scholarly journals Use of high dose antipsychotic medication

1997 ◽  
Vol 21 (9) ◽  
pp. 566-569 ◽  
Author(s):  
Graeme Yorston ◽  
Alison Pinney
Keyword(s):  
Antipsychotic Medication ◽  
Royal College ◽  
Recommended Dose ◽  
British National Formulary ◽  
High Dose ◽  
National Formulary ◽  
Number Of Patients ◽  
Novel Method ◽  
Antipsychotic Prescribing ◽  
High Doses

An audit of antipsychotic prescribing was carried out on community and in-patient samples. A novel method of expressing total daily antipsychotic dose as a percentage of the British National Formulary maximum recommended dose was used. Of 226 patients who had been prescribed antipsychotics, 16 (7%) were found to be on high closes. Their medical notes were examined to ascertain whether the Royal College of Psychiatrists guidelines were being followed. Recommendations on ways in which practice could be improved were made and a re-audit was carried out. The number of patients receiving high doses fell to 6 (3%) out of 206.

scholarly journals Chlorpromazine equivalents and percentage of British National Formulary maximum recommended dose in patients receiving high-dose antipsychotics

2000 ◽  
Vol 24 (4) ◽  
pp. 130-132 ◽  
Author(s):  
Graeme Yorston ◽  
Alison Pinney
Keyword(s):  
Recommended Dose ◽  
British National Formulary ◽  
High Dose ◽  
National Formulary ◽  
High Potency ◽  
Patients At Risk ◽  
Risk Patients ◽  
Low Toxicity ◽  
High Doses ◽  
Flupenthixol Decanoate

Aims and MethodsThe study compared two methods of identifying patients prescribed high doses of antipsychotic medication among in-patients and out-patients in Buckinghamshire. High doses were defined as those in excess of 1000 mg chlorpromazine equivalents (CPZE) per day or more than 100% of the maximum recommended dose in the British National Formulary (BNF).ResultsA total of 258 patients were identified as being prescribed antipsychotics, 30 of whom received high doses. There was 93% concordance between the two methods for identifying these patients. Nine of the 12 patients who had been prescribed high potency (> 1000 mg CPZE/day) but low toxicity (> 100% BNF maximum) therapy were receiving flupenthixol decanoate.A group of six high-risk patients were identified who had been prescribed lower potency drugs at supra-maximal doses.Clinical ImplicationsExpressing total antipsychotic dose as a percentage of the BNF maximum is easy to understand and calculate. It helps to ensure patients at risk of antipsychotic toxicity are easily identified to ensure monitoring guidelines can be followed.

scholarly journals Neuroleptic prescribing in an adolescent psychiatric in-patient unit

1996 ◽  
Vol 20 (9) ◽  
pp. 538-540 ◽  
Author(s):  
K. Lowe ◽  
H. Smith ◽  
A. Clark
Keyword(s):  
Clinical Practice ◽  
Children And Adolescents ◽  
Antipsychotic Medication ◽  
Royal College ◽  
Psychotic Disorders ◽  
Consensus Statement ◽  
Comprehensive Evaluation ◽  
High Dose ◽  
Age Group ◽  
Antipsychotic Prescribing

The Royal College of Psychiatrists' consensus statement suggests that prescribing high dose antipsychotic medication in children and adolescents should rarely be necessary. Our objective was to study the prescribing of antipsychotic medication in a regional adolescent unit during a three-year period. We found that antipsychotic prescribing on this unit is common in psychotic disorders and often high closes are required. This is not in keeping with the recommendations of the consensus statement. Review of clinical practice on other adolescent units is needed, together with a more comprehensive evaluation of the outcome of psychotic disorders in this age group.

scholarly journals High-dose antipsychotic treatment in clinical practice

1999 ◽  
Vol 23 (11) ◽  
pp. 661-664 ◽  
Author(s):  
Philip J. Tyson ◽  
Ann M. Mortimer ◽  
Jason A Wheeler
Keyword(s):  
Clinical Practice ◽  
Antipsychotic Medication ◽  
Royal College ◽  
Treatment Compliance ◽  
Antipsychotic Treatment ◽  
Clinical Implications ◽  
High Dose ◽  
Dose Treatment ◽  
High Dose Treatment ◽  
High Doses

Aims and methodA trust-wide audit of antipsychotic prescription was conducted in order to investigate the prevalence of high-dose treatment in a population with schizophrenia and assess compliance with Royal College of Psychiatrists' guidelines on the use of high doses. Details of antipsychotic medication were recorded and in cases of high-dose treatment compliance with the College's guidelines was assessed.ResultsSixteen out of 361 patients (4%) were receiving high-dose medication. At re-audit this figure fell to four patients (1%). High-dose treatment comprised of a combined depot and oral medication in most cases. There was poor compliance with the College's guidelines.Clinical implicationsThe study stresses the importance of monitoring patients on high-dose antipsychotics, particularly when taken in combination.

scholarly journals Antipsychotic prescribing in light of the consensus statement of the College

1997 ◽  
Vol 21 (7) ◽  
pp. 408-410 ◽  
Author(s):  
K. L. Newton ◽  
R. Murthy ◽  
J. Qureshi
Keyword(s):  
General Hospital ◽  
Royal College ◽  
Medical Staff ◽  
Consensus Statement ◽  
District General Hospital ◽  
Recommended Dose ◽  
High Dose ◽  
Prescribing Practices ◽  
Retrospective Survey ◽  
Antipsychotic Prescribing

A retrospective survey was undertaken to evaluate the prescribing practices of medical staff in a District General Hospital in light of the Consensus Statement by the Royal College of Psychiatrists on the use of high dose antipsychotics (1993). Two per cent of 247 patients were prescribed a higher than recommended dose of antipsychotic. None of these cases had been prescribed ‘supra-BNF doses of antipsychotic on a regular basis, but with the addition of ‘as required’ (PRN) medication the recommended dose was exceeded. In only one patient was the high dosage administered. A further analysis of these patients is made.

scholarly journals Use of high-dose depot neuroleptics

1999 ◽  
Vol 23 (6) ◽  
pp. 339-342 ◽  
Author(s):  
N. Purandare ◽  
L. Aitken ◽  
P. Joshi ◽  
C. S. Thomas
Keyword(s):  
Medical Records ◽  
British National Formulary ◽  
Clinical Implications ◽  
High Dose ◽  
National Formulary ◽  
Number Of Patients ◽  
Depot Neuroleptics ◽  
Depot Medication

Aims and methodsTo identify and reduce the number of patients receiving depot neuroleptics above the British National Formulary maximum. The medical records were scrutinised and individual consultants were informed of the results.ResultsFor the team involved in this audit there was a significant reduction in the prescription of high-dose depot medication, but this did not generalise to other teams.Clinical implicationsDifferent teams should repeat the audit and a new depot card has been developed.

Clinical use of High-Dose Neuroleptics

1994 ◽  
Vol 164 (1) ◽  
pp. 94-96 ◽  
Author(s):  
Steven R. Hirsch ◽  
Thomas R. E. Barnes
Keyword(s):  
British National Formulary ◽  
High Dose ◽  
Clinical Use ◽  
National Formulary ◽  
Public Concern ◽  
Neuroleptic Treatment ◽  
Clinical Issues ◽  
Small Minority ◽  
Dose Treatment ◽  
High Dose Treatment

There has been increasing public concern about the risks of high-dose antipsychotic (neuroleptic) treatment, arising in part from an, as yet unproven, association between high-dose treatment and death in a small minority of patients. The clinical issues related to the use of neuroleptics in doses exceeding the maximum recommended in theBritish National Formulary(BNF) were discussed at the Psychopharmacology Subcommittee. When, if ever, should the recommended doses be exceeded?

scholarly journals High-dose antipsychotic medication

1996 ◽  
Vol 20 (11) ◽  
pp. 676-680 ◽  
Author(s):  
Peter L. Cornwall ◽  
Fuad Hassanyeh ◽  
Caprice Horn
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Practice ◽  
Antipsychotic Medication ◽  
Antipsychotic Drugs ◽  
Maximum Dose ◽  
High Dose ◽  
National Formulary ◽  
Physical Status ◽  
High Dose Treatment

We audited the use of high-dose antipsychotic drugs in patients admitted to a special (intensive) care unit over two periods. Five out of 57 patients in the first sample and three out of 62 in the second were treated with a single antipsychotic drug above the British National Formulary maximum dose. The proportion of patients treated with antipsychotic drugs such that the total dose in chlorpromazine equivalents was greater than 1000 mg, fed. The audit showed improvements in clinical practice, particularly with respect to the onset of, indication for and outcome of high-dose treatment and in monitoring the patients' physical status.

The impact of a change in prescribing policy on antipsychotic prescribing in a general adult psychiatric hospital

2014 ◽  
Vol 31 (3) ◽  
pp. 167-173 ◽  
Author(s):  
J. Kelly ◽  
F. Kelly ◽  
K. Santlal ◽  
S. O’Ceallaigh
Keyword(s):  
Mental Health ◽  
Psychiatric Hospital ◽  
Antipsychotic Medication ◽  
High Dose ◽  
Evidence Based ◽  
Second Generation Antipsychotics ◽  
Before And After ◽  
Antipsychotic Prescribing ◽  
Clinically Significant ◽  
The Impact

ObjectivesTo examine the impact of a change in local prescribing policy on the adherence to evidence-based prescribing guidelines for antipsychotic medication in a general adult psychiatric hospital.MethodsAll adult in-patients had their clinical record and medication sheet reviewed. Antipsychotic prescribed, dose prescribed and documented indications for prescribing were recorded. This was done before and after the implementation of the change in hospital antipsychotic prescribing policy.ResultsThere were no significant differences in age, sex, Mental Health Act status, psychiatric diagnosis or documented indications for prescribing multiple or high dose antipsychotics between the two groups. There was an increase in the preferential prescribing of multiple second-generation antipsychotics (p=0.01) in the context of a significant reduction in the prescribing of multiple antipsychotics overall (p=0.02). There were no significant reductions in prescribing of mixed generations of antipsychotics (p=0.12), high dose antipsychotics (p=1.00) or as required (PRN) antipsychotics (p=0.74).ConclusionsChanges in local prescribing policy can improve adherence to quality prescribing guidelines and cause clinically significant improvements in patterns of prescribing in a general adult psychiatric hospital.

scholarly journals How well do psychiatric trainees interpret electrocardiographs

1996 ◽  
Vol 20 (11) ◽  
pp. 651-652 ◽  
Author(s):  
James P. Warner ◽  
Julia A. Gledhill ◽  
Frankie Connell ◽  
John G. Coghlan
Keyword(s):  
Antipsychotic Medication ◽  
Royal College ◽  
Qt Interval ◽  
Consensus Statement ◽  
High Dose ◽  
Do So

The consensus statement by the Royal College of Psychiatrists recommended that patients on high dose antipsychotic medication receive regular electro-cardiographic monitoring to identify prolongation of the QT interval. A survey of trainee psychiatrists in three hospitals investigated the accuracy with which trainees could identify this abnormality and found only 20% could do so.

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