scholarly journals A survey of in-patient and out-patient antipsychotic prescriptions in Hong Kong

2008 ◽  
Vol 32 (3) ◽  
pp. 103-105 ◽  
Author(s):  
Gabriel B. K. Hung ◽  
H. K. Cheung
Keyword(s):  
Hong Kong ◽  
Consensus Statement ◽  
Clinical Implications ◽  
High Dose ◽  
Prescription Data ◽  
Antipsychotic Medications ◽  
Legal Implications ◽  
Low Levels ◽  
High Doses ◽  
Almost All

Aims and MethodAntipsychotic prescriptions were analysed for a large sample of psychiatric in-patients and out-patients in Hong Kong. Case notes for patients receiving high doses were reviewed and compared with the most recent consensus statement issued by the Royal College of Psychiatrists.ResultsDemographic and prescription data were obtained from 1254 in-patients and 19 986 out-patients. Antipsychotic medications were prescribed to 1129 in-patients and 7520 out-patients, with 9.2% of in-patients and 1.8% of out-patients receiving a high dose. Almost all case notes failed to record the clinical indications for high-dose prescribing or that the patient had been informed. Electrocardiograms were performed in a very small proportion of patients receiving a high dose.Clinical ImplicationsLow levels of adherence to established guidelines for high-dose antipsychotic prescription were found in this study, with clinical and medico-legal implications. The results of this study highlight the need for staff education and regular audit of antipsychotic doses in the in-patient and out-patient setting.

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 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 Clozapine antipsychotic polypharmacy: audit of use and patient monitoring

2013 ◽  
Vol 37 (10) ◽  
pp. 322-325 ◽  
Author(s):  
Sam Wilson ◽  
Ross Hamilton ◽  
John Callender ◽  
Angela MacManus ◽  
Sheila Howitt ◽  
...  
Keyword(s):  
Antipsychotic Medication ◽  
Patient Monitoring ◽  
Dose Range ◽  
Clinical Implications ◽  
High Dose ◽  
Antipsychotic Medications ◽  
Dose Monitoring ◽  
Wide Range

Aims and methodWe audited prescribing within our area to ascertain how widespread the practice of antipsychotic polypharmacy using clozapine was, and whether it was being carried out within existing standards, including those of high-dose monitoring when required.ResultsData on 169 patients were reviewed in year one, rising to 193 in year three. Around 30% of patients on clozapine received additional antipsychotic medication. A disturbingly low proportion of patients on clozapine whose antipsychotic polypharmacy brought them into the high-dose range were being monitored appropriately after three audit cycles (the proportion rose from 10% in cycle 1 to 28% in cycle 3). A wide range of additional antipsychotic medications was used.Clinical implicationsClozapine antipsychotic polypharmacy was prevalent at just below a third of all patients in this review. Prescribers should be alert to the fact that clozapine antipsychotic polypharmacy can push patients into the high-dose range and ensure appropriate monitoring.

scholarly journals Monitoring patients on high-dose antipsychotics

1998 ◽  
Vol 22 (11) ◽  
pp. 671-674 ◽  
Author(s):  
Joan M. Barber ◽  
Jennifer Connaughton ◽  
Morag Wright
Keyword(s):  
Antipsychotic Medication ◽  
Consensus Statement ◽  
Journal Club ◽  
Clinical Implications ◽  
High Dose ◽  
Cardiac Events ◽  
Risk Avoidance ◽  
Similar Improvement ◽  
Prescribing Behaviour ◽  
New System

Aims and methodFollowing the publication of the 1994 Consensus Statement on the use of high-dose antipsychotic medication, we identified our high-dose patients and undertook an audit of the recommended physical investigations. The patients were identified by scrutiny of prescription records. Data were collected retrospectively at six-monthly intervals for four audit cycles. Results were fed back to clinicians at the hospital journal club.ResultsThe percentage of patients identified in the high-dose category fell from 35 to 23% over 18 months. Electrocardiograph monitoring of the group increased from 5 to 63%. Other tests showed a similar improvement. A very small number of abnormal results was shown. There were no untoward cardiac events.Clinical implicationsIntroduction of the standards of physical monitoring advised in the Consensus Statement has implications of cost to the NHS to be balanced against risk avoidance for patients. The number of abnormalities detected in our population was low. Changing prescribing behaviour in response to reported abnormal findings proved unexpectedly slow and a new system was required.

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 Hidden high-dose antipsychotic prescribing: effects of p.r.n. doses

1998 ◽  
Vol 22 (11) ◽  
pp. 675-677 ◽  
Author(s):  
John Milton ◽  
John Lawton ◽  
Mark Smith ◽  
Ann Buckley
Keyword(s):  
Antipsychotic Medication ◽  
Antipsychotic Drugs ◽  
Consensus Statement ◽  
Antipsychotic Treatment ◽  
High Dose ◽  
Junior Doctors ◽  
Drug Prescribing ◽  
Junior Staff ◽  
Actual Use ◽  
High Doses

Aims and methodThe Royal College of Psychiatrists' Consensus Statement on “The use of high-dose antipsychotic medication’ suggests only fully qualified psychiatrists (MRCPsych) should recommend the prescribing of high-dose antipsychotic treatment. We observed changes in anti-psychotic prescribing in two surveys of psychiatric in-patients conducted eight and 32 months after publication of the Consensus Statement.ResultsOverall mean chlorpromazine equivalent doses of antipsychotic drugs reduced between the surveys. When p.r.n. (as required) prescribing (usually done by junior doctors) is included, mean potential doses and numbers of patients who might receive ‘high-doses' increases substantially, although the reduction between surveys in total mean dose and proportion of patients on high-dose antipsychotic medication is preserved, and the actual use of p.r.n. medication was low (4–5% of p.r.n. prescriptions).Clinical implicationsWe recommend the development of local guidelines for junior staff concerning antipsychotic drug prescribing, regular monitoring of p.r.n. medication by consultants, and pharmacists' involvement in reviews of patients prescribed high-dose antipsychotic medication.

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.

Double-Blind Study of Imipramine versus Phenelzine in Melancholias and Dysthymic Disorders

1987 ◽  
Vol 151 (5) ◽  
pp. 639-642 ◽  
Author(s):  
J. Vallejo ◽  
C. Gasto ◽  
R. Catalan ◽  
M. Salamero
Keyword(s):  
Major Depression ◽  
Blind Study ◽  
Dysthymic Disorder ◽  
Clinical Implications ◽  
High Dose ◽  
Double Blind Study ◽  
Double Blind Trial ◽  
Double Blind ◽  
Blind Trial ◽  
High Doses

In a 6-week double-blind trial, the efficacy of imipramine and high dose phenelzine were compared in the treatment of Major Depression with Melancholia, and Dysthymic Disorder (DSM-III). Both drugs were found to be equally efficacious in the treatment of 32 patients suffering from Major Depression. In 32 Dysthymic patients, phenelzine in high doses was found to be superior to imipramine. The clinical implications of these findings are discussed.

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 Photobiomodulation with LEDs And Laboratory Parameters in the Contexts of Oral Mucositis After High-Dose Methotrexate in Children

2021 ◽  
Author(s):  
Isabella Melo Brito Ferreira ◽  
Marco Tulio Brazão-silva ◽  
José Miguel Alves Junior ◽  
Kristianne Porta Santos Fernandes ◽  
Douglas Magno Guimaraes
Keyword(s):  
Febrile Neutropenia ◽  
Oral Mucositis ◽  
Liver Toxicity ◽  
High Dose ◽  
Laboratory Parameters ◽  
Low Levels ◽  
Low Incidence ◽  
High Doses ◽  
Relationship Of ◽  
The Relationship

Abstract Purpose The present, retrospective cohort study evaluated the efficacy of photobiomodulation (PBM) with LEDs to prevent and treat oral mucositis (OM) in pediatric patients receiving high doses of MTX, and the relationship of the occurrence of OM with laboratory parameters as possible risk factors for the development of OM. Methods The medical records of children who received high doses of MTX (> 2g/m2) and photobiomodulation with LEDs were reviewed. Development of OM, hepatic and renal function, hemogram, delayed MTX excretion, febrile neutropenia were analyzed. Results Only 28 cases of OM were observed in the 358 cycles of high-dose MTX analyzed. Oral mucositis was associated with low levels of hemoglobin (p < 0.0001), hematocrits (p < 0.0001), ALT (p < 0.0001), and AST (p = 0.002). The risk of developing OM was associated with AST (OR 7.24; 95%CI 2.56–20.45), urea (OR 6.95; 95%CI 1.49–32.42), hemoglobin (OR 6.04; 95%CI 2.33–15.64), and febrile neutropenia (OR 4.41; 95%CI 2.89–15.73). This risk increases when these parameters are associated. Conclusion The low incidence of mucositis, compared with the literature, indicates that PBM can prevent and reduce the severity of OM, as well as hospitalization time. The risk of OM development is associated with febrile neutropenia, hematological, and kidney and liver toxicity, with the risk increasing when these factors are associated.

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