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Use of atypical antipsychotics by consultant psychiatrists working in forensic settings

The Bracton Centre, Oxleas NHS Trust, Bexley Hospital, Old Bexley Lane, Bexley, Kent DA5 2BF

Declaration of interest

C.P. has received speaker fees from Lilly and consultancy fees from Lilly and Pfizer.

AIMS AND METHOD

Atypical antipsychotics have less neurological side-effects than the older drugs but are only available as oral preparations. This may limit their use in forensic patients. We sent a postal questionnaire to all consultant psychiatrists working in forensic settings in the UK to determine their views.

RESULTS

The response rate was 60%. Respondents tended to overestimate the benefits and underestimate the side-effects of the atypical antipsychotics. The majority often prescribed atypical antipsychotics and depots together. Psychoeducation and serum level monitoring were used to optimise/monitor compliance by 50%.

CLINICAL IMPLICATIONS

Using atypical antipsychotics as monotherapy is problematic in forensic settings. The extent of polypharmacy means that patients may experience the side-effects of both typical and atypical antipsychotics. More could be done to facilitate and monitor compliance.

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