COVID-19, leading to speculation that inhaled corticosteroids (ICS) may protect against infection with SARS-CoV-2, and development of serious sequelae. We evaluated the association between ICS and COVID-19 related death using linked electronic health records in the UK.MethodsWe conducted cohort studies on two groups of people (COPD and asthma) using the OpenSAFELY platform to analyse data from primary care practices linked to national death registrations. People receiving an ICS were compared to those receiving alternative respiratory medications. Our primary outcome was COVID-19 related death.FindingsWe identified 148,588 people with COPD and 817,973 people with asthma receiving relevant respiratory medications in the four months prior to 01 March 2020. People with COPD receiving ICS were at a greater risk of COVID-19 related death compared to those receiving a long-acting beta agonist (LABA) and a long-acting muscarinic antagonist (LAMA) (adjusted HR = 1.38, 95% CI = 1.08 – 1.75). People with asthma receiving high dose ICS were at an increased risk of death compared to those receiving a short-acting beta agonist (SABA) only (adjusted HR = 1.52, 95%CI = 1.08 – 2.14); the adjusted HR for those receiving low-medium dose ICS was 1.10 (95% CI = 0.82 – 1.49). Quantitative bias analyses indicated that an unmeasured confounder of only moderate strength of association with exposure and outcome could explain the observed associations in both populations.InterpretationThese results do not support a major role of ICS in protecting against COVID-19 related deaths. Observed increased risks of COVID-19 related death among people with COPD and asthma receiving ICS can be plausibly explained by unmeasured confounding due to disease severity.FundingThis work was supported by the Medical Research Council MR/V015737/1.

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Reducing high dose antipsychotic therapy (HDAT) in a community mental health team (CMHT)

BJPsych Open ◽

10.1192/bjo.2021.325 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S110-S111

Author(s):

Richard Walsh ◽

Sonn Patel ◽

Valentina Loddo ◽

Rebecca Fahy ◽

Elizabeth Walsh

Keyword(s):

Antipsychotic Medication ◽

Cumulative Dose ◽

Best Practice ◽

Baseline Survey ◽

High Dose ◽

Antipsychotic Therapy ◽

Daily Dose ◽

Prescribing Practice ◽

Oral Antipsychotic ◽

The Impact

AimsThe consensus statement (CR190) of The Royal College of Psychiatrists states that the benefit of prescribing HDAT does not outweigh the risk of the increased side effect burden. HDAT is defined as the “daily dose of a single antipsychotic exceeding the upper limit for that drug as stated in the Summary of Product Characteristic (SPC) or British National Formulary (BNF),” and as the cumulative daily dose of two or more antipsychotics (for combined prescription). The prevalence of HDAT has been shown to vary widely and protocols for monitoring poorly implemented. In 2018 we completed a baseline survey of the prevalence of HDAT within our CMHT. We assessed our prescribing practice as compared to seven best practice audit criteria, which were adopted. Our aim is to resurvey closing the audit loop to 1) establish the current prevalence of HDAT and 2) assess the impact the intervention on prescribing practice.MethodMulti-disciplinary case notes for all registered patients were studied. A database was created including sociodemographic details, chart diagnosis, and medication. The proportion of patients prescribed antipsychotic medication was identified. The dose of each medication was converted into a percentage of BNF maximum recommended dose for that drug. For combined antipsychotic prescription, the cumulative dose was obtained adding the single percentages together. Exceeding 100% was regarded as HDAT. All HDAT patients were assessed against identified audit criteria as outlined by the Humber NHS Foundation Trust.ResultOf a total of 246 patients, 177 (72%) were prescribed antipsychotic medication. Of these, 14 (8%) were in receipt of HDAT. This compared to 68% prescribed antipsychotics and 9% in receipt of HDAT in the baseline audit. The average cumulative dose for every category (oral medication, depot and both) was calculated with a range from 1% to 168% (mean = 70%) for oral antipsychotic (single/combined), 1% to 193% (mean = 50%) for depots and 20% to 257% (mean = 95%) for combination of oral and depot. This compares with ranges of 1.6% to 215% (mean = 44.3%) for oral antipsychotic (single/combined), 0.04% to 100% (mean = 25.8%) for depots and 21% to 425% (mean = 119.6%) for combination of oral and depot in the baseline audit. Similar to the baseline survey no patient met all seven audit criteria but there was better adherence overall with best practice guidance. Blood and ECG monitoring were the most consistent parameters measured.ConclusionLower HDAT was achieved post intervention. Results, whilst positive, indicate the need for ongoing audit to maintain best standards.

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An early mainstream economist from Hungary: István Varga (1897–1962)

Acta Oeconomica ◽

10.1556/aoecon.53.2003.2.4 ◽

2003 ◽

Vol 53 (2) ◽

pp. 195-213 ◽

Cited By ~ 1

Author(s):

K. Majoros

Keyword(s):

Austrian Economic ◽

National Income ◽

Anglo Saxon ◽

Turbulent Times ◽

The Usa ◽

New Ideas ◽

Modern Economic ◽

The Uk ◽

Economic Thinking ◽

Lasting Influence

The study introduces a Hungarian economic thinker, István Varga*, whose valuable activity has remained unexplored up to now. He became an economic thinker during the 1920s, in a country that had not long before become independent of Austria. The role played by Austria in the modern economic thinking of that time was a form of competition with the thought adhered to by the UK and the USA. Hungarian economists mainly interpreted and commented on German and Austrian theories, reasons for this being that, for example, the majority of Hungarian economists had studied at German and Austrian universities, while at Hungarian universities principally German and Austrian economic theories were taught. István Varga was familiar not only with contemporary German economics but with the new ideas of Anglo-Saxon economics as well — and he introduced these ideas into Hungarian economic thinking. He lived and worked in turbulent times, and historians have only been able to appreciate his activity in a limited manner. The work of this excellent economist has all but been forgotten, although he was of international stature. After a brief summary of Varga’s profile the study will demonstrate the lasting influence he has had in four areas — namely, business cycle research and national income estimations, the 1946 Hungarian stabilisation program, corporate profit, and consumption economics — and will go on to summarise his most important achievements.

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