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Diverse response from psychiatrists to CTOs

Published online by Cambridge University Press:  02 January 2018

Peter Lepping*
Affiliation:
Betsi Cadwaladr University Health Board, Bangor University, Wales, email: peter.lepping@wales.nhs.uk
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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, 2013

Van Zyl et al’s study Reference Lawton-Smith1 highlights the importance of increased awareness of venous thromboembolism (VTE) in mental health services for older people. However, it is also important to be aware of the risks of thromboprophylaxis within this setting. The authors claim that the incidence rates of VTE in old age mental health services were comparable with those in general hospitals. However, it does not follow from this that the same approaches for VTE screening and thromboprophylaxis used in general hospitals should be applied, particularly with respect to the risks of thrombocytopenia and bleeding from prophylactic low molecular weight heparin, Reference Lepping and Malik2 which may be exacerbated in mental health in-patient settings, where the average length of stay is likely to be longer than in an acute medical unit. In fact, recent meta-analyses have questioned whether such risks outweigh the potential benefits even within the general hospital setting. Reference Burns, Rugkåsa, Molodynski, Dawson, Yeeles and Vazquez-Montes3 Further evidence should be sought before such VTE prevention strategies are widely implemented in mental healthcare settings, lest they lead to patient harm.

References

1 Lawton-Smith, SH. CTOs – use with caution (letter). Psychiatrist 2013; 37: 308.Google Scholar
2 Lepping, P, Malik, M. Community treatment orders: current practice and a framework to aid clinicians. Psychiatrist 2013; 37: 54–7.Google Scholar
3 Burns, T, Rugkåsa, J, Molodynski, A, Dawson, J, Yeeles, K, Vazquez-Montes, M, et al. Community treatment orders for patients with psychosis (OCTET): a randomised controlled trial. Lancet 2013; 381: 1627–33.Google Scholar
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