scholarly journals Variation between services in polypharmacy and combined high dose of antipsychotic drugs prescribed for in-patients

2002 ◽  
Vol 26 (11) ◽  
pp. 418-420 ◽  
Author(s):  
Maria Harrington ◽  
Paul Lelliott ◽  
Carol Paton ◽  
Maria Konsolaki ◽  
Tom Sensky ◽  
...  
Keyword(s):  
Mental Health ◽  
Clinical Practice ◽  
Antipsychotic Drugs ◽  
Service Level ◽  
Case Mix ◽  
Clinical Implications ◽  
High Dose ◽  
Prescribing Practice ◽  
Acute Psychiatric Wards ◽  
High Doses

Aims and MethodA 1-day census provided an opportunity to examine the variation between 44 mental health services in the frequency of prescribing high doses and polypharmacy of antipsychotic drugs to in-patients on acute psychiatric wards.ResultsThe proportion of patients prescribed a high dose ranged 0–50% and simultaneous use of more than one antipsychotic drug ranged 12–71%. A number of case-mix variables explained 26% and 40%, respectively, of the variance between services on these two indicators of prescribing practice.Clinical ImplicationsServices with high rates of prescription of high dose or polypharmacy might consider a review of clinical practice and of service-level factors that might affect prescribing.

scholarly journals The influence of patient variables on polypharmacy and combined high dose of antipsychotic drugs prescribed for in-patients

2002 ◽  
Vol 26 (11) ◽  
pp. 411-414 ◽  
Author(s):  
Paul Lelliott ◽  
Carol Paton ◽  
Maria Harrington ◽  
Maria Konsolaki ◽  
Tom Sensky ◽  
...  
Keyword(s):  
Mental Health ◽  
Antipsychotic Medication ◽  
Antipsychotic Drugs ◽  
Clinical Implications ◽  
High Dose ◽  
Patient Factors ◽  
Younger Age ◽  
Patient Variables ◽  
Unexplained Variance ◽  
High Doses

Aims and MethodA1-day census, involving 3576 psychiatric in-patients prescribed antipsychotic medication, was conducted as a prelude to a multi-centre audit. The aim was to explore the extent to which a number of patient variables explain antipsychotic polypharmacy and the use of high doses of these drugs.ResultsPrescriptions of more than one type of antipsychotic drug were made for 50.5% of patients. Patient factors that influenced the probability of polypharmacy were: younger age, being male, detained under the Mental Health Act and on a rehabilitation or forensic ward, and a diagnosis of schizophrenia. The effect of ethnicity was not significant. Polypharmacy was the most powerful factor influencing the probability of being prescribed a high dose. Identified patient variables accounted for only 18% of the variance in dose prescribed.Clinical ImplicationsThe patient and clinician factors that account for the unexplained variance need to be identified.

scholarly journals The results of a multi-centre audit of the prescribing of antipsychotic drugs for in-patients in the UK

2002 ◽  
Vol 26 (11) ◽  
pp. 414-418 ◽  
Author(s):  
Maria Harrington ◽  
Paul Lelliott ◽  
Carol Paton ◽  
Chike Okocha ◽  
Richard Duffett ◽  
...  
Keyword(s):  
Mental Health ◽  
Antipsychotic Drugs ◽  
Clinical Implications ◽  
High Dose ◽  
National Formulary ◽  
National Guidelines ◽  
Consensus Statements ◽  
High Doses ◽  
The Uk ◽  
Audit Standards

Aims and MethodForty-seven UK mental health services participated in a 1-day audit of prescribing of antipsychotic drugs. Audit standards were derived from national guidelines and consensus statements.ResultsOf the 3132 patients, 20% were prescribed a total dose of antipsychotic medication above that recommended by the British National Formulary. The majority of case notes failed to record an indication for high-dose prescribing or that the patient had been informed; only 8% had undergone an electrocardiogram. Forty-eight per cent of patients were prescribed more than one antipsychotic drug.Clinical ImplicationsAntipsychotic prescribing for in-patients often runs counter to existing guideline recommendations. It is likely that many patients who are prescribed high doses or polypharmacy are unaware that their prescription is out of line with guideline recommendations and is inadequately monitored.

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 Polypharmacy and high-dose antipsychotics at the time of discharge from acute psychiatric wards

2011 ◽  
Vol 35 (8) ◽  
pp. 288-292 ◽  
Author(s):  
Tongeji E. Tungaraza ◽  
Uzma Zahid ◽  
Bhanumurthy Venkataramaiah
Keyword(s):  
Small Proportion ◽  
Psychiatric Ward ◽  
Clinical Implications ◽  
High Dose ◽  
National Formulary ◽  
Antipsychotic Medications ◽  
Acute Psychiatric Wards ◽  
High Doses ◽  
Acute Psychiatric Ward ◽  
Discharge Summaries

Aims and methodTo determine the extent of prescribed antipsychotic polypharmacy and high-dose antipsychotics at the time of discharge from an acute psychiatric ward. Copies of discharge summaries for patients between the ages of 18 and 65 were examined; only those that had antipsychotic medications at the time of discharge were included. Names and doses of antipsychotics and all other medications concurrently prescribed were recorded.ResultsA total of 651 discharge summaries were included in the study. Nearly a quarter of individuals were discharged on one antipsychotic as the only medication to take home; only 6.8% were discharged on a high-dose antipsychotic and of those on combinations 59.6% were on depot medications. Combining antipsychotics significantly predicted the use of high dose.Clinical implicationsMost patients were discharged on doses of antipsychotics within the British National Formulary limits; however, a small proportion is still sent home on high doses of antipsychotics. Combining antipsychotics remains the strongest predictor of high-dose antipsychotic use; clinicians need to be aware of this.

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.

scholarly journals Capacity, compliance and electroconvulsive therapy (ECT): the practice of ECT among consultant psychiatrists

2006 ◽  
Vol 30 (1) ◽  
pp. 13-15 ◽  
Author(s):  
Richard Law-Min ◽  
John Patrick Stephens
Keyword(s):  
Mental Health ◽  
Clinical Practice ◽  
Electroconvulsive Therapy ◽  
Best Practice ◽  
Response Rate ◽  
Common Law ◽  
Good Practice ◽  
Legal Framework ◽  
Clinical Implications ◽  
Clinical Vignettes

Aims and MethodThe aim of this study was to seek the views of consultant psychiatrists on the legal framework they would use when considering treatment with electroconvulsive therapy (ECT). A questionnaire, consisting of three clinical vignettes, was sent to 70 consultants in the Wessex rotation (East Dorset/Hampshire region).ResultsA total of 56 questionnaires were returned; a response rate of 80%. Most consultant psychiatrists agree when giving ECT to capacitated and non-consenting patients. However, there was a lack of consensus when dealing with seemingly incapacitated but compliant patients.Clinical ImplicationsMore clarification in this area is needed. Trusts can assist clinicians by devising their own policies based on nationally agreed standards of best practice. The treatment of mentally incapacitated but compliant patients is an area of practice where uncertainty exists. If proceeding under common law in such cases, it is good practice to discuss with relatives/carers and obtain a second opinion from a consultant colleague. The most recent Bournewood judgement and the new Mental Health Bill will have further implications for clinical practice.

scholarly journals Survey of long-stay patients on acute psychiatric wards

2008 ◽  
Vol 32 (10) ◽  
pp. 380-383 ◽  
Author(s):  
Martin Commander ◽  
Dharjinder Rooprai
Keyword(s):  
Mental Health ◽  
Acute Hospital ◽  
Clinical Implications ◽  
Clinical Expertise ◽  
Health Strategy ◽  
Hospital Patients ◽  
Acute Psychiatric Wards ◽  
Community Facilities ◽  
Acute Wards

Aims and MethodTo describe the profile of patients staying on acute wards for longer than 6 months and to compare staff appraisals of accommodation needs with patients' placements at 2 years.ResultsLong-stay patients consistently occupied around a fifth of all acute beds. the nursing and medical staff recommendations and patients' placements at 2 years showed only moderate agreement. Aside from remaining in hospital, patients were most likely to be living in a residential or nursing home at follow-up.Clinical ImplicationsThere is a need to sharpen the focus of mental health strategy on non-acute hospital provision and 24-h-staffed community facilities. In particular, it is important to recognise the contribution of clinical expertise to the assessment and placement of long-stay in-patients.

scholarly journals Acute in-patient psychiatry: how patients spend their time on acute psychiatric wards

2007 ◽  
Vol 31 (5) ◽  
pp. 167-170 ◽  
Author(s):  
Jonathan Radcliffe ◽  
Roger Smith
Keyword(s):  
Mental Health ◽  
Social Interaction ◽  
Group Activity ◽  
Clinical Implications ◽  
Opting Out ◽  
Acute Psychiatric Wards ◽  
Health Trust

Aims and MethodWe observed levels of social interaction and activity among in-patients on 16 acute psychiatric wards in 6 hospitals in a large mental health trust. Each ward was observed for 1 week and attendance at organised activities was audited over 3-week periods.ResultsAt any time during the day 84% of in-patients were socially disengaged and mainly inactive. On average only 4% of in-patients' time was spent in an organised group activity, with many in-patients opting out altogether. Provision and take-up of group activity programmes varied widely between wards.Clinical ImplicationsProvision of organised activity needs to be a higher priority in acute services, and there should be national and local standards for what should be provided. Concerted organisational strategies and assertive approaches by staff are needed to engage in-patients in group activity programmes.

scholarly journals Five-year follow-up of an evidence-based prescribing intervention

2008 ◽  
Vol 32 (5) ◽  
pp. 183-186 ◽  
Author(s):  
David Meagher ◽  
Ananth Pullela ◽  
Marek Meisinger ◽  
Niamh Geaney ◽  
Sinead O'Brien
Keyword(s):  
Clinical Implications ◽  
High Dose ◽  
Evidence Based ◽  
Community Mental Health Service ◽  
Prescribing Practices ◽  
Multidisciplinary Intervention ◽  
Prescribing Practice ◽  
Multifaceted Interventions ◽  
The Impact

Aims and MethodWe studied the impact of an evidence-based multidisciplinary intervention to reduce six sub-optimal aspects of psychotropic prescribing, combined as a Prescribing Practice Quality (PPQ) score over a 5-year follow-up period in a community mental health service.ResultsSub-optimal prescribing practices were significantly reduced after 1 year and these improvements were sustained at 5-year follow-up. The PPQ scores were significantly reduced (P<0.001) in both the overall population attending at each follow-up point as well as in the ever-present population (n=163). Use of high-dose antipsychotics and thioridazine ceased entirely; use of sedative hypnotic agents was less amenable to reduction.Clinical ImplicationsMultifaceted interventions can achieve sustained improvements in prescribing practices in real-world settings.

scholarly journals The Mental Health Act 1983

1999 ◽  
Vol 23 (9) ◽  
pp. 534-536 ◽  
Author(s):  
Vijay Bhatti ◽  
Jeremy Kenney-Herbert ◽  
Rosemarie Cope ◽  
Martin Humphreys
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Clinical Practice ◽  
Random Sample ◽  
Clinical Implications ◽  
The West ◽  
Mental Health Act ◽  
West Midlands

Aims and methodA one-in-five random sample (n=104) of practitioners approved under Section 12(2) of the Mental Health Act 1983 in the West Midlands was selected. Opinions were sought on issues relating to current law and potential reform.ResultsEighty-three (80%) doctors were interviewed. Over half (52%) stated that the term ‘mental illness' in the Act was unsatisfactory. Two-thirds (68%) specified the need for a review of legislation relating to treatment in the community.Clinical implicationsThere was a diversity of views. This is likely to be reflected in the clinical practice of those interviewed. Many respondents believed that there was a need for reform in specific areas of the Act.

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