Prevalence and Correlates of "High Dose" Antipsychotic Prescribing: Findings from a Hospital Audit

Abstract

Background:High dose antipsychotic prescribing is common in psychiatric care, despite a lack of its benefit from research evidence. While several studies have explored the prevalence and factors associated with high dose antipsychotic prescribing, no such report has emanated from a developing country like Nigeria.Aim:The aims of this study were to determine the prevalence of high dose prescribing among in-patients at a tertiary psychiatric hospital and to determine the pattern of antipsychotic drugs prescribed.Materials and Methods:An audit of in-patients at a regional tertiary psychiatric facility was carried out. We examined case notes and conducted oral interviews where necessary, on all patients receiving antipsychotics using a proforma designed for the study.Results:The prevalence of high dose prescribing was 38% (65/171) using a prescribed daily dose/defined daily dose ratio of 1.5. The rate of antipsychotic polypharmacy was 7% (12/171). The atypical antipsychotic, olanzapine was the most commonly prescribed antipsychotic in monotherapy. Predictors of high dose prescribing were diagnoses (P = 0.04), polypharmacy (P = 0.04), a history of previous in-patient care (P = 0.02), and use of anticholinergic drugs (P = 0.01).Conclusions:High dose prescribing was common among in-patients audited. Further studies are needed to examine factors that promote “high dose” prescribing.

The Role of Five Facets of Mindfulness in a Mindfulness-Based Psychoeducation Intervention for People With Recent-Onset Psychosis on Mental and Psychosocial Health Outcomes

“…The majority were single, divorced or widowed (59%), attained secondary school or , coronary heart disease (n = 10), and other cardiovascular diseases (n =24). d "High dose" referred to a ratio of prescribed daily dose (PDD) to defined daily dose (DDD) >1.5, doses over 1 g/day in chlorpromazine equivalent or dosage exceeding the recommended British National Formulary limits in case of multiple anti-psychotics used (43). "Low dose" referred to an average dose of ≥0.5 and <1 DDD unit or <0.5 g/day of chlorpromazine equivalent; and "moderate dose" was defined as an average dose of 1-1.5 DDD unit or 0.5-1.0 g/day of chlorpromazine equivalent (44).…”

Evaluation of physical fitness and weight status among fisherwomen in relation to their occupational workload

“…In the present study, although fisherwomen perform more work related to strength than control females do, they are not found to have more MUAC ( Table 3 ), which is an estimate of energy storage and protein mass of the body and an indirect estimate of strength [ 34 ]. Waist circumference as well as waist-to-hip ratio [ 35 – 37 ] is found to be significantly lower in fisherwomen than in control subjects and is another indicator of lower fat percentage in young fisherwomen than in control subjects; this may be related to their poor socioeconomic status. Of these two parameters, waist circumference is considered to be a better index for fat location than WHR for predicting lipid profile in adult women [ 38 ].…”

Trends in the use of antipsychotics in the Israeli inpatient population, 2004–2013

“…Apart from the above explanations, our findings could be accounted for by the fact that clinicians tend to increase dosing of medications in an attempt to achieve a better response. Prescription of high doses of antipsychotics is common in hospitalized patients, despite the lack of evidence for such an approach [ 24 ]. For example, olanzapine and quetiapine are well tolerated at high doses, and these doses may also produce greater improvement [ 25 , 26 ], whereas increasing the dose of risperidone beyond the optimal recommended dose range (4–8 mg/day) does not improve effectiveness, but exposes the patients to higher rates of side effects [ 27 ].…”