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Review of College guidelines on high-dose neuroleptic use in a psychiatric intensive care unit

Department of Psychiatry, Homerton Hospital, Homerton Row, London E9 6SR

Rachel Jones, Registrar in Psychiatry and James V. Lucey, Consultant and Senior Lecturer

Department of Psychological Medicine, St Bartholomew's and the Royal London School of Medicine and Dentistry, Queen Mary and Westfield College, University of London

^* Correspondence

Aims and method Guidelines on high-dose antipsychotic medication contained in the Royal College of Psychiatrists consensus statement were examined in a prospective study of 73 patients admitted to a psychiatric intensive care unit (ICU).

Results The mean (s.d.) neuroleptic dose received was 884mg (667) chlorpromazine equivalence per day. Thirteen patients received more than 1200mg chlorpromazine equivalence per day during at least one week, although adopting measures advocated in the guidelines allowed a reduction in neuroleptic dose for 10 of these patients. Illness severity and a patient's past history were associated with neuroleptic use.

Clinical implications Adherence to the College guidelines is thus possible on a psychiatric ICU.