Antipsychotic polypharmacy in outpatients at Birch Hill Hospital: incidence and adherence to guidelines.

The purpose of this article is to determine prescribing rates and adherence to guidelines with regard to antipsychotic polypharmacy, high-dose prescribing, and sedative use in an outpatient population. A prospective case-note audit involving 250 consecutive attendees of an outpatient clinic was carried out. Data were analyzed using descriptive statistical methods. Differences between the groups were estimated using t test and chi(2) where applicable. Results showed that the rate of polypharmacy was 17.4%. Reasons for polypharmacy were documented in 53% of cases. High-dose antipsychotics were used in 2.5% of the monotherapy group and in 38% of the polypharmacy group. An ECG was done in 35% of patients on high-dose antipsychotic therapy. In the monotherapy group, 6.2% versus 26.5% in the polypharmacy group of patients were on at least 1 sedative or hypnotic (odds ratio [OR], 5.47; 95% confidence interval [CI], 2.02-14.82; P < .001). Forty-two percent of patients prescribed sedatives had schizophrenia spectrum disorders, and none of the patients were diagnosed with anxiety disorders. The current study confirms that despite repeated recommendations against the practice, polypharmacy rates remain consistent at the 20% level. Thorough documentation, calculating the total antipsychotic dose, and obtaining an ECG would constitute good practice.

Dynamics of inpatient child psychiatric care in the timeframe 1995-2005 (Vilnius University Child Developmental Centre).

Objective. The goals of this study were to analyse the formation of a multidisciplinary team, the variation of patient types and diagnoses in the Child Developmental Centre as well as the evolution of therapeutic interventions and trends of psychopharmacology in the timeframe 1995-2005. Methods. Analysis of medical documentation on personnel resources as well as general information about patients and applied therapeutic interventions was made. Results. The study results showed that the number of nurses and caretakers was gradually increasing and services became more adequate with inclusion of social workers, speech therapists and teachers. Analysis showed an increase in the following disorders: mood, hyperkinetic, mixed disorders of conduct and emotions, those with onset specific to childhood. The total number of children receiving pharmacological treatment increased. Conclusions. Delivery of adequate inpatient child psychiatric service is strongly dependent on administrative support, presence of qualified personnel, and adequate financial funding. There was a significant increase in the number of certain diagnoses and applied psychopharmacological treatment over the years studied that reflects international trends for treatment, prevalence and comorbidity of psychopathology in children. In view of child needs, establishment of age-specific inpatient units and development of special treatment programs are essential.

A meta-analysis of heart rate and QT interval alteration in anorexia nervosa.

OBJECTIVE: Reports have suggested association between sudden death and QT prolongation in AN patients. Incidence and clinical consequences of cardiac abnormalities remain controversial. As the course of AN disease is long-lasting it remains unclear how often psychiatrists should send AN patients for somatic and especially cardiological investigation. The objective of the study was to aggregate the published data on HR and QT alteration and to perform a meta-analysis of the HR and QT alteration in patients with anorexia nervosa. METHODS: A Medline search of all English language studies from 1994 to 2005 was performed. The inclusion criteria were confirmed diagnosis of AN, measurement of QTc and mean heart rate. Data from 10 studies were analyzed using weighted linear regression model. RESULTS: Analysis showed that bradycardia and relationship between HR and BMI decreases as the disease continues. QTc interval in AN patients was within normal range although significantly longer than in controls. CONCLUSION: Further investigations of sudden death in patients with AN due to cardiac arrest are needed and a model of clinical monitoring of cardiovascular system should be elaborated. If QTc prolongation is detected even in the normal range further cardiological examination for risk assessment and systematic clinical surveillance of the cardiovascular system should be considered.