Antipsychotic Polypharmacy and High Doses in a Rural Portuguese Community Mental Health Service

Introduction: Antipsychotic polypharmacy (APP) and high dose (APHD) remain a common practice in the treatment of severe mental illness, even though they are not supported by current international guidelines. Methods: We aimed to establish the prescribing patterns of antipsychotics in a community mental health service in a rural setting, to determine the prevalence of APP and APHD treatment and to identify associated factors. Results: We identified 284 patients. APP was present in 46.5% patients and was associated to younger age, single status, more previous psychiatric admissions, and anticholinergic prescription. Prescription of APHD was observed in 14.4% patients and was associated with previous inpatient admissions, being prescribed with a first generation long‑acting injectable antipsychotic and anticholinergics. We also found that APP and APHD were mutually associated. Conclusion: Despite current guidelines, we found prevalences of APP and APHD of 46.5% and 14.4%, respectively. Further studies are necessary to better evaluate the antipsychotic prescription patterns in Portugal.

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Changing prescribing patterns in an Irish community mental health service

Irish Journal of Psychological Medicine ◽

10.1017/ipm.2017.63 ◽

2017 ◽

Vol 37 (1) ◽

pp. 8-14

Author(s):

R. Rowntree ◽

N. McCarthy ◽

L. Feeney

Keyword(s):

Mental Health ◽

Mental Health Service ◽

Community Mental Health ◽

Health Service ◽

Business Intelligence ◽

Community Mental Health Services ◽

Mental Illnesses ◽

Prescribing Patterns ◽

Community Mental Health Service ◽

Time Period

ObjectivesMedication is an important component of the treatment of many mental illnesses. Very little information is available about the particular medications that are being prescribed by community mental health services and how this has changed over time. We set out to obtain details of psychiatric medications being prescribed by one Irish community mental health service.MethodAll prescribing by the Cluain Mhuire Community Mental Health Service became electronic during 2004. Using Business Intelligence software, we obtained details of all psychiatric medications prescribed from 2005 to 2016. We compared numbers of prescriptions written in the first 6 years (2005–2010) with the following 6 (2011–2016).ResultsOlanzapine was the most commonly prescribed medication throughout but its use declined by one-quarter over the study period. Clozapine, quetiapine, aripiprazole and haloperidol prescribing increased. Prescriptions for mood stabilisers and antidepressants fell by 25%. Sedative prescriptions declined by almost 50%. Absolute numbers of prescriptions written for methylphenidate and pregabalin were small but increased dramatically over the time period.ConclusionsThis community mental health service prescribed less of most psychiatric medications in 2016, than had been the case in 2005. This is despite an increase in the numbers of patients seen over the same period. It is not clear if this pattern is echoed in other services.

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Off-label prescribing in people with recurrent depressive disorder attending a community mental health service

The Psychiatrist ◽

10.1192/pb.bp.110.030783 ◽

2011 ◽

Vol 35 (3) ◽

pp. 84-89 ◽

Cited By ~ 1

Author(s):

Chinedu E. Uzoechina ◽

Pieter Hilvering ◽

Cathryn Rogers ◽

Sinead O'Brien ◽

Ananth Pullela ◽

...

Keyword(s):

Mental Health ◽

Mental Health Service ◽

Community Mental Health ◽

Health Service ◽

Depressive Disorder ◽

Treatment Plan ◽

Antipsychotic Agents ◽

High Dose ◽

Community Mental Health Service ◽

Off Label

Aims and methodWe investigated deliberate and inadvertent off-label prescribing in individuals with recurrent depressive disorder attending a community mental health service.ResultsOff-label prescribing occurred in 87 of 226 people with recurrent depressive disorder (38%) and involved antipsychotic agents (41), maintenance benzodiazepine use (33), antidepressant polypharmacy (28), high-dose antidepressants (19) and use of antidepressants outside of the recommended age range (16). Off-label prescribing was part of a deliberate and documented treatment plan for a half (n = 43) of individuals. Participants receiving off-label prescribing had higher total Health of the Nation Outcome Scale (HoNOS) scores, were attending more frequently and were older and had more chronic illness duration. Inadvertent off-label prescribing was related to higher scores on the behavioural disturbance subscale of the HoNOS.Clinical implicationsOff-label prescribing is a common phenomenon in people with recurrent depressive disorder and relates to greater illness severity and chronicity. Although off-label prescribing is frequently deliberate, in many cases it is undesirable and unplanned.

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