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Audit of antipsychotic and anticholinergic prescribing: Leeds CMHT 2000–1

Published online by Cambridge University Press:  02 January 2018

Emma Whicher
Affiliation:
Leeds Community Mental Health Trust, The Andrew Sims Centre, High Royds Hospital, Bradford Road, Menston LS29 6AQ
Jane Riley
Affiliation:
Leeds Community Mental Health Trust, The Andrew Sims Centre, High Royds Hospital, Bradford Road, Menston LS29 6AQ
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Abstract

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Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © Royal College of Psychiatrists, 2003

We read with interest the paper by Harrington et al (Psychiatric Bulletin, November 2002, 26, 414-418). It mirrored the results of a recent audit we did on atypical, high dose and co-prescribing of antipsychotics, as well as concurrent anticholinergic prescribing. Drug card information on all general adult inpatients, aged 18-65, prescribed an antipsychotic on a regular basis was collected during a single visit in April 2000. Re-audit occurred in June 2001, and on this occasion adult day hospital patients were included.

Overall, 231 inpatients received a regular prescription for an antipsychotic drug in 2000 and 321 patients in 2001 (213 in-patients and 99 day hospital patients). There were high levels of atypical antipsychotic prescribing (49%, 95% confidence interval [CI] 42-55 in 2000 and 52%, 95% CI 46-57 in 2001), co-prescribing (20%, 95% CI 15-26 in 2000 and 25, 95% CI 20-30 in 2001) and above British National Formulary (2002) limits prescribing (15%, 95% CI 11-20 in 2000 and 17%, 95% CI 12-21 in 2001) when compared to total antipsychotic prescribing. Furthermore, there were high levels of anticholinergic prescribing with atypical antipsychotics alone (21, 95% CI 13-31 in 2000 and 18%, 95% CI 12-26 in 2001).

These prescribing patterns increase the risk of side-effects and negate the cost benefits of atypical antipsychotics. They also run counter to 1993 Royal College of Psychiatrists guidelines on antipsychotic prescribing and World Health Organization anticholinergic prescribing guidelines (World Health Organization, 1990; Reference BarnesBarnes, 1990). This audit appears to indicate problems in dissemination and a lack of widespread knowledge of current guidelines.

References

Barnes, T. R. (1990) Comment on the WHO consensus statement: prophylactic use of anticholinergics in patients on long-term neuroleptic treatment. British Journal of Psychiatry, 156, 412.Google Scholar
British National Formulary (2002) BNF 43, March. London: British Medical Association & Royal Pharmaceutical Society.Google Scholar
Royal College of Psychiatrists (1993) Consensus Statement on the Use of High Dose Antipsychotic Medication. Council Report CR26. London: Royal College of Psychiatrists.Google Scholar
World Health Organization (1990) Prophylactic Use of Anticholinergics in Patients on Long-term Neuroleptic Treatment. A Consensus Statement. Geneva: World Health Organization.Google Scholar
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