Abstract
Aims and methodThe 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.ResultsOverall 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 implicationsWe 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.
Highlights
New ton et ai (1997) found only 2% of in-patients were prescribed high-dose antipsychotic medication, all as a direct result of p.r.n. prescribing, this contrasts with their calculation of 42.4% of patients prescribed high-dose antipsychotic medication in another study (Krasucki & McFarlane, 1996), when p.r.n. prescriptions were included
The pre scription cards of all adult acute, rehabilitation and open forensic ward psychiatric in-patients were examined on two occasions, eight and 32 months after publication of the Consensus Statement
High-dose antipsychotic medication prescribing was de fined as a total daily dose >1000mg chlorpromazine equivalents (calcu lated from BNF (Number 33, March 1997) and Bazire (1997), see Table 1)
Summary
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
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