This audit may be relevant in dual-diagnosis clinics or any in-patient ward with service users who have substance misuse problems.
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).
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.
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.
The percentage of patients who met each of the above standards was calculated. The data were displayed as bar graphs and pie charts.
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.
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.
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.