Prescribing of Psychotropic Drugs in an Acute Inpatient Unit

Abstract

Recent articles in the Australian and New Zealand Journal of Psychiatry [1,2] have discussed changes in the prescribing of antidepressant and antipsychotic drugs. Beerworth and Tiller [1] noted the medicolegal advantages of initiating pharmacological therapy for depression with newer antidepressants, such as selective serotonin re-uptake inhibitors (SSRIs), selective serotonin/noradrenaline re-uptake inhibitors (SNRIs), reversible inhibitors of monoamine oxidase A (RIMAs) and 5HT 2 receptor antagonists, rather than older antidepressants such as the tricyclics. Parker et al.[2] investigated changes in the use of antipsychotic drugs, reporting that 33% of a sample of psychiatrists surveyed in 1996 advocated the use of an atypical antipsychotic agent (risperidone) in preference to conventional antipsychotics in the treatment of first-episode psychosis. Parker et al.[2] also noted that the antipsychotic drug doses favoured by their sample of psychiatrists were about half those recommended by the Quality Assurance Project in 1984. Recently published treatment algorithms for depression and schizophrenia [3-7] vary in their recommendations regarding the place of the newer agents in the clinical pathway. This may reflect differences in the methods used to derive the algorithms, but also indicates a lack of consensus in defining best practice.There has been little information published recently about the actual use of novel antipsychotic and antidepressant drugs in psychiatric practice in Australia. Such information would be helpful in gauging the extent to which the newer treatments have been adopted.This letter reports on the medication prescribed on one day (13 August 1998) at Cramond Clinic, a 40bed acute psychiatric inpatient unit serving the Western suburbs of Adelaide. Thirty-five medication sheets were available. The remaining patients were in the process of admission or discharge, or not on the ward.Sixty-one percent (n = 17) of the 28 patients receiving antipsychotic medication were prescribed the atypical drugs olanzapine (n = 14) or risperidone (n = 3). The mean daily dose of olanzapine was 14 mg, and of risperidone was 1 mg. Typical antipsy-