Book contents
- Frontmatter
- Contents
- Editors
- Contributors
- Foreword
- Preface
- Introduction
- Completing an audit project
- I Disorders
- II Legislation
- III Physical health
- IV Record-keeping
- V Service provision
- VI Training
- VII Treatment
- 73 Alcohol withdrawal: management
- 74 Anticholinesterase inhibitors: monitoring of cardiac side-effects
- 75 Anticholinesterase inhibitors: prescribing
- 76 Antimuscarinic medications
- 77 Antipsychotics: combined and high dose
- 78 Antipsychotics: prescribing
- 79 Antipsychotics: use in dementia
- 80 Attention-deficit hyperactivity disorder: prescribing
- 81 Atypical antipsychotics: monitoring
- 82 Behavioural problems in adults with intellectual disabilities: medication management
- 83 Benzodiazepines in old age psychiatry
- 84 Covert administration of medication
- 85 Depot antipsychotics: side-effects
- 86 Diazepam as rescue medication in epilepsy
- 87 Electroconvulsive therapy: facilities
- 88 Electroconvulsive therapy: indications
- 89 Hypnotics
- 90 Lithium: monitoring
- 91 Medicines reconciliation
- 92 Mood stabilisers: monitoring
- 93 Nurses’ administration of medication
- 94 Prescribing: British National Formulary limits
- 95 Prescribing: Mental Capacity Act
- 96 Prescribing: p.r.n. medication
- 97 Prescription charts
- 98 Psychological therapies
- 99 Psychotherapy re-referrals
- 100 Psychotropic prescriptions in dual diagnosis
- 101 Rapid tranquillisation
- Appendices
100 - Psychotropic prescriptions in dual diagnosis
from VII - Treatment
Published online by Cambridge University Press: 02 January 2018
- Frontmatter
- Contents
- Editors
- Contributors
- Foreword
- Preface
- Introduction
- Completing an audit project
- I Disorders
- II Legislation
- III Physical health
- IV Record-keeping
- V Service provision
- VI Training
- VII Treatment
- 73 Alcohol withdrawal: management
- 74 Anticholinesterase inhibitors: monitoring of cardiac side-effects
- 75 Anticholinesterase inhibitors: prescribing
- 76 Antimuscarinic medications
- 77 Antipsychotics: combined and high dose
- 78 Antipsychotics: prescribing
- 79 Antipsychotics: use in dementia
- 80 Attention-deficit hyperactivity disorder: prescribing
- 81 Atypical antipsychotics: monitoring
- 82 Behavioural problems in adults with intellectual disabilities: medication management
- 83 Benzodiazepines in old age psychiatry
- 84 Covert administration of medication
- 85 Depot antipsychotics: side-effects
- 86 Diazepam as rescue medication in epilepsy
- 87 Electroconvulsive therapy: facilities
- 88 Electroconvulsive therapy: indications
- 89 Hypnotics
- 90 Lithium: monitoring
- 91 Medicines reconciliation
- 92 Mood stabilisers: monitoring
- 93 Nurses’ administration of medication
- 94 Prescribing: British National Formulary limits
- 95 Prescribing: Mental Capacity Act
- 96 Prescribing: p.r.n. medication
- 97 Prescription charts
- 98 Psychological therapies
- 99 Psychotherapy re-referrals
- 100 Psychotropic prescriptions in dual diagnosis
- 101 Rapid tranquillisation
- Appendices
Summary
Setting
This audit may be relevant in dual-diagnosis clinics or any in-patient ward with service users who have substance misuse problems.
Background
It has been noted that the prescription of psychotropics in patients with substance misuse problems infrequently meets the national gold standards. Psychotropics, when taken concomitantly with illicit substances or substitution treatments for substance misuse disorders, can cause physical complications (Lingford-Hughes et al, 2004).
Standards
The standards of the current audit were based on the guideline issued by the British Association of Psychopharmacology on depression and substance misuse (Lingford-Hughes et al, 2004).
ᐅ Patients with established depression and alcohol misuse and dependence should be prescribed selective serotonin reuptake inhibitors (SSRIs), and tricyclic antidepressants should be avoided in such cases.
ᐅ In the case of depression with opioid dependence, again, SSRIs are preferred, and tricyclic antidepressants should be avoided.
ᐅ The SSRI antidepressants are recommended as first-line pharmacotherapy for the treatment of comorbid anxiety with alcohol misuse and dependence.
ᐅ Atypical antipsychotics are favoured over typical antipsychotics for the treatment of schizophrenia with comorbid substance misuse disorders.
ᐅ Benzodiazepines are not recommended for the treatment of anxiety in patients who misuse alcohol or who have a history of alcohol misuse.
Method
Data collection
All medical records of psychiatric patients who had been reviewed in the drug and alcohol clinic were examined for entries and documentation relating to patient demographics, substances used, associated comorbidities, the psychotropic prescribed and the indication for its use.
Data analysis
The percentage of patients who met each of the above standards was calculated. The data were displayed as bar graphs and pie charts.
Resources required
People
It is suggested that this audit is undertaken by at least two people, owing to the large amount of information to be obtained for data analysis.
Time
The data collection itself may take up to four sessions. The data can be obtained over a few weeks. Primary care doctors may need to be contacted to gather information on the psychotropic usage by the patient.
Results
ᐅ Approximately 30% of the patients with substance misuse problems had comorbid psychiatric conditions.
ᐅ Of the comorbid illnesses, 78% were depression, anxiety or mixed anxiety and depressive disorders.
- Type
- Chapter
- Information
- 101 Recipes for Audit in Psychiatry , pp. 231 - 232Publisher: Royal College of PsychiatristsPrint publication year: 2011