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Antipsychotic prescribing of consultant forensic psychiatrists working in different levels of secure care with patients with schizophrenia

  • Anna Machin (a1) and Lucy McCarthy (a2)
Abstract
Aims and method

To detect any differences in the antipsychotic prescribing practices of consultant forensic psychiatrists working in different levels of secure care with patients diagnosed with schizophrenia, and to identify potential reasons for any differences. Prescribing data were collected from four secure hospitals within one National Health Service trust. A questionnaire was sent to consultant forensic psychiatrists working at those hospitals as well as those working in the trust's community forensic services.

Results

Consultants working in high security prescribed more oral antipsychotics than consultants working in medium and low security, who prescribed more depot antipsychotics, as established via the prescribing data. The questionnaire provided insight regarding the reasons for these preferences.

Clinical implications

There were differences in the antipsychotic prescribing practices of consultant forensic psychiatrists working in different levels of secure care, and, overall, the rate of depot antipsychotic prescribing was lower than might be expected. Although it was positive that the rate of polypharmacy was low when compared with earlier studies, the lower-than-expected rate of depot antipsychotic prescribing has clinical implications.

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Copyright
This is an open-access article published by the Royal College of Psychiatrists and distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Correspondence to Anna Machin (anna.machin@nottshc.nhs.uk)
Footnotes
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Declaration of interest

None.

Footnotes
References
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1 Royal College of Psychiatrists. Consensus Statement on High-Dose Antipsychotic Medication (CR190). Royal College of Psychiatrists, 2014.
2 National Institute for Health and Clinical Excellence. Psychosis and Schizophrenia in Adults: Treatment and Management (CG178). NICE, 2014.
3 David, AS, Adams, C, Depot antipsychotic medication in the treatment of patients with schizophrenia: (1) Meta-review; (2) Patient and nurse attitudes. Health Technol Assess, 2001; 5: 34.
4 Taylor, PJ, Leese, M, Williams, D, Butwell, M, Daly, R, Larkin, E. Mental disorder and violence. A special (high security) hospital study. Br J Psychiatry 1998; 172: 218–26.
5 Lelliot, P, Audini, B, Duffett, R. Survey of patients from an inner-London health authority in medium secure psychiatric care. Br J Psychiatry 2001; 178: 62–6.
6 Paton, C, Lelliott, P, Harrington, M, Okacha, C, Sensky, T, Duffett, R. Patterns of antipsychotic and anticholinergic prescribing for hospital inpatients. J Psychopharmacol 2003; 17: 223–9.
7 Office for National Statistics. Ethnicity and National Identity in England and Wales: 2011. ONS, 2012.
8 Pereira, S, Dawson, P, Sarsam, M. The National Survey of PICU and Low Secure Services: 1. Patient characteristics. J Psychiatr Intens Care 2006; 2: 712.
9 Taylor, D, Paton, C, Kapur, S. Maudsley Prescribing Guidelines (11th edition). Wiley-Blackwell, 2012.
10 Lloyd, K, Moodley, P. Psychotropic medication and ethnicity: an inpatient survey. Soc Psychiatry Psychiatr Epidemiol 1992; 27: 95101.
11 Connolly, A, Taylor, D. Ethnicity and quality of antipsychotic prescribing among inpatients in South London. Br J Psychiatry 2008; 193: 161–2.
12 Kane, JM, Kishimoto, T, Correll, CU. Assessing the comparative effectiveness of long-acting injectable vs. oral antipsychotic medications in the prevention of relapse provides a case study in comparative effectiveness research in psychiatry. J Clin Epidemiol 2013; 66: S3741.
13 Hong, J, Novick, D, Brugnoli, R, Bertsch, J, Haro, JM. Changes in adherence and treatment costs following initiation of oral or depot typical antipsychotics among previously non-adherent patients with schizophrenia. Hum Psychopharm Clin 2013; 28: 438–46.
14 Zhu, B, Ascher-Svanum, H, Shi, L, Faries, D, Montgomery, W, Marder, SR. Time to discontinuation of depot and oral first-generation antipsychotics in the usual care of schizophrenia. Psychiatr Serv 2008; 59: 315–17.
15 Stone, DC, Niz, DO. Treatment considerations in the forensic patient with schizophrenia. Curr Pharm Design 2004; 10: 2263–7.
16 Arango, C, Bombin, I, Gonzalez-Salvador, T, Garcia-Cabeza, I, Bobes, J. Randomised clinical trial comparing oral versus depot formulations of zuclopenthixol in patients with schizophrenia and previous violence. Eur Psychiat 2006; 21: 3440.
17 Kirson, NY, Weiden, PJ, Yermakov, S, Huang, W, Samuelson, T, Offord, SJ, et al. Efficacy and effectiveness of depot versus oral antipsychotics in schizophrenia: synthesizing results across different research designs. J Clin Psychiat 2013; 74: 568–75.
18 Lafeuille, M, Laliberté-Auger, F, Lefebvre, P, Frois, C, Fastenau, J, Duh, MS. Impact of atypical long-acting injectable versus oral antipsychotics on rehospitalization rates and emergency room visits among relapsed schizophrenia patients: a retrospective database analysis. BMC Psychiatry 2013; 13: 221.
19 Johnson, DAW. Observations on the use of long-acting depot neuroleptic injections in the maintenance treatment of schizophrenia. J Clin Psychiat 1984; 45: 1321.
20 Leucht, C, Heres, S, Kane, JM, Kissling, W, Davis, JM, Leucht, S. Oral versus depot antipsychotic drugs for schizophrenia: a critical systematic review and meta-analysis of randomised long-term trials. Schizophr Res 2011; 127: 8392.
21 Haddad, PM, Chaudhry, IB, Husain, N, McLaughlin, S, Cunningham, P, David, AS, et al. Psychiatrists' attitudes to antipsychotic depot injections (i): Preferences and choice. Eur Psychiatry 2008; 23: 160–1.
22 Potkin, S, Bera, R, Zubek, D, Lau, G. Patient and prescriber perspectives on long-acting injectable (LAI) antipsychotics and analysis of in-office discussion regarding LAI treatment for schizophrenia. BMC Psychiatry 2013; 13: 261.
23 Caroli, F, Raymondet, P, Izard, I, Plas, J, Gall, B, Delgado, A, et al. Opinions of French patients with schizophrenia regarding injectable medication. Patient Prefer Adher 2011; 5: 165–71.
24 Centre for Mental Health, National Mental Health Development Unit. Pathways to Unlocking Secure Mental Health Care. Centre for Mental Health, 2011.
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Antipsychotic prescribing of consultant forensic psychiatrists working in different levels of secure care with patients with schizophrenia

  • Anna Machin (a1) and Lucy McCarthy (a2)
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