Depot Clinic Research Articles

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What is your job title and remit at work ? I’m senior nurse in the physical treatment centre, part of the Hadrian Clinic at Newcastle General Hospital. My remit is very diverse. I manage/ co-ordinate all services within the centre and organise and deliver aromatherapy. Other services operating from the centre include ECT, a clozaril clinic and depot clinic.

Switching patients to atypical oral antipsychotics: A retrospective audit of depot clinic attenders

Objectives: To compare the 12-month clinical outcome of patients attending a depot clinic who were changed to oral atypical antipsychotic medication, with those who remained on depot preparations. Method: A systematic review of the case records of all patients aged between 18 and 65 attending the depot clinic at Fremantle Hospital, Western Australia. Results: The records of 72 patients were identified (mean age 43.3 years; duration of illness 8.5 years; 37% female); 71% had schizophrenia. Twenty-five patients were successfully switched to an oral atypical antipsychotic (34%), 34 controls remained on a depot (47%), five were managed on a combination of a depot and an atypical, and eight returned to depot medication after a trial of an oral atypical. At 12 month follow-up, patients on oral atypicals showed significant improvement on the CGI (z = − 2.57, p = 0.01), less akathisia (z = − 2.12, p = 0.03), and reduced use of antiparkinsonian medication (z = − 1.97, p = 0.04); these changes were not mirrored in the controls. On multivariate analysis, being on an atypical agent was an independent predictor of improved outcome as measured by the CGI scale (t = − 2.1, p = 0.04), but also weight gain (t = − 2.9, p = 0.006). Conclusions: This retrospective survey reveals that a proportion of patients on depot antipsychotic medication can successfully be changed to oral atypical agents, with enhanced clinical outcomes. Declaration of interest: This study was supported by an investigator-initiated grant to SK and DC from Janssen Cilag. DC has received honoraria, travel support, and other grant funding from both Janssen Cilag and Eli Lilly.

Is there a role for the depot clinic in the modern management of schizophrenia?

The value of antipsychotic medication in preventing relapse in schizophrenia has been apparent since soon after its introduction (National Institute of Mental Health, Psychopharmacology Service Centre Study Group, 1964) but non-compliance remains a problem. Failure to take prescribed medication is a challenge in general medicine but presents special difficulties when treating mental illness; residual symptoms of psychosis and impaired insight after discharge increase the likelihood that a patient will stop taking antipsychotic medication, thereby contributing to higher relapse rates. The development of depot antipsychotic medication that could be administered intramuscularly at intervals of several weeks raised treatment and outcome expectations for patients who were felt to be at higher risk of non-compliance when in the community. The need for regular administration and monitoring of patients receiving depot medication led to depot and maintenance medication clinics. Today, with increasing numbers of patients who would previously have been receiving depot medication now taking atypical oral antipsychotics, is there still a need for the depot clinic?

Psychiatric nurses' attitudes towards patient autonomy in depot clinics.

The aim of this qualitative study was to explore how psychiatric nurses experience patient autonomy in relation to their professional role in depot clinics. The administration of depot neuroleptics at outpatient clinics is a common task for psychiatric nurses in many countries. The procedure is characterized by brief contacts often allowing little opportunity for adequate monitoring of the treatment and a dialog between nurses and patients. As nurses have an important role in involving patients in decision-making, there is a need to analyse the nurses' attitudes towards giving depot neuroleptics from the perspective of autonomy. Nine experienced psychiatric nurses were interviewed using open-ended questions. The steps of a phenomenological descriptive method guided the data analysis. The structure describes how benevolent attitudes towards patient autonomy motivated the nurses' interventions in relation to how they experienced their own professional authority. The structure consists of four variations: (1) Beneficent interventions used with patients perceived as co-operative when the nurses experienced a high degree of professional authority. (2) Paternalistic interventions used with patients perceived as ambiguous towards medication when the nurses experienced an arbitrary professional authority in collaboration with team members. (3) Weak paternalistic interventions used with patients perceived as unwilling when the nurses experienced having sufficient professional authority in the treatment situation. (4) Nonmaleficent interventions used with patients perceived as being resigned when the nurses experienced a low degree of professional authority within the team. The findings indicate that psychiatric nurses' experience of their professional authority is closely related to the organization of the depot treatment and that brief contacts do not favour the establishment of collaborative relationships with patients. When injection-giving nurses, as patients' key workers, have overall responsibility for co-ordinating the patients' treatment they can encourage patient autonomy by helping patients understand the meaning of depot medication and its benefits. Further clinical research regarding the involvement of nurses in the treatment as well as patients' experiences of treatment with depot neuroleptics is needed to allow suggestions about improvements of the organization of the treatment.

Psychopharmacology: Insight and Comorbid SubstanceMisuse and Medication ComplianceAmong Patients With Schizophrenia

The authors examined levels of noncompliance with oral antipsychotic medication regimens and factors influencing it among 87 Ss consecutively readmitted to a hospital with an acute psychotic relapse of schizophrenia or schizoaffective disorder. Compliance was assessed using a structured clinical interview. Ss also completed a self-report questionnaire to measure insight (M. Birchwood et al, 1994) and the Drug Attitude Inventory to assess attitudes toward medication. Of the 87 Ss, the 21 Ss taking depot medication (DM) were significantly more likely than the 66 Ss (mean age 37.3 yrs) taking only oral medication (OM) to be regularly compliant. Only 22 of the 66 OM Ss were compliant vs 12 of the 21 DM Ss. 15 of the OM Ss had comorbid substance use or dependence disorders, 14 of who were irregularly compliant. Excluding Ss with current comorbid substance misuse, the 21 regularly compliant Ss had a significantly higher mean insight score than the irregularly compliant Ss. Overall, results suggest that comorbid substance misuse, negative subjective response to neuroleptics, and lack of insight contribute to noncompliance.

Long-term follow-up of attendance in an outpatient depot clinic

Long-term follow-up of attendance in an outpatient depot clinic

Long-term medication in depot clinics and patients' rights: an issue for assertive outreach

This study investigated the knowledge and attitude of 100 patients about their depot neuroleptic medication. Patients were well informed about their medication, particularly those seen in depot clinics. Most patients were content with service delivery but 48% did not realise that they had a choice about receiving their treatment. This aspect of patients' rights should be addressed and demands sensitive management in the case of depot refusers, or when assertive outreach is planned. We suggest that such issues should be incorporated into an educational programme and discussed with patients when they are relatively well.

Depot clinics

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Depot clinic: consumers' viewpoint

With the emphasis on ‘care in the community’ there have been moves to provide psychiatric care away from the large psychiatric hospitals, which have resulted in the development of community mental health teams and the expansion of primary care and health centres to cater for people with psychiatric needs. The opinions of patients attending a hospital-based depot neuroleptic clinic are reported. A 17-item questionnaire was designed addressing the functioning of the clinic, including aspects of the medical and nursing care offered and the overall service provided. The majority of patients were in favour of attending this facility and expressed their wish for the service to continue.

Cost-benefit of a depot neuroleptic clinic: 10 years' follow-up of functioning of a clinical-administrative model

The purpose of the study was to compare die costs of the hospitalizations of 205 psychotic patients before entering an outpatient Depot Neuroleptic Clinic (PreDNC) with the costs of the admissions of this group of patients, occurring over a 10-year follow-up period of functioning of the unit after entering the Depot Clinic (InDNC). The cost-benefit ratio and the operating costs of this outpatient unit were assessed. The average years of illness of the sample studied PreDNC and InDNC were 8.6±6.5 years and 7.1±3.1 years respectively (NS), which included a total of 671 hospitalizations (511 PreDNC and 160 InDNC). Hospitalizations PreDNC accounted for 47,600 inpatient days in contrast to 11,100 inpatient days InDNC, representing a reduction of 77% in the total costs of hospitalization: year/inpatient PreDNC US$223 versus US$51 InDNC. The ambulatory care cost in the InDNC period for the sample studied included 38,700 consultations, provided by a multidisciplinary team, and pharmacological expenses. The number...

Monitoring of blood pressure at a GP depot clinic

Monitoring of blood pressure at a GP depot clinic

Psychological Well-Being in Families with a Member Suffering from Schizophrenia

Levels of stress in carers of long-term schizophrenia sufferers attending a depot clinic were assessed. Nine out of 25 carers (36%) were identified as possible or definite cases on either the GHQ or the HAD. However, a substantial proportion of carers managed to cope with the difficulties without suffering psychologically.

Clinical characteristics, health beliefs and compliance with maintenance treatment: a comparison between regular and irregular attenders at a depot clinic

This study investigated the relationship between clinical characteristics, health beliefs and compliance with depot neuroleptic maintenance treatment in schizophrenic patients by comparing a group of 40 irregular clinic attenders with another group of regular attenders matched by age and sex. While the 2 groups showed no difference in drug-induced extrapyramidal effects, the former were significantly more often depressed than the latter. Test-retest reliability coefficients of a 4-section health belief questionnaire showed marked variation in individual items. The 2 groups showed no difference in their perception of past effect of illness, likelihood of a relapse if maintenance treatment was stopped and effects of maintenance treatment.

In defence of the depot clinic

The depot clinic has long been part of the traditional British psychiatric service. With moves towards care in the community many of the traditional, particularly hospital based, methods of service delivery are becoming unfashionable. The depot clinic has been criticised (Beveridge, 1987) for being out of date, not geared to the needs of the patient, inaccessible and unable to provide personalised care, especially regarding the family factors recognised to be important in the management of chronic psychosis, and is portrayed as a facility designed for the convenience of the staff not the patient. This has led to suggestions for alternative methods of administering treatment to these patients, e.g. at home, from GP, health centre based.

Are Depot Clinics Out of Date?

Are Depot Clinics Out of Date?

Are Depot Clinics Out of Date?

Depot Clinics or ‘Moderate Clinics’ tend to be similar. They are usually regarded as ‘low priority’ and often staffed by clinical assistants with only a limited training in psychiatry. Typically a large number of patients turn up each week, and there is little time for a detailed assessment of their needs. The clinic is often seen as ‘a chore’ by medical and nursing staff who may feel that the long-term care and support of patients with chronic disabling illnesses lacks excitement. One gains the impression that the patients with the less attractive personalities or those presenting repetitive management problems are more likely to be referred.