Aims and MethodForty-seven UK mental health services participated in a 1-day audit of prescribing of antipsychotic drugs. Audit standards were derived from national guidelines and consensus statements.ResultsOf the 3132 patients, 20% were prescribed a total dose of antipsychotic medication above that recommended by the British National Formulary. The majority of case notes failed to record an indication for high-dose prescribing or that the patient had been informed; only 8% had undergone an electrocardiogram. Forty-eight per cent of patients were prescribed more than one antipsychotic drug.Clinical ImplicationsAntipsychotic prescribing for in-patients often runs counter to existing guideline recommendations. It is likely that many patients who are prescribed high doses or polypharmacy are unaware that their prescription is out of line with guideline recommendations and is inadequately monitored.

The development of atypical antipsychotics has not only given the prescriber more options, but also increased the complexity of decision making. We examined current prescribing practice for antipsychotic and anticholinergic drugs, which involved a 1-day census of all antipsychotic and anticholinergic drugs prescribed for 4191 inpatients in 49 UK mental health services. Eighty-five percent of inpatients were prescribed antipsychotics, 48% of whom were prescribed more than one. Atypical antipsychotics were widely prescribed and combined with typicals in over 60% of cases. Large doses of antipsychotics were frequently prescribed 'as required'. The dose administered was always much less than the dose prescribed and nothing at all was administered against 79% of prescriptions. Antipsychotic prescribing often deviates from recommended practice. Nursing staff have considerable discretion to administer large doses of antipsychotics on an 'as required' basis.

Twenty years of activity by the Royal College of Psychiatrists and three large-scale audits have been associated with only modest improvement in local practice.

Aims and methodThe use of electroconvulsive therapy (ECT) was surveyed over the first six months of 1996 in Wales. Data on the indications for ECT and clinical outcome were collected in the first three months.ResultsThe computed annual rate was 22 patients treated with ECT per 100 000 population. Women constituted 71% of those receiving ECT (236/321). Eighty-three per cent had an affective disorder, and 80% had failed to respond to previous treatments. Only 33% of patients had been prescribed more than one class of antidepressant and only 25% had received augmentation with lithium or an alternative drug before being given ECT.Clinical implicationsECT is mostly used after a failure of patients to respond adequately to a course of antidepressants.