Can the use of long-acting injectable antipsychotic preparations be increased in routine clinical practice and the benefits realised?

Background: The use of continuing antipsychotic medication is an established evidence-based strategy for preventing relapse in people with schizophrenia, but medication adherence is known to be suboptimal. Covert non-adherence can be eliminated by the use of long-acting injectable (LAI) formulations. We sought to (1) raise awareness among clinicians of the potential benefits of LAI antipsychotic formulations, (2) increase use of these formulations for the treatment of schizophrenia in routine clinical practice and thereby (3) reduce the number of relapses requiring hospitalisation in patients with schizophrenia under our care.

Physical health monitoring after rapid tranquillisation: clinical practice in UK mental health services.

Background: We aimed to assess the quality of physical health monitoring following rapid tranquillisation (RT) for acute behavioural disturbance in UK mental health services.

Methods: The Prescribing Observatory for Mental Health (POMH-UK) initiated an audit-based quality improvement programme addressing the pharmacological treatment of acute behavioural disturbance in mental health services in the UK.

Results: Data relating to a total of 2454 episodes of RT were submitted by 66 mental health services.

The pharmacological management of acute behavioural disturbance: Data from a clinical audit conducted in UK mental health services.

Background: A quality improvement programme addressing prescribing practice for acutely disturbed behaviour was initiated by the Prescribing Observatory for Mental Health.

Method: This study analysed data from a baseline clinical audit conducted in inpatient mental health services in member trusts.

Results: Fifty-eight mental health services submitted data on 2172 episodes of acutely disturbed behaviour.

Mobile phone text message reminders of antipsychotic medication: is it time and who should receive them? A cross-sectional trust-wide survey of psychiatric inpatients.

Background: Poor adherence to antipsychotic medication is a widespread problem, and the largest predictor of relapse in patients with psychosis. Electronic reminders are increasingly used to improve medication adherence for a variety of medical conditions, but have received little attention in the context of psychotic disorders. We aimed to explore the feasibility and acceptability of including short message service (SMS) medication reminders in the aftercare plan of service users discharged from inpatient care on maintenance antipsychotic medication.

Text message reminders of appointments: a pilot intervention at four community mental health clinics in London.

Objective: Forgetting is commonly stated as a reason for missing mental health appointments. The authors examined the effect of short message service (SMS), or text message, reminders on the attendance of appointments at four community mental health clinics in London.

Methods: Attendance of outpatient appointments roughly between March and June of 2008 (N=648), 2009 (N=1,081), and 2010 (N=1,088) was examined.

Buccal midazolam for agitation on psychiatric intensive care wards.

Midazolam is a benzodiazepine known to be effective as a treatment for status epilepticus and for rapid tranquillisation. Buccal midazolam has recently become available in the UK. We introduced it as a treatment option for rapid tranquillisation on our intensive care wards.

The use of academic detailing to improve evidence based prescribing of risperidone long acting injection.

Objective. It takes 6 weeks for plasma levels of risperidone long-acting injection (RLAI) to reach steady state, and randomised controlled trials demonstrate a flat dose-response curve. In clinical practice, the dose of RLAI is often increased rapidly at the start of treatment and many patients receive a dose above 25 mg/2 weeks.

Patterns of antipsychotic and anticholinergic prescribing for hospital inpatients.

The development of atypical antipsychotics has not only given the prescriber more options, but also increased the complexity of decision making. We examined current prescribing practice for antipsychotic and anticholinergic drugs, which involved a 1-day census of all antipsychotic and anticholinergic drugs prescribed for 4191 inpatients in 49 UK mental health services. Eighty-five percent of inpatients were prescribed antipsychotics, 48% of whom were prescribed more than one.