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High dose neuroleptics — who gives them and why?

Brent East Sector, 13-15 Brondensbury Road, London NW6 6BX; tel: 020 8937 6329; fax: 020 8937 6333

Neil Preston

Research Psychiatric Rehabilitation Services, Fremantle Hospital and Health Services, PO Box 480 Fremantle, Western Australia 6160, Australia

Roger Wesby, Consultant Psychiatrist

Barnet Hospital

Correspondence: e-mail: alcuin{at}alc-jean.demon.co.uk

AIMS AND METHOD

Neuroleptic medication is often used in excess of the BNF maximum. The purpose of this study was to examine the relationship of neuroleptic dose to patient, prescriber and environmental factors, by using a cross sectional ‘snapshot’ study of psychiatric in-patient prescriptions combined with a retrospective case note survey.

RESULTS

It was found that certain consultants prescribe higher doses of neuroleptics than others. Patients with a history of aggression had a nine and a half times higher chance of being prescribed higher doses of neuroleptics. Patients with a greater than 5-year history of neuroleptic prescription received higher doses.

CLINICAL IMPLICATIONS

High neuroleptic prescription is related more to patients' past reputation and prescriber differences than to patients' current behaviour.

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