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Naturalistic study of the antipsychotic medication review service at the Maudsley Hospital

Maudsley Hospital

Ruth Ohlsen, Research Nurse Specialist

Institute of Psychiatry

David Taylor, Chief Pharmacist

South London and Maudsley NHS Trust

Lyn Pilowsky, Reader in and Head of Section Neurochemical Imaging and Psychiatry

Institute of Psychiatry, London SE5 8AF

Declaration of interest

D.T. has received unrelated consultancy fees from all manufacturers of atypical antipsychotics. L.P. has received unrelated and unrestricted charitable grants and lecture and consultancy fees from AstraZeneca, Eli Lilly, Novartis, Janssen Pharmaceuticals, Synthelabo and GlaxoSmithKline. She is also a Medical Research Council Senior Clinical Research Fellow.

Correspondence: (e-mail: l.pilowsky{at}iop.kcl.ac.uk )

AIMS AND METHOD

To evaluate the effectiveness of the antipsychotic medication review service (AMRS) at the Maudsley Hospital. Patient notes were analysed from the AMRS and estimates of Global Assessment Scale (GAS) scores were made from entries in the notes. Data on hospital admissions before and during attendance at the AMRS were obtained from the trust-wide computerised patient administration system.

RESULTS

A statistically significant improvement in GAS scores was seen for patients who stayed in contact with the AMRS. Patients who did not respond to the first atypical drug often made a good response to an alternative atypical antipsychotic. Patients attending the AMRS had fewer hospital admissions than they did before attendance, although this was not statistically significant.

CLINICAL IMPLICATIONS

Although more expensive on a dose-by-dose rate, atypical antipsychotics may be cost effective by improving compliance and reducing the number of relapses and hospital admissions. Specialised services with frequent patient contact can be effective in preventing relapse and improving global function.

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