High-dose antipsychotic drug use in a forensic setting

Abstract

Antipsychotic drugs remain the mainstay of treatment of individuals with psychotic illnesses such as schizophrenia. They are sometimes prescribed in combination or at doses above recommended limits, particularly in individual cases of treatment resistance. Our study aimed to investigate the use of antipsychotic treatment at a forensic unit covering the south-west of England, with a particular focus on high-dose prescribing, audited against recognized standards. We devised a data collection sheet. Information sources were the prescription charts and ward-based multidisciplinary case-notes. Our cohort had diverse diagnoses and backgrounds. Antipsychotics were prescribed to 70% of patients. Polypharmacy was present in just over a quarter of the sample. There were 16% of patients in the category of high dose. These were all secondary to polypharmacy. Generally, standards for high-dose medication were not adhered to. Polypharmacy is a significant cause of high-dose medication. This may not have been acknowledged by the clinical teams as each individual drug was within recommended limits.

Keywords:

• Forensic
• Antipsychotics
• Polypharmacy
• High Dose
• Audit