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

Published online by Cambridge University Press:  02 January 2018

John Milton ,
John Lawton ,
Mark Smith  and
Ann Buckley
John Milton*
Affiliation:
Nottingham Healthcare NHS Trust, Duncan Macmillan House, Porchester Road, Nottingham NG3 6AA
John Lawton
Affiliation:
Clinical Audit Department, Nottingham Healthcare NHS Trust, Nottingham
Mark Smith
Affiliation:
Clinical Audit Department, Nottingham Healthcare NHS Trust, Nottingham
Ann Buckley
Affiliation:
South Birmingham Mental Health NHS Trust, Mindleson Way, Birmingham
*
∗Correspondence
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Abstract

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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.

Type
Original Papers
Information
Psychiatric Bulletin , Volume 22 , Issue 11 , November 1998 , pp. 675 - 677
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 © 1998 The Royal College of Psychiatrists

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