scholarly journals How well do psychiatric trainees interpret electrocardiographs

1996 ◽  
Vol 20 (11) ◽  
pp. 651-652 ◽  
Author(s):  
James P. Warner ◽  
Julia A. Gledhill ◽  
Frankie Connell ◽  
John G. Coghlan
Keyword(s):  
Antipsychotic Medication ◽  
Royal College ◽  
Qt Interval ◽  
Consensus Statement ◽  
High Dose ◽  
Do So

The consensus statement by the Royal College of Psychiatrists recommended that patients on high dose antipsychotic medication receive regular electro-cardiographic monitoring to identify prolongation of the QT interval. A survey of trainee psychiatrists in three hospitals investigated the accuracy with which trainees could identify this abnormality and found only 20% could do so.

scholarly journals Neuroleptic prescribing in an adolescent psychiatric in-patient unit

1996 ◽  
Vol 20 (9) ◽  
pp. 538-540 ◽  
Author(s):  
K. Lowe ◽  
H. Smith ◽  
A. Clark
Keyword(s):  
Clinical Practice ◽  
Children And Adolescents ◽  
Antipsychotic Medication ◽  
Royal College ◽  
Psychotic Disorders ◽  
Consensus Statement ◽  
Comprehensive Evaluation ◽  
High Dose ◽  
Age Group ◽  
Antipsychotic Prescribing

The Royal College of Psychiatrists' consensus statement suggests that prescribing high dose antipsychotic medication in children and adolescents should rarely be necessary. Our objective was to study the prescribing of antipsychotic medication in a regional adolescent unit during a three-year period. We found that antipsychotic prescribing on this unit is common in psychotic disorders and often high closes are required. This is not in keeping with the recommendations of the consensus statement. Review of clinical practice on other adolescent units is needed, together with a more comprehensive evaluation of the outcome of psychotic disorders in this age group.

scholarly journals [No Title]

1994 ◽  
Vol 18 (10) ◽  
pp. 647-647
Author(s):  
A. Valmana ◽  
M. Potter
Keyword(s):  
Antipsychotic Medication ◽  
Consensus Statement ◽  
High Dose

Sir: We welcome the recent Consensus Statement on the Use of High Dose Antipsychotic Medication (Thompson, 1994) but would welcome further guidance on the use of high dosages, particularly when polypharmacy is involved.

scholarly journals Monitoring patients on high-dose antipsychotics

1998 ◽  
Vol 22 (11) ◽  
pp. 671-674 ◽  
Author(s):  
Joan M. Barber ◽  
Jennifer Connaughton ◽  
Morag Wright
Keyword(s):  
Antipsychotic Medication ◽  
Consensus Statement ◽  
Journal Club ◽  
Clinical Implications ◽  
High Dose ◽  
Cardiac Events ◽  
Risk Avoidance ◽  
Similar Improvement ◽  
Prescribing Behaviour ◽  
New System

Aims and methodFollowing the publication of the 1994 Consensus Statement on the use of high-dose antipsychotic medication, we identified our high-dose patients and undertook an audit of the recommended physical investigations. The patients were identified by scrutiny of prescription records. Data were collected retrospectively at six-monthly intervals for four audit cycles. Results were fed back to clinicians at the hospital journal club.ResultsThe percentage of patients identified in the high-dose category fell from 35 to 23% over 18 months. Electrocardiograph monitoring of the group increased from 5 to 63%. Other tests showed a similar improvement. A very small number of abnormal results was shown. There were no untoward cardiac events.Clinical implicationsIntroduction of the standards of physical monitoring advised in the Consensus Statement has implications of cost to the NHS to be balanced against risk avoidance for patients. The number of abnormalities detected in our population was low. Changing prescribing behaviour in response to reported abnormal findings proved unexpectedly slow and a new system was required.

scholarly journals Hidden high-dose antipsychotic prescribing: effects of p.r.n. doses

1998 ◽  
Vol 22 (11) ◽  
pp. 675-677 ◽  
Author(s):  
John Milton ◽  
John Lawton ◽  
Mark Smith ◽  
Ann Buckley
Keyword(s):  
Antipsychotic Medication ◽  
Antipsychotic Drugs ◽  
Consensus Statement ◽  
Antipsychotic Treatment ◽  
High Dose ◽  
Junior Doctors ◽  
Drug Prescribing ◽  
Junior Staff ◽  
Actual Use ◽  
High Doses

Aims and methodThe Royal College of Psychiatrists' Consensus Statement on “The use of high-dose antipsychotic medication’ suggests only fully qualified psychiatrists (MRCPsych) should recommend the prescribing of high-dose antipsychotic treatment. We observed changes in anti-psychotic prescribing in two surveys of psychiatric in-patients conducted eight and 32 months after publication of the Consensus Statement.ResultsOverall mean chlorpromazine equivalent doses of antipsychotic drugs reduced between the surveys. When p.r.n. (as required) prescribing (usually done by junior doctors) is included, mean potential doses and numbers of patients who might receive ‘high-doses' increases substantially, although the reduction between surveys in total mean dose and proportion of patients on high-dose antipsychotic medication is preserved, and the actual use of p.r.n. medication was low (4–5% of p.r.n. prescriptions).Clinical implicationsWe recommend the development of local guidelines for junior staff concerning antipsychotic drug prescribing, regular monitoring of p.r.n. medication by consultants, and pharmacists' involvement in reviews of patients prescribed high-dose antipsychotic medication.

scholarly journals High-dose antipsychotic treatment in clinical practice

1999 ◽  
Vol 23 (11) ◽  
pp. 661-664 ◽  
Author(s):  
Philip J. Tyson ◽  
Ann M. Mortimer ◽  
Jason A Wheeler
Keyword(s):  
Clinical Practice ◽  
Antipsychotic Medication ◽  
Royal College ◽  
Treatment Compliance ◽  
Antipsychotic Treatment ◽  
Clinical Implications ◽  
High Dose ◽  
Dose Treatment ◽  
High Dose Treatment ◽  
High Doses

Aims and methodA trust-wide audit of antipsychotic prescription was conducted in order to investigate the prevalence of high-dose treatment in a population with schizophrenia and assess compliance with Royal College of Psychiatrists' guidelines on the use of high doses. Details of antipsychotic medication were recorded and in cases of high-dose treatment compliance with the College's guidelines was assessed.ResultsSixteen out of 361 patients (4%) were receiving high-dose medication. At re-audit this figure fell to four patients (1%). High-dose treatment comprised of a combined depot and oral medication in most cases. There was poor compliance with the College's guidelines.Clinical implicationsThe study stresses the importance of monitoring patients on high-dose antipsychotics, particularly when taken in combination.

scholarly journals Antipsychotic prescribing in light of the consensus statement of the College

1997 ◽  
Vol 21 (7) ◽  
pp. 408-410 ◽  
Author(s):  
K. L. Newton ◽  
R. Murthy ◽  
J. Qureshi
Keyword(s):  
General Hospital ◽  
Royal College ◽  
Medical Staff ◽  
Consensus Statement ◽  
District General Hospital ◽  
Recommended Dose ◽  
High Dose ◽  
Prescribing Practices ◽  
Retrospective Survey ◽  
Antipsychotic Prescribing

A retrospective survey was undertaken to evaluate the prescribing practices of medical staff in a District General Hospital in light of the Consensus Statement by the Royal College of Psychiatrists on the use of high dose antipsychotics (1993). Two per cent of 247 patients were prescribed a higher than recommended dose of antipsychotic. None of these cases had been prescribed ‘supra-BNF doses of antipsychotic on a regular basis, but with the addition of ‘as required’ (PRN) medication the recommended dose was exceeded. In only one patient was the high dosage administered. A further analysis of these patients is made.

scholarly journals Audit of out-patients on ‘higher dose’ antipsychotics

1997 ◽  
Vol 21 (7) ◽  
pp. 445-448 ◽  
Author(s):  
John R. Taylor ◽  
Ian B. Cookson
Keyword(s):  
Royal College ◽  
Medical Staff ◽  
Consensus Statement ◽  
Ancillary Services ◽  
Baseline Survey ◽  
High Dose ◽  
Effective Change ◽  
Provision Of Services ◽  
Depot Antipsychotics ◽  
At Home

Standards developed from the Royal College of Psychiatrists' consensus statement on the use of high-dose antipsychotics were audited. The baseline survey and two completed audit cycles are described showing improvement in the monitoring and management of out-patients on higher dose depot antipsychotics. Initially the main problem was poor attendance at hospital appointments. Practice was changed by (a) medical staff becoming more assertive and visiting non-attenders at home; (b) a phlebotomist visiting patients at home. Deinstitutionalisation has relocated many patients with chronic psychoses into the community, but services, including the ancillary services, have sometimes been slow to follow. This audit found that the most effective change was the provision of services to patients in their own home.

scholarly journals Use of high dose antipsychotic medication

1997 ◽  
Vol 21 (9) ◽  
pp. 566-569 ◽  
Author(s):  
Graeme Yorston ◽  
Alison Pinney
Keyword(s):  
Antipsychotic Medication ◽  
Royal College ◽  
Recommended Dose ◽  
British National Formulary ◽  
High Dose ◽  
National Formulary ◽  
Number Of Patients ◽  
Novel Method ◽  
Antipsychotic Prescribing ◽  
High Doses

An audit of antipsychotic prescribing was carried out on community and in-patient samples. A novel method of expressing total daily antipsychotic dose as a percentage of the British National Formulary maximum recommended dose was used. Of 226 patients who had been prescribed antipsychotics, 16 (7%) were found to be on high closes. Their medical notes were examined to ascertain whether the Royal College of Psychiatrists guidelines were being followed. Recommendations on ways in which practice could be improved were made and a re-audit was carried out. The number of patients receiving high doses fell to 6 (3%) out of 206.

scholarly journals Monitoring of patients on high dose antipsychotic medication

1997 ◽  
Vol 21 (10) ◽  
pp. 612-614 ◽  
Author(s):  
Kate Sillifant ◽  
Jacqueline Muir ◽  
Mary Crabb ◽  
Stephen Read
Keyword(s):  
Learning Disabilities ◽  
Liver Function ◽  
Antipsychotic Medication ◽  
Royal College ◽  
Liver Function Tests ◽  
High Dose ◽  
Essentially Normal ◽  
Cell Counts ◽  
Routine Monitoring ◽  
Mild Anaemia

In the light of recently published Royal College of Psychiatrists' guidelines on the use of high dose antipsychotic medication, electrocardiographic and blood investigations were performed on 11 patients with learning disabilities receiving such treatment. All patients had normal electrocardiograms (ECGs). Four patients had asymptomatic low white cell counts and mild anaemia was detected in three individuals. Three patients were hyponatraemic; liver function tests were essentially normal. Issues around routine monitoring of such patients are discussed.

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