A retrospective study of psychotropic drug use among individuals with mental illness issued a community treatment order

Authors

  • N. Gisev,

    Corresponding author
    1. Faculty of Pharmacy, The University of Sydney, Sydney, NSW, Australia
    • Correspondence to:

      Natasa Gisev, Faculty of Pharmacy, Pharmacy and Bank Building (A15), The University of Sydney, NSW, Australia

      Tel.: +612 9036 7081

      Fax: +612 9351 3491

      Email: natasa.gisev@sydney.edu.au

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  • J. S. Bell,

    1. Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Parkville, Vic., Australia
    2. Faculty of Health Sciences, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
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  • T. F. Chen

    1. Faculty of Pharmacy, The University of Sydney, Sydney, NSW, Australia
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  • Disclosures

    The authors declare that they have no competing interests. The authors alone are responsible for the content and writing of the paper.

Summary

Background

Community treatment orders (CTOs) are legal orders which require individuals with mental illness to accept treatment in the community. Previous studies report that long-acting injectable (LAI) antipsychotics are associated with CTOs, however, little is known about the specific treatment plans prescribed in CTOs. The objective of this study was to describe the patterns of psychotropic drugs prescribed to individuals issued a CTO, focusing on LAI antipsychotics, antipsychotic polypharmacy and high-dose antipsychotics.

Methods

This was a retrospective cross-sectional study of 378 individuals randomly selected from a sample of 1317 individuals with a CTO expiry date up to and including 30 April 2010, taken from all 2856 individuals issued a CTO by the New South Wales Mental Health Review Tribunal, Australia, in 2009. De-identified information relating to individuals' treatment plans, demographic and clinical details were systematically extracted.

Results

A total of 377 (99.7%) individuals were prescribed at least one antipsychotic. Of these, 310 (82%) were prescribed a LAI antipsychotic, either alone (45%), or in combination with, an oral antipsychotic (37%). Risperidone was the most prevalent antipsychotic, prescribed to 164 (43%) individuals. Antipsychotic polypharmacy was prescribed to 121 (32%) individuals and between 20% and 27% of individuals were prescribed high-dose antipsychotics. Antipsychotic polypharmacy accounted for 74–80% of individuals prescribed high-dose antipsychotics.

Conclusions

The results from this study confirm that LAI antipsychotics are commonly prescribed in CTOs. Antipsychotic polypharmacy was also common, and accounted for the majority of individuals prescribed high-dose antipsychotics. Further research is needed to determine the potential outcomes and implications of the patterns observed.

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