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Use of antipsychosis and adjunctive medications by an inner urban community psychiatric service

Authors

  • Nicholas A. Keks,

  • Kylie Altson,

  • Judy Hope,

  • Natalie Krapivensky,

  • Christine Culhane,

  • Amgad Tanaghow,

  • Peter Doherty,

  • Anne Bootle


  • Psychiatric Service, The Alfred, Commercial Road, Prahran, Victoria 3181, Australia. Email: N.Keks@alfred.org.au

Nicholas A.Keks Professor of Psychiatry, Monash University and The Alfred (Correspondence); Kylie Altson, Research Assistant; Judy Hope, PhD Candidate; Natalie Krapivensky, Senior Registrar; Christine Culhane, Pharmacist for the Psychotropic Drug Information Centre, Mental Health Research Institute of Victoria; Amgad Tanaghow, Deputy Director; Peter Doherty, Director; Anne Bootle, Pharmacist

Abstract

Objective: The aim of this paper is to survey patterns of use of new generation and conventional antipsychosis and adjunctive drugs by an inner urban community psychiatric service.

Method: All prescriptions for antipsychosis medications and all patients receiving these drugs in May 1998 were identified. Case record review yielded demographic and diagnostic data. Information was also obtained directly from prescribers.

Results: Of 859 patients, 77% received antipsychosis medication; 53% of prescriptions for antipsychotics were for new generation drugs: risperidone (42%), olanzapine (37%) and clozapine (21%). Mean doses were 4.1 ± 2.5 mg (risperidone), 14.7 ± 8.2 mg (olanzapine) and 377.4 ± 178.9 mg (clozapine). Doses for men tended to be higher than those for women, but the differences were not significant. DSM-IV diagnosis was schizophrenia for 74% of patients on atypicals, but patients with other diagnoses were also being treated with these drugs. Risperidone was more commonly used in combination with benzodiazepines and anticholinergics than olanzapine and clozapine, while clozapine was less likely to be combined with antidepressants and mood stabilisers. Of the conventionals, 66% were in depot form, mostly because of non-compliance. Combinations of antipsychotics were prescribed to 13% of patients.

Conclusion: New generation antipsychosis medications were prescribed more commonly than conventional drugs in this service for a wide range of diagnoses. Adjunctive medications were commonly utilised. These findings underline the clinical complexity of antipsychotic treatment in a changing environment.

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