Abrupt cessation of smoking is associated with a potentially serious risk of toxicity in patients taking clozapine. Plasma clozapine levels must be monitored closely and adjustments made in dosage, if necessary, for at least six months after cessation.

Smoking causes almost 90% of deaths from lung cancer, about 80% of deaths from bronchitis and emphysema, and approximately 17% of deaths from heart disease. It increases the risk of developing cancer of the mouth, lip, throat, bladder, kidney, stomach, liver and cervix.

Forensic patients need not be at increased risk of QTc abnormality provided risk factors are properly managed. A high dose of antipsychotic medication increases the risk of QTc prolongation.

Background and aim:The atypical antipsychotic Risperidone is now available in a long-acting injectable form, risperidone consta (Risperidone Long-Acting Injection, RLAI). Patients in forensic psychiatry settings often have complex and difficult presentations marked by co-morbidity, poor concordance and treatment resistance. The potential role of RLAI in treating this patient group is not yet clear and this study aimed to investigate its use in an English high secure hospital.Method:The hospital pharmacy database was used to identify all patients prescribed RLAI during a four year period. Anonymised data for these patients was then obtained from the database and pharmacy casenotes.Results:24 patients were prescribed RLAI, the vast majority of whom had a diagnosis of schizophrenia. Mean length of treatment with RLAI was 281 days (range 2-925 days). 7 patients remain on RLAI (including 4 who were discharged to less secure settings). RLAI was stopped due to relative lack of efficacy in 13 patients, 9 of whom were subsequently treated with clozapine. In 1 case RLAI was stopped as it was no longer clinically indicated and for 3 patients data was not available. RLAI appeared to be well tolerated and there were no cases of it being stopped due to adverse effects.Conclusions:In this small study of a highly specialised and complex group of patients RLAI was not associated with any serious adverse effects. A third of patients responded to RLAI such that they remain on it or were able to be discharged to conditions of lesser security.