Abstract
Aims and MethodForty-seven UK mental health services participated in a 1-day audit of prescribing of antipsychotic drugs. Audit standards were derived from national guidelines and consensus statements.ResultsOf the 3132 patients, 20% were prescribed a total dose of antipsychotic medication above that recommended by the British National Formulary. The majority of case notes failed to record an indication for high-dose prescribing or that the patient had been informed; only 8% had undergone an electrocardiogram. Forty-eight per cent of patients were prescribed more than one antipsychotic drug.Clinical ImplicationsAntipsychotic prescribing for in-patients often runs counter to existing guideline recommendations. It is likely that many patients who are prescribed high doses or polypharmacy are unaware that their prescription is out of line with guideline recommendations and is inadequately monitored.
Highlights
Of the 3132 patients, 20% were prescribed a total dose of antipsychotic medication above that recommended by the British National Formulary
Forty-eight per cent of patients were prescribed more than one antipsychotic drug
It is likely that many patients who are prescribed high doses or polypharmacy are unaware that their prescription is out of line with guideline recommendations and is inadequately monitored
Summary
Of the 3132 patients, 20% were prescribed a total dose of antipsychotic medication above that recommended by the British National Formulary. In the UK, 23 antipsychotic drugs are available on prescription, many by more than one route Most sideeffects of these drugs are dose related, cause substantial morbidity and may contribute to poor treatment adherence (American Psychiatric Association, 1997). Reviews have concluded that, in general, the use of high doses or of polypharmacy (simultaneous use of more than one antipsychotic drug) offers little, if any, benefit over moderate doses of a single drug, in relation to the disadvantages (Royal College of Psychiatrists, 1993). This evidence has influenced the development of national guidelines and consensus statements. {See editorial, pp. 401^402, and pp. 411-414 and pp. 418-420, this issue
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