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.