High dose antipsychotic use and poly pharmacy are common practices.Many psychiatrists consider this as a clinical necessity though evidence base to support this practice is thin.‘Taylor 2010 argued that the concept of more antipsychotic(s) must always be or might be, ‘better’ is virtually groundless. High dose/poly pharmacy practice could increase mortality among psychiatric patients. Royal college of Psychiatrists have produced consensus statements on the use of high dose antipsychotics.
A psychiatric ICU unit in UK reports the results of their audit examining the prescription practices before and after the guideline were adopted by the unit.
The number of patients receiving a single antipsychotic (dose within BNF limits) increased from 30% in 2005 to 55% in 2006 and the number of patients prescribed a high dose (all prescription types) declined from 33% in 2005 to 8% in 2006.
There are a number of limitations to this audit. However, it shows that prescribing practice can change if units adopt and follow the recommendations/ guidelines. Educating prescribers , conducting regular audits and providing feedback are essential for such changes.
A study of polypharmacy / high dose antipsychotic use across different countries/ health care environments is possible if readers are interested in this. Please contact me if interested.
Summary of the article:
L Steve Choong, Tim Coupe and JayaPrabha Vijayan (2012). A simple clinical audit of antipsychotic medication prescribing on Hollywell Psychiatric Intensive Care Unit (PICU). Journal of Psychiatric Intensive Care / Volume 8 / Issue 01 / April 2012,8, pp 11-14
The Consenus Recommendation is avaialable here: http://www.rcpsych.ac.uk/usefulresources/publications/collegereports/cr/cr138.aspx