Abstract

Standards developed from the Royal College of Psychiatrists' consensus statement on the use of high-dose antipsychotics were audited. The baseline survey and two completed audit cycles are described showing improvement in the monitoring and management of out-patients on higher dose depot antipsychotics. Initially the main problem was poor attendance at hospital appointments. Practice was changed by (a) medical staff becoming more assertive and visiting non-attenders at home; (b) a phlebotomist visiting patients at home. Deinstitutionalisation has relocated many patients with chronic psychoses into the community, but services, including the ancillary services, have sometimes been slow to follow. This audit found that the most effective change was the provision of services to patients in their own home.

Highlights

  • Standards developed from the Royal College of Psychiatrists' consensus statement on the use of highdose antipsychotics were audited

  • Standards based on the consensus statement were formally agreed in April 1995 when a baseline survey was completed

  • A third of patients were on additional oral antipsychotics, but the dose only exceeded 100 mg in chlorpromazine equivalents in four cases

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Summary

The study

Fonoll'ohwigihnegr adnoseinsi'tiaolf dseuprvoety anitnips1y9c9h4otiocsf, 32 paantidenttshe publication of the consensus statement, a system was introduced for all patients on higher dose depots to be reviewed three-monthly at the out-patient clinic, and for the patient's physical state, routine bloods and electrocardiogram (ECG) to be checked annually at the depot clinic. Standards based on the consensus statement were formally agreed in April 1995 when a baseline survey was completed. These standards were that all out-patients on higher dose depot antipsychotics should have:. If the patient had marked positive symptoms (i.e. a score of 3 on delusions, hallucinations or incoherence, or a combined score of 4) the dose was increased on a fixed scale. Further reductions were not made because of concern that this would increase the risk of relapse (Cookson, 1987)

Characteristics of the patients
Results of the audit
Abnormalities found during the physical investigations
Review of the standards
Improvements in clinical practice
Acta Psychiatrien
Edited by Andrew Sims
Full Text
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