Neuroleptic drug use in psychiatric intensive therapy units: problems with complying with the consensus statement

Jonathan Hillam,Chris Evans

doi:10.1192/pb.20.2.82

Abstract

The pharmacological management of acute behavioural disturbance in psychosis is not straightforward. The real, or perceived, dose:effect relationship of the various neuroleptics in common use has an important influence on prescribing patterns leading, in certain situations, to very high doses of neuroleptic medication being prescribed. Data from a study of the use of neuroleptic medication in two psychiatric intensive therapy units illustrate the potential extent of the problem. Over half of the cases were not amenable to accurate dosage monitoring due to the use of depot neuroleptics, Clopixol Acuphase or polypharmacy. The majority received doses exceeding the limit suggested by the British National Formulary. Efforts to standardise the use of such drugs would help to optimise the clinical management of this challenging group of patients.

Highlights

The pharmacological management of acute beha vioural disturbance in psychosis is not straightforward
The use of high dose neuroleptic medication is an issue which has recently generated a great deal of publicity, and increasing concern over serious side-effects and sudden deaths has lead to the publication of a consensus statement on the subject by the Royal College of Psychiatrists (1993)
Recent literature has referred to the doses of antipsychotic medication prescribed in relation to British National Formulary (BNP; British Medical Association & Royal Pharmaceutical Society of Great Britain, 1993) guidelines (e.g. C'eqaruvivilal,len1c9e'94)(,Maunllden theet ocÃo-n,1ce9p9t4). ofOfnepuarrotilceupltaicr importance in this respect are the problems encountered in the pharmacological management of severe acute behavioural disturbance in association with psychosis

Summary

Introduction

The pharmacological management of acute beha vioural disturbance in psychosis is not straightforward. The use of high dose neuroleptic medication is an issue which has recently generated a great deal of publicity, and increasing concern over serious side-effects and sudden deaths has lead to the publication of a consensus statement on the subject by the Royal College of Psychiatrists (1993).

Results

Conclusion