Six Years of Re-education and Restrictions Sufficient to Change Inappropriate Prescribing Habits

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A six-year program run by the NHS Foundation Trust aimed at reducing high rates of inappropriate polypharmacy and overprescribing by physicians and psychiatrists to mental health patients in UK inner cities was successful, according to a study in Therapeutic Advances in Psychopharmacology.

The program took place in “SLAM,” which the researchers described as “an inner city trust which serves a multicultural population of approximately 1.2 million with high rates of immigration and social deprivation.”

“There is no conclusive evidence that either high doses or combinations of antipsychotics are more effective than standard doses or monotherapy alone,” stated the researchers. Over half of the patients in SLAM were being prescribed a high-dose antipsychotic or a combination of antipsychotics, the highest rate in the UK.

The program involved educating and training the psychiatrists and physicians about overprescribing, and then implementing explicit restrictions on drug levels which could only be circumvented through special procedures. All patients’ drug levels were then submitted to regular, independent reviews which eventually became weekly for any patients that were on higher doses.

Another study in the same journal reported on by Mad In America in January found that a training program for physicians at four clinics produced no measurable improvements in patterns of over-prescribing of psychiatric medications; however, that training and education program ran for only one year.

Mace, Shubhra, and David Taylor. “Reducing the Rates of Prescribing High-Dose Antipsychotics and Polypharmacy on Psychiatric Inpatient and Intensive Care Units: Results of a 6-Year Quality Improvement Programme.” Therapeutic Advances in Psychopharmacology 5, no. 1 (February 1, 2015): 4–12. doi:10.1177/2045125314558054. (Abstract)

2 COMMENTS

  1. “There is no conclusive evidence that either high doses or combinations of antipsychotics are more effective than standard doses or monotherapy alone,” stated the researchers. But there is conclusive evidence on drugs.com that high doses or combinations of antipsychotics can cause anticholinergic intoxication, a syndrome which emulates the symptoms of schizophrenia.

    “MONITOR: Agents with anticholinergic properties (e.g., … neuroleptics …) may have additive effects when used in combination. Excessive parasympatholytic effects may result in paralytic ileus, hyperthermia, heat stroke, and the anticholinergic intoxication syndrome … Central symptoms may include memory loss, disorientation, incoherence, hallucinations, psychosis, delirium, hyperactivity, twitching or jerking movements, stereotypy, and seizures … Use of neuroleptics in combination with other neuroleptics or anticholinergic agents may increase the risk of tardive dyskinesia.”

    It’s hard to convince patients they are schizophrenic, unless the doctors create the symptoms of schizophrenia with their high doses and combinations of neuroleptics. I would imagine the primary cause of schizophrenia in the world today is the central symptoms of neuroleptic induced anticholinergic intoxication being misdiagnosed by doctors as schizophrenia. It’s so ironic the psycho / pharmaceutical industries call drugs known to cause “psychosis,” “antipsychotics.”

    And the psychiatrists apparently want to harm the bipolar patients even more than the schizophrenic patients because they add “mood stabilizers,” in addition to the antipsychotics, to the bipolar patients’ drug cocktails. According to drugs.com the “mood stabilizers” have moderate drug interaction warnings with the antipsychotics, too.

    “MONITOR: The concomitant administration of lithium with neuroleptic agents may increase the risk of extrapyramidal reactions and neurotoxicity. In addition, central nervous system-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects….”

    Is it appropriate to have a “standard of care” which is known to consist of moderate drug interaction warnings? I’m quite certain the reason our society is seeing such poor results within the “mental health industry” is because the psych drugs cause the symptoms of the DSM disorders, rather than curing them.