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High-dose antipsychotic prescribing: comparison survey

Published online by Cambridge University Press:  02 January 2018

Neeraj Bajaj*
Affiliation:
State Hospital, Carstairs ML11 8RP, email: nbajaj@doctors.org.uk
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Abstract

Type
The columns
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, 2008

In May 2006, the Royal College of Psychiatrists published the consensus statement on high-dose antipsychotic medication, highlighting that up to a quarter of psychiatric in-patients are prescribed a high dose of antipsychotic medication (Royal College of Psychiatrists, 2006).

I carried out a cross-sectional survey collecting data on type, doses and combinations of antipsychotic medication used at the regional medium secure unit, general adult psychiatric wards and psychiatric intensive care unit. Data were analysed to calculate the proportion of patients on high-dose antipsychotic medication. Information sources were the prescription kardex and ward-based casenotes. The College's definition of high-dose antipsychotic was used (Royal College of Psychiatrists, 2006).

At the regional medium secure unit, 30% of patients on antipsychotic medication (n=12 out of the total 41) were on high-dose antipsychotics. On general adult wards and psychiatric intensive care unit this number was 6 (17%, n=35 on antipsychotic medication). Of the total study sample on high-dose antipsychotic medication (n=18), polypharmacy was present in 94% of the patients.

This survey shows that patients on forensic wards are almost twice as likely to be prescribed high-dose antipsychotics as those on psychiatric intensive care units and general adult wards. Patients on high-dose antipsychotic medication are not only at risk of increased side-effects but also arrhythmias and sudden death. More needs to be done to change prescribing habits and to encourage evidence-based prescribing.

References

Royal College of Psychiatrists (2006) Consensus Statement on High-dose Antipsychotic Medication. Council Report CR138. Royal College of Psychiatrists.Google Scholar
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