Royal College of Psychiatrists

End “routine” prescribing of high-dose antipsychotics, psychiatrists are urged

Psychiatrists should end the “routine” prescribing of high-dose antipsychotics to adult patients, a report has recommended.

The Royal College of Psychiatrists (RCP) report reveals that up to a quarter of adult psychiatric in-patients are on high doses of antipsychotics. The report recognises there is a “possible link” between antipsychotic drugs and sudden death. However the report adds there is “no consensus” on there being a causal link.

The RCP working group which compiled the report defines a “high dose” as either a daily dose of an antipsychotic which exceeds the upper limit stated in the British National Formulary, or a total daily dose of two or more antipsychotics which exceeds the formulary’s maximum.

High-dose antipsychotics should only be prescribed after a risk–benefit assessment by a fully trained psychiatrist, said the report.

“This should be undertaken in consultation with the wider clinical team and the patient and a patient advocate, if available”, read the “consensus statement” report.

It also states that evidence reveals that high-dose prescribing for “treatment-resistant” schizophrenia is “unsuccessful or inappropriate”. Therefore, high doses should “rarely be used” in such cases.

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