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

Nottingham Healthcare NHS Trust, Duncan Macmillan House, Porchester Road, Nottingham NG3 6AA

John Lawton, Senior Pharmacist and Mark Smith

Clinical Audit Department, Nottingham Healthcare NHS Trust, Nottingham

Ann Buckley, Senior Registrar in Psychiatry

South Birmingham Mental Health NHS Trust, Mindleson Way, Birmingham

^* Correspondence

Aims and method The 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.

Results Overall 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 implications We 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.

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