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 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 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 Specialised in-patient psychiatric service for women

1999 ◽  
Vol 23 (1) ◽  
pp. 31-33 ◽  
Author(s):  
Doro Kohen
Keyword(s):  
Inner City ◽  
Mental Health Professionals ◽  
Psychiatric Patients ◽  
Psychiatric Service ◽  
Psychiatric Ward ◽  
Clinical Implications ◽  
Admission Criteria ◽  
Single Gender ◽  
Staffing Levels ◽  
Acute Psychiatric Ward

Aims and methodTo describe one of the first psychiatric services in the inner-city especially designated for female psychiatric patients with severe mental illness.ResultsThe referral system, the staffing levels and the admission criteria have been established following needs of the patients, especially young women with perinatal problems and women from ethnic minorities.Clinical implicationsThis single gender acute psychiatric ward has received welcome attention from mental health professionals and management at every level, and it is hoped that further discussion will help to clarify future policies and guidelines on all aspects of this venture.

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 The outcome of rough sleepers with mental health problems admitted to a psychiatric ward

1999 ◽  
Vol 23 (3) ◽  
pp. 164-166 ◽  
Author(s):  
Zoë C. Graham ◽  
Frankie S. Salton-Cox ◽  
Peter D. White
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Mental Health Problems ◽  
Psychiatric Ward ◽  
Clinical Implications ◽  
Involuntary Admission ◽  
Psychiatric Admission ◽  
Acute Psychiatric Ward

Aims and methodTo describe the outcome of rough sleepers admitted to an acute psychiatric ward; the professional most involved with the person was interviewed.ResultsEleven out of 12 people admitted with a psychosis were accommodated and in touch with mental health services at follow-up (median of 21 months) compared with two out of 10 people, admitted without a psychosis, accommodated and four out of 10 people in touch with mental health services.Clinical implicationsPsychiatric admission with good aftercare is worthwhile for rough sleepers with a psychosis, even if it requires involuntary admission.

scholarly journals On-site testing for drugs of misuse in the acute psychiatric ward

2009 ◽  
Vol 33 (9) ◽  
pp. 343-346 ◽  
Author(s):  
Sharif Ghali
Keyword(s):  
Drug Testing ◽  
Assessment Tool ◽  
Ease Of Use ◽  
Psychiatric Ward ◽  
Site Testing ◽  
Laboratory Methods ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Acute Psychiatric Wards ◽  
Acute Psychiatric Ward

Aims and MethodTo explore why and how on-site urine drug testing is performed in in-patient settings. Data were collected by questionnaire in four acute psychiatric wards.ResultsThe most commonly cited reasons for testing were suspected drug use and as a routine part of the admission procedure. On-site testing was typically favoured over laboratory methods owing to the rapid turnaround of results and ease of use. In 81% of cases the result of the tests had no effect on immediate management. the majority of staff had not received formal training in their use.Clinical ImplicationsClinical use of on-site drug tests does not reflect their established limitations. Guidance is required to direct staff in the use of this commonly used assessment tool.

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.

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 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.

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