Abstract
Aims and methodTo estimate the community prevalence of combination antipsychotic therapy and high-dose antipsychotic treatment via audit. Patients with an ICD-10 diagnosis of schizophrenia were identified through the NHS Greater Glasgow and Clyde Health Board patient information management system and their mental health records examined.ResultsIn audit 1, 135 records were examined. The age range of patients was 24–74 years; 73% were male. Twelve per cent were on combined antipsychotic treatment and 3.7% required high-dose antipsychotics. Sixty-nine per cent of patients had documented in their record the reason for combined antipsychotic treatment compared with 40% on high-dose antipsychotics. In audit 2 (1 year later), 150 records were examined. Demographic details and prescription patterns remained similar to that of audit 1. However, 10% of patients received combined antipsychotic therapy and 2% remained on high-dose antipsychotics. Documented reasons for combination therapy increased to 87%, and to 67% for patients on high-dose antipsychotics.Clinical implicationsWe need robust clinical trials, overcoming the problems of clinical effectiveness and clinical efficiency, to establish the merits of preferred antipsychotic combinations, as combination and high-dose antipsychotic treatments are unlikely to be eliminated in clinical practice in the foreseeable future.
Highlights
Twelve per cent were on combined antipsychotic treatment and 3.7% required high-dose antipsychotics
Sixty-nine per cent of patients had documented in their record the reason for combined antipsychotic treatment compared with 40% on high-dose antipsychotics
10% of patients received combined antipsychotic therapy and 2% remained on high-dose antipsychotics
Summary
Clozapine was the favoured antipsychotic medication for high-dose antipsychotic treatment, followed by amisulpride and olanzapine in both audits, consistent with other reports of the use of clozapine in chronic and treatment-resistant cases of schizophrenia.[14,15,22,23] Prescription of aripiprazole increased by more than double in 1 year and was more commonly used in patients who were mentally stable but experienced side-effects, especially weight gain It was occasionally used as an adjunct to clozapine, as evidence suggests helping patients to lose weight and to improve other metabolic parameters.[14] The prevalence of chlorpromazine or haloperidol prescription, in addition to depot medication, for agitation or insomnia fell by 30% in audit 2. The age range for the HDAT group was 24-76 years (mean 48 years)
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