CWPT Medicines Management

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A novel way to understand and communicate the burden of Antipsychotic Prescribing for Adults across Specialist Intellectual Disability Services in England and Wales: the APHID feasibility study protocol
(Frontiers Media, 2025) Stanyard, Emily; Neilens, Helen; Allgar, Victoria; Bailey, Matthew; Musicha, Crispin; Purandare, Kiran; Perera, Bhathika; Roy, Ashok; sawhney, indermeet; Watkins, Lance; Jaydeokar, Sujeet; Lennard, Sarah; Mitchell, Sarah; McGowan, Paula; Laugharne, Richard; Tromans, Samuel; Shankar, Rohit; University of Plymouth; Central and North West London NHS Foundation Trust; University College London; Coventry and Warwickshire Partnership NHS Trust; Hertfordshire Partnership University NHS Foundation Trust; University of South Wales; Cheshire and Wirral Partnership, NHS Foundation Trust; Cornwall Partnership NHS Foundation Trust; University of Leicester; Peninsula Medical School, Faculty of Medicine and Dentistry, University of Plymouth; Intellectual Disabilities; Medical and Dental; Roy, Ashok
BackgroundThe stopping overmedication of people with a learning disability, autism, or both (STOMP) programme was launched in 2016 in response to concerns about the over-prescribing of medication in people with intellectual disability. The programmes focus has been on the withdrawal of antipsychotic treatment for the individual person than the service or dosage optimisation. It could be that cumulative service level antipsychotic treatment converted and presented as chlorpromazine units could allow for comparison of services on how antipsychotic treatment is being utilised and allow for comparing of practices between services in different regions. The aim of this feasibility study is to explore if cumulative service scores of antipsychotic treatment burden could define prescribing patterns across different specialist intellectual disability services in England and Wales, focused on those on ≥2 antipsychotic treatments. There is no evidence to use ≥2 antipsychotic treatments for any individual.MethodsThe study is a feasibility cross-sectional study investigating service antipsychotic treatment cumulative burden at seven annual time points, 2017-2023. De-identified data for adult patients with intellectual disability under the care of specialist intellectual disability services in receipt of ≥2 oral and/or long-acting IM (intramuscular) injectable (depot) antipsychotic treatments are included. Demographic and clinical data will be collated, in addition to information on the prescribed antipsychotic treatments. The data will be evaluated for data completeness and will be inputted into the Statistical Process Control tool. Outcomes will be measured using a combination of methods including descriptive analysis (including mean, standard deviation and percentage values), and a mixed effects regression model, to determine changes in chlorpromazine equivalent dose values over time. ResultsSeven England and Wales National Health Service intellectual disability services are recruiting up to 490 people. There were recognised challenges in identifying the relevant eligible cohort across services and administering a common set of outcome measures. Discussion This study is intended to inform decisions to design a wider registry that would involve antipsychotic treatment prescribing data for patients across multiple sites nationwide. Developing a de-identified database using routinely collected data, without the requirement for informed consent, comes with unique benefits and challenges.
Rabbit Syndrome: Update on aetiology and management for pharmacists, psychiatrists and dentists
(IJCMPR Publications, 2019-03) Antoun Reyad, Ayman; Girgis, Eriny; Mishriky, Raafat; University of Wolverhampton; Coventry and Warwickshire Partnership NHS Trust; Birmingham and Solihull Mental Health NHS Foundation Trust; Aston medical School, Aston University; Community Dental Service; Medical and Dental; Girgis, Eriny
Rabbit syndrome (RS) is an involuntary movement disorder, characterized by fast and fine movements of oral and masticatory muscles along the mouth vertical axis in the absence of tongue involvement. RS prevalence varies between 2.3% to 4.4% and could result from the administration of antipsychotics and antidepressants. In case of second generation antipsychotics, there is a reduced risk of RS compared with first generation antipsychotics with mainly isolated literature case reports especially with the use of risperidone as antipsychotic. RS affects only the buccal region, with the possible involvement of the basal ganglia, in particular the substantia nigra. The management of RS include reduction or change of the psychotropic treatment and use of anticholinergic medications such as trihexyphenidyl. Although RS is rare and easily treatable, it is essential that dentists and psychiatrists could distinguish this syndrome from other movement disorders such as tardive dyskinesia.
A Commentary on Lipid Disorder and HDL-Cholesterol in HIV Patients: Changing Trends
(Bioaccent, 2019) Das, Satyajit; Coventry & Warwickshire Partnership NHS Trust; Integrated Sexual Health Service and Clinical Assessment Service; Medical and Dental; Das, Satyajit
With the advent of highly active antiretroviral therapy (HAART) there have been remarkable improvements in the survival of HIV patients. However, complications in the form of dyslipidaemia, insulin resistance, bone problems and liver and kidney disorders have been found to be more noticeable compared to AIDS defining illnesses. The continuous exposures of antivirals of different class with different side effects profile have led to a new trend of problems.
The Effect of Low Dose Oral Vitamin D on Bone Mineral Density Changes in HIV Patients: 36 Months Follow Up
(Bentham Science Publishers, 2020) Dhother, Jasreen; Bopitiya, Shyamalie; Taha, Huda; Das, Satyajit; Coventry & Warwickshire Partnership Trust; Department HIV Medicine; Medical and Dental; Dhother, Jasreen; Bopitiya, Shyamalie; Taha, Huda; Das, Satyajit
Background: A high incidence of vitamin-D deficiency and abnormal bone mineral density (BMD) is reported among Human Immunodeficiency Virus (HIV) infected patients. The study highlighted the effect of oral low dose vitamin-D replacement in patients with a known vitamin- D deficiency on the levels of vitamin-D [25 (OH)D], parathyroid hormone (PTH) and Bone Mineral Density (BMD) of hip and spine. Methods: Patients took a daily low dose of 800IU of vitamin-D. The following details were collected on all patients: demographics, CD-4 cell count, viral load, fracture risk factors, treatment history, corrected calcium, alkaline phosphatase (ALP), Parathyroid Hormone (PTH) (intact PTH), vitamin D 25(OH)D, inorganic phosphate and BMD of hip and spine at baseline, 12 and 36 months. Results: Our Cohort consisted of 86 patients. Patient details included: mean age 42.8 (+/-7.7) years, 48 (55%) females 64, (74%) black African, CD-4 count 440.7 (+/-180.8) cells/dL, plasma VL 1.6 log (+/-2.3) copies/mL, duration of illness 80.9 (34.1) months, duration of exposure to antiretroviral 65.2 (+/-27.9) months. At baseline, no difference in BMD of hip or spine was observed, however, a higher PTH (0.001) in patients taking Tenofivir and a lower vitamin-D was noticed in patients taking Efavirenz. After 36 months, patients on vitamin D replacement (n=44) had a significant increase in vitamin- D level (15.4 +/-10.4 vs 104.1+/-29.1 p=0.0001), lower PTH (6.3 +/-3.4 vs 4.4 +/-1.4 p=0.0001) ALP (108.9+/-78.8 vs 90.6+/-45.8 p=0.05) but no change in corrected calcium (2.13 +/-0.1 vs 2.16 +/-0.34 p=0.5) and BMD of spine (1.039+/-0.226 vs.1.027+/-0.211, p=0.77), and BMD of hip (1.020 +/- 0.205 vs. 1.039, p=0.61). In a multivariate logistic regression analysis that included all significant variables, vitamin-D replacement independently was associated with increase in vitamin- D level (OR 2.08, CI 1.03, 4.12, p=0.005), decrease in PTH level (OR 0.53, CI 0.35, 0.82, p=0.04), but not with change in corrected calcium, alkaline phosphatase, BMD of hip or spine. Conclusion: After 36 months of follow up, the replacement of low dose once daily oral vitamin-D in the treatment experienced HIV infected patients with vitamin-D deficiency can increase vitamin- D level, reduce PTH level without any change in BMD of spine and hip.
Malignancies Spectrum in the Era of Modern HAART
(BIOACCENT, 2019-06) Seneviratne, Kanchana; Shah, Rajiv; Taha, Huda; Venkatesan, Pradhib; Das, Satyajit; Pammi, Manjula; Nottingham University Hospitals NHS Trust; Coventry and Warwickshire Partnership NHS Trust; HIV; Medical and Dental; Taha, Huda; Das, Satyajit
In the current highly active antiretroviral therapy (HAART) era, studies suggest AIDS defining malignancies (ADM) are decreasing and non- AIDS defining malignancies (NADM) are increasing. We aimed to review all types of malignancies and risk factors in our HIV cohort over a period of ten years. Methods T his was a retrospective cohort study of all malignancy diagnoses and risk factors collected (2004-2014) from two teaching hospitals in the Midlands, United Kingdom. The demographic data and clinical features were collated and the primary end point of survival analysed. Secondary endpoints included risk factors for ADM compared to NADM. Results 111malignancy diagnoses 63 (54%) ADM and 48 (46%) NADM identified. Survival was worse once diagnosed with a NADM. About half of the ADM and a third of the NADM had a new HIV diagnosis at the same time or soon after the malignancy diagnosis. Haematological malignancies were the commonest malignancy in both groups. Oncogenic virus was an independent predictor of ADM risk . Conclusions Despite new and improved HAART regimens, ADM remain high in newly diagnosed HIV individuals and NADM are on the rise in those on longstanding HAART with stable HIV. Not only continuing HIV testing in new ADM as per the indicator conditions, but it is also important to increase HIV testing in new diagnoses of NADM such as all haematological malignancies and lung cancer.
Clozapine-induced hepatitis confirmed by rechallenge
(Wiley, 2019-08-13) Kanani, Muhammad-Kazim; Nandhra, Harpal; Coventry and Warwickshire Partnership NHS Trust; Psychiatry; Medical and Dental; Kanani, Muhammad-Kazim; Nandhra, Harpal
Clozapine is an atypical antipsychotic that holds a unique role in the management of treatment-resistant schizophrenia. Well known side-effects include agranulocytosis and myocarditis but associated hepatic disorders are less familiar and listed under ‘rare or very rare’ by the British National Formulary.1 However, a transient elevation of transaminases has been estimated to affect up to 50% of patients treated with clozapine.2 This article describes a patient with minimally elevated LFTs who subsequently developed symptomatic hepatitis following the initiation of clozapine therapy.
Practical Guidance on the Use of Lurasidone for the Treatment of Adults with Schizophrenia
(Springer Nature, 2019-05-16) Javed, Afzal; Arthur, Holger; Curtis, Logos; Hansen, Lars; Pappa, Sofia; Coventry and Warwickshire Partnership NHS Trust; Stockholm Health Care Services; Geneva University Hospitals; Southern Health NHS Foundation Trust; West London Mental Health Trust; Psychiatry; Medical and Dental; Javed, Afzal
Introduction: Lurasidone is an atypical antipsychotic that was approved in Europe in 2014 for the treatment of schizophrenia in adults aged ≥ 18 years. Clinical experience with lurasidone in Europe is currently limited, and there is therefore a need to provide practical guidance on using lurasidone for the treatment of adults with schizophrenia. Methods: A panel of European psychiatrists with extensive experience of prescribing lurasidone was convened to provide recommendations on using lurasidone to treat adults with schizophrenia. Results: Extensive evidence from clinical trials and the panel's clinical experience suggest that lurasidone is as effective as other atypical agents, with the possible exception of clozapine. Lurasidone is associated with a lower propensity for metabolic side effects (in particular, weight gain) and hyperprolactinaemia than most other atypical antipsychotics and has a relatively benign neurocognitive side effect profile. Patients switching to lurasidone from another antipsychotic may experience weight reduction and/or improvements in the ability to focus/concentrate. Most side effects with lurasidone (such as somnolence) are transitory, easily managed and/or ameliorated by dose adjustment. Akathisia and extrapyramidal symptoms may occur in a minority of patients, but these can be managed effectively with dose adjustment, adjunctive therapy and/or psychosocial intervention. Conclusions: Given the crucial importance of addressing the physical as well as mental healthcare needs of patients, lurasidone is a rational therapeutic choice for adults with schizophrenia, both in the acute setting and over the long term.
Clozapine induced neutropenia, onset after 6 years of treatment: a case report
(Lippincott, Williams & Wilkins, 2020-05) Bullock, Stuart A; Bescoby-Chambers, Nicholas J.C.; Coventry and Warwickshire Partnership NHS Trust; The University of Warwick; Health Education England; Psychiatry; Medical and Dental; Bullock, Stuart A; Bescoby-Chambers, Nicholas J.C.
No abstract available.
Can orexin receptor antagonist offer a future option in pharmacological management of insomnia in older adults?
(Hamad Medical Corporation for Educational Purposes, 2024-10) Tsang, Yuk Ting; Mishriky, Raafat; Girgis, Eriny; Antoun Reyad, Ayman; University of Wolverhampton; Hamad Medical Corporation, Qatar; Coventry and Warwickshire Partnership Trust; Dental Department; Medical and Dental; Girgis, Eriny
Insomnia is a sleep condition in the general population including older adults. Pharmacological treatments may have limited efficacy and unacceptable side effects profile for the older population. Daridorexant, a dual orexin receptor antagonist has shown promise in improving some sleep parameters. We discuss its clinical application and efficacy in this article. Methods: We searched databases including PubMed and Science Direct and checked clinical trials that determined its efficacy using parameters such as wake time after sleep onset (WASO), latency to persistent sleep (LPS) and total sleep time (TST), at different doses. Results: Small doses such as 5 and 10 mg did not show clinical efficacy, while 25mg and 50mg were superior in improving the efficacy outcomes with mild adverse reactions. Daridorexant reduced wake time after sleep onset (WASO), latency to persistent sleep (LPS), whilst increasing total sleep time (sTST). It was associated with a mild risk of headache and fatigue but did not cause other adverse associated with traditional therapies, such as withdrawal or rebound insomnia. This review supports clinicians such as psychiatrists, physicians and pharmacists in choosing the best treatment options taking into consideration patients’ conditions and preferences. The authors do not recommend prescribing before more longitudinal and larger studies.
A visual antiretroviral regimen based tool to support cost-effective prescribing in treatment-naive individuals : defining the baseline
(Wiley, 2017-04-04) Page, M.; Barnes, J.; Ahmed, I.; Munatsi, S.; Ghanem, M.; Riddell, L.; Palfreeman, A.; Lenko, A.; Goodall, L.; Arumainayagam, J.; Dear, W.; McCathie, R.; Samuels, J.; Penn, C.; Hilton, L.; Taha, H.; Mughal, A.; Bhaduri, S.; Roberts, M.; Price, H.; Murray, C.; Ng, A.; David, L.; Booker, N.; Wellwood, S.; Crowe, G.; Heart of England NHS Foundation Trust, Birmingham; Nottingham University Hospital NHS Trust; Northamptonshire Healthcare NHS Foundation Trust; University Hospitals of Leicester NHS Trust, UK; Staffordshire and Stoke-on-Trent Partnership NHS Trust; Walsall Healthcare NHS Trust; Royal Wolverhampton NHS Trust; Southend University Hospital NHS Foundation Trust; Coventry and Warwickshire Partnership NHS Trust; Worcestershire NHS Acute Trust; Mid Essex Hospital Services NHS Trust; Burton Hospitals NHS Foundation Trust; South Staffordshire and Shropshire Healthcare NHS FT; George Eliot Hospital NHS Trust, Nuneaton; Lincolnshire Community Health Service NHS Trust; Princess Alexandra Hospital NHS Trust, Redditch; Medical and Dental; David, L.; Booker, N.
Poster abstract P146 from the 23rd Annual Conference of the British HIV Association (BHIVA), Liverpool, UK, 4–7 April 2017.
The importance of clinical observation: A case of subtle tardive dyskinesia with paliperidone palmitate
(Sage Journals, 2018-01-16) Hisham, Omer; Thompson, Andrew; University Hospitals Coventry and Warwickshire NHS Trust; University of Warwick; Coventry and Warwickshire Partnership Trust; Psychiatry; Medical and Dental; Thompson, Andrew
No abstract is available.
Neuroleptic Malignant Syndrome: The Value of Diagnostic Criteria
(Physicians Postgraduate Press, 2018-08) Rowland, Tobias; Banga, Anil; Ayadurai, Nirmalan; Coventry and Warwickshire Partnership NHS Trust; Psychiatry; Medical and Dental; Rowland, Tobias; Banga, Anil; Ayadurai, Nirmalan
Neuroleptic malignant syndrome (NMS) is a rare but potentially serious reaction to antipsychotic medications. The incidence of NMS is around 0.9%,1 with an estimated mortality of 5.6%–12%.2,3 Early recognition is key and a low index of suspicion is required as the presentation shares symptoms with other disorders,1,4,5 which is further compounded by a lack of definitive diagnostic criteria.
Phelan-McDermid syndrome, bipolar disorder and treatment with lithium
(Wiley, 2018-06-21) Rowland, Tobias; Pathania, Rani; Roy, Ashok; University of Warwick; Coventry and Warwickshire Partnership NHS Trust; Psychiatry; Medical and Dental; Rowland, Tobias; Pathania, Rani; Ashok, Roy
Background Phelan-McDermid syndrome is caused by a deletion at chromosome 22q13.3, and results in a phenotype characterised by intellectual disability, features of autism, physical and mental health conditions. It is becoming increasingly recognised that bipolar disorder represents part of this phenotype. Materials and methods This case study describes 2 patients with Phelan-McDermid syndrome presenting with bipolar mania at inpatient unit for adults with intellectual disability. Both patients presented with severe disturbance of their behaviour, at times exhibiting aggression, disinhibition and hypersexuality. Results Despite treatment with a number of atypical antipsychotics and anticonvulsant mood stabilising agents, both patients showed the greatest improvement when started on lithium, and were successfully treated with this medication. Conclusions This adds further support to the growing evidence of bipolar disorder contributing to the phenotype of Phelan-McDermid syndrome, and clinicians should have a low threshold for considering the use of lithium in these patients.
Association of Low Vitamin D with Complications of HIV and AIDS: A literature Review
(Bentham Science, 2018-12) Chokuda, Evelyn; Reynolds, Chris; Das, Satyajit; Coventry & Warwickshire Partnership NHS Trust; Department of HIV Medicine; Medical and Dental; Chokuda, Evelyn; Reynolds, Chris; Das, Satyajit
With the advent of combination antiretroviral therapy (cART), the survival of HIV patients has improved dramatically, but the complications of the disease and treatment have become an important issue in the management of HIV patients. Vitamin-D deficiency is common in HIV patients. Low vitamin-D is associated with different comorbidities in the HIV uninfected general population. In this review, we first briefly describe vitamin D synthesis and mechanism of action and we focus on the epidemiological and clinical data dealing with the relationship between vitamin D deficiency in HIV infection with several comorbidities which has been found to be increasingly common in patients living with HIV infection. We searched the PubMed database using the keywords "HIV," "vitamin D" and other common disorders or conditions that are relatively common in HIV infection. The other conditions included in the search were osteoporosis and fracture, cardiovascular disease, diabetes and insulin resistance, active tuberculosis, hepatitis-C co-infection, and HIV disease progression. Articles presenting original data as well as systematic reviews and met analysis related to HIV population were included in our analysis. Vitamin-D deficiency seems to be associated with several adverse outcomes in HIV patients but a definite cause and effect relationship with vitamin-D is yet to be confirmed in most of the cases. However, the literature supporting the efficacy of vitamin-D supplementation is lacking.
Sertraline for anxiety in adults with a diagnosis of autism (STRATA): study protocol for a pragmatic, multicentre, double-blind, placebo-controlled randomised controlled trial
(BioMed Central, 2024-01-11) Rai, Dheeraj; Webb, Doug; Lewis, Amanda; Cotton, Leonora; Norris, Jade Eloise; Alexander, Regi; Baldwin, David S; Brugha, Traolach S; Cochrane, Madeleine; Del Piccolo, Maria Chiara; Glasson, Emma J; Hatch, Katherine K; Kessler, David; Langdon, Peter E; Leonard, Helen; Mills, Nicola; Vazquez Morales, Maximiliano; Morgan, Zoe; Mukherjee, Raja; Realpe, Alba X; Russell, Ailsa; Starkstein, Sergio; Taylor, Jodi; Turner, Nicholas; Thorn, Joanna; Welch, Jack; STRATA autistic advisory group; Wiles, Nicola; University of Bristol; NIHR Bristol Biomedical Research Centre; Avon & Wiltshire Partnership Mental Health NHS Trust; Hertfordshire Partnership NHS Foundation Trust; University of Southampton; University of Leicester; Surrey and Borders Partnership NHS Foundation Trust; University of Western Australia; University of Warwick; Coventry and Warwickshire Partnership NHS Trust; University of Bath; Dorset County Hospital NHS Foundation Trust; Learning Disabilities; Additional Professional Scientific and Technical Field; Langdon, Peter, E.
Background: Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed to manage anxiety in adults with an autism diagnosis. However, their effectiveness and adverse effect profile in the autistic population are not well known. This trial aims to determine the effectiveness and cost-effectiveness of the SSRI sertraline in reducing symptoms of anxiety and improving quality of life in adults with a diagnosis of autism compared with placebo and to quantify any adverse effects. Methods: STRATA is a two-parallel group, multi-centre, pragmatic, double-blind, randomised placebo-controlled trial with allocation at the level of the individual. It will be delivered through recruiting sites with autism services in 4 regional centres in the United Kingdom (UK) and 1 in Australia. Adults with an autism diagnosis and a Generalised Anxiety Disorder Assessment (GAD-7) score ≥ 10 at screening will be randomised 1:1 to either 25 mg sertraline or placebo, with subsequent flexible dose titration up to 200 mg. The primary outcome is GAD-7 scores at 16 weeks post-randomisation. Secondary outcomes include adverse effects, proportionate change in GAD-7 scores including 50% reduction, social anxiety, obsessive-compulsive symptoms, panic attacks, repetitive behaviours, meltdowns, depressive symptoms, composite depression and anxiety, functioning and disability and quality of life. Carer burden will be assessed in a linked carer sub-study. Outcome data will be collected using online/paper methods via video call, face-to-face or telephone according to participant preference at 16, 24 and 52 weeks post-randomisation, with brief safety checks and data collection at 1-2, 4, 8, 12 and 36 weeks. An economic evaluation to study the cost-effectiveness of sertraline vs placebo and a QuinteT Recruitment Intervention (QRI) to optimise recruitment and informed consent are embedded within the trial. Qualitative interviews at various times during the study will explore experiences of participating and taking the trial medication. Discussion: Results from this study should help autistic adults and their clinicians make evidence-based decisions on the use of sertraline for managing anxiety in this population.
Cariprazine as a treatment for negative psychotic symptoms in first-episode psychosis: case series.
(Cambridge University Press, 2022-04-28) Demjaha, Arsime; Iacoponi, Eduardo; Hansen, Lars; Peddu, Pradeep; McGuire, Philip; King's College London; South London and Maudsley NHS Foundation Trust; Southampton University; Coventry and Warwickshire Partnership NHS Trust;; Psychiatry; Medical and Dental; Peddu, Pradeep
Negative psychotic symptoms are among the most disabling features of schizophrenia, and are strongly associated with relatively poor clinical and functional outcomes. However, there are no effective treatments for negative symptoms, and this represents a major unmet clinical need. Recent research has shown that negative symptoms are already present in many patients at illness onset. There is evidence that cariprazine may improve negative symptoms in patients with chronic schizophrenia. However, its utility in treating negative symptoms in the early stage of the disorder is unclear. Here, we report six cases of patients with first-episode psychosis who were treated with cariprazine.
The neuropsychiatric effects of nitrous oxide and low vitamin B12
(Cambridge University Press, 2021-09-30) Farmer, Joseph; Romain, Karen; Ibrahim, Mina; Kumar, Manoj Therayil; Moore, William York; Coventry and Warwickshire Partnership Trust; Institute for Mind & Brain, Kerala, India; Herefordshire Mental Health and Learning Disability Services; Psychiatry; Medical and Dental; Farmer, Joseph; Romain, Karen; Ibrahim, Mina; Kumar, Manoj; Moore, William York
This narrative review article aims to update knowledge on the neuropsychiatric complications of nitrous oxide use and low vitamin B12. We consider common forms and uses of nitrous oxide (N2O) and review its mechanism of action, and then explore the potential impacts of use. In particular, neuropsychiatric effects mediated by low vitamin B12 are considered and the correct interpretation of laboratory results explored. This is of particular importance as where vitamin B12 is inactivated by chronic nitrous oxide use, blood test levels of vitamin B12 may not reflect the quantity of functional B12 in patients.
Prescribing antipsychotic medication for adults with intellectual disability: shared responsibilities between mental health services and primary care
(Cambridge University Press, 2021-07-26) Paton, Carol; Roy, Ashok; Purandare, Kiran; Rendora, Olivia; Barnes, Thomas R. E.; Imperial College London; Royal College of Psychiatrists, UK; Coventry and Warwickshire Partnership NHS Trust; Central and North West London NHS Foundation Trust;; Learning Disabilities; Medical and Dental; Roy, Ashok
Aims and method We conducted a secondary analysis of data from a Prescribing Observatory for Mental Health audit to assess the quality of requests from intellectual disability services to primary care for repeat prescriptions of antipsychotic medication. Results Forty-six National Health Service Trusts submitted treatment data on 977 adults with intellectual disability, receiving antipsychotic medication for more than a year, for whom prescribing responsibility had been transferred to primary care. Therapeutic effects had been monitored in the past 6 months in 80% of cases with a documented communication indicating which service was responsible for this and 72% of those with no such communication. The respective proportions were 69% and 42% for side-effect monitoring, and 79% and 30% for considering reducing/stopping antipsychotic medication. Clinical implications Where continuing antipsychotic medication is prescribed in primary care for people with intellectual disability, lack of guidance from secondary care regarding responsibilities for monitoring its effectiveness may be associated with inadequate review.

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