Abstract
A retrospective survey was undertaken to evaluate the prescribing practices of medical staff in a District General Hospital in light of theConsensus Statementby the Royal College of Psychiatrists on the use of high dose antipsychotics (1993). Two per cent of 247 patients were prescribed a higher than recommended dose of antipsychotic. None of these cases had been prescribed ‘supra-BNFdoses of antipsychotic on a regular basis, but with the addition of ‘as required’ (PRN) medication the recommended dose was exceeded. In only one patient was the high dosage administered. A further analysis of these patients is made.
Highlights
The relationship between dose and therapeutic efficacy of antipsychotics prescribed for patients suffering with schizophrenia remains unclear
There have been publications advising against the use of high dose of antipsychotics except as a last resort (Baldessarini et al, 1988; Drug and Therapeutics Bulletin, 1992)
A recent audit on the use of antipsychotic medication in a large psychiatric hospital found that nearly half of the patients on antipsychotics were prescribed doses in chlorpromazine equiva lents in excess of BNF guidelines (Warner et ai, 1995)
Summary
A retrospective survey was undertaken to evaluate the prescribing practices of medical staff in a District General Hospital in light of the Consensus Statement by the Royal College of Psychiatrists on the use of high dose antipsychotics (1993). HCigohntrdoollseeds sitnud'iterseamceonmt resistant' patients have failed to show superior effectiveness of megadose regimes (Bjorndal et al 1980; Kane, 1987) These findings are supported by positron emmission tomography studies which have shown that a level of dopamine D2 occupancy associated with antipsychotic efficacy (>65%) occurs at modest doses, e.g. chlorpromazine 300-400 mg (Farde et al, 1992). A recent audit on the use of antipsychotic medication in a large psychiatric hospital found that nearly half of the patients on antipsychotics were prescribed doses in chlorpromazine equiva lents in excess of BNF guidelines (Warner et ai, 1995). This hospital included a regional unit for patients suffering with treatment-resis tant schizophrenia.
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