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Antipsychotic prescribing for vulnerable populations: a clinical audit at an acute Australian mental health unit at two-time points

Overview of attention for article published in BMC Psychiatry, April 2017
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Title
Antipsychotic prescribing for vulnerable populations: a clinical audit at an acute Australian mental health unit at two-time points
Published in
BMC Psychiatry, April 2017
DOI 10.1186/s12888-017-1295-1
Pubmed ID
Authors

Sara S McMillan, Sara Jacobs, Louise Wilson, Theo Theodoros, Gail Robinson, Claire Anderson, Gabor Mihala, Amanda J Wheeler

Abstract

Antipsychotics are recognised as a critical intervention for schizophrenia and bipolar disorder. Guidelines globally endorse the routine practice of antipsychotic monotherapy, at the minimum effective dose. Even in treatment-resistant schizophrenia, clozapine use is endorsed before combining antipsychotics. This aim of this study was to review antipsychotic polytherapy alone, high-dose therapy alone, polytherapy and high-dose prescribing patterns in adults discharged from an inpatient mental health unit at two time-points, and the alignment of this prescribing with clinical guideline recommendations. Additionally, associations with polytherapy and high-dose antipsychotic prescribing, including patient and clinical characteristics, were explored. A retrospective clinical audit of 400 adults (200 patients at two different time-points) discharged with at least one antipsychotic. Preliminary findings and education sessions were provided to physicians between Cohorts. Outcomes (polytherapy alone, high-dose therapy alone, polytherapy and high-dose therapy) were compared between study Cohorts using chi-squared and rank-sum tests. Associations between outcomes and covariates were assessed using multivariable logistic regression. Most patients (62.5%) were discharged on a single antipsychotic within the recommended dose range. There was a clear preference for prescribing second generation antipsychotics, and in this respect, prescribing is aligned with current evidence-based guidelines. However, sub-optimal prescribing practices were identified for both Cohorts in relation to polytherapy and high-dose antipsychotic rates. Involuntary treatment, frequent hospitalisations and previous clozapine use significantly increased the risk of all three prescribing outcomes at discharge. In a significant minority, antipsychotic prescribing did not align with clinical guidelines despite increased training, indicating that the education program alone was ineffective at positively influencing antipsychotic prescribing practices. Further consideration should be given when prescribing antipsychotics for involuntary patients, people with frequent hospitalisations, and those who have previously trialled clozapine.

Twitter Demographics

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Mendeley readers

The data shown below were compiled from readership statistics for 40 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 40 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 12 30%
Researcher 7 18%
Other 5 13%
Student > Doctoral Student 4 10%
Student > Postgraduate 3 8%
Other 5 13%
Unknown 4 10%
Readers by discipline Count As %
Medicine and Dentistry 19 48%
Psychology 5 13%
Nursing and Health Professions 3 8%
Social Sciences 3 8%
Biochemistry, Genetics and Molecular Biology 2 5%
Other 1 3%
Unknown 7 18%

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 13 April 2017.
All research outputs
#7,473,389
of 9,684,470 outputs
Outputs from BMC Psychiatry
#2,064
of 2,525 outputs
Outputs of similar age
#190,107
of 264,253 outputs
Outputs of similar age from BMC Psychiatry
#83
of 122 outputs
Altmetric has tracked 9,684,470 research outputs across all sources so far. This one is in the 12th percentile – i.e., 12% of other outputs scored the same or lower than it.
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We're also able to compare this research output to 122 others from the same source and published within six weeks on either side of this one. This one is in the 15th percentile – i.e., 15% of its contemporaries scored the same or lower than it.