Dr Anne-Marie Grew
NHS Greater Glasgow and Clyde
Review of off-label antipsychotic prescribing in Renfrewshire drug service
Dr Anne-Marie Grew
My name is Dr Anne-Marie Grew, I’m a ST5 higher trainee psychiatrist currently working in the Renfrewshire Drug Service in Paisley, Scotland. I am undertaking my higher training in General Adult Psychiatry.
My current year of working is as part of my endorsement year in Addictions Psychiatry. I have found working in Addictions Psychiatry particularly interesting as it marries up requirement and monitoring of Opiate Replacement Therapy along with the concurrent monitoring of patients’ mental state.
I have a particular interest in clinical governance and patient safety. This review of off-label prescribing was directed towards these management parameters.
I hope to continue work into promoting effective clinical governance and enhanced patient safety structures in my future working career.
This review looks at the prescription of antipsychotic medication within the Renfrewshire Drug Service and the indications for commencement.
A service-wide computerised prescribing programme search was undertaken for any patients prescribed antipsychotic medication within the first six months of 2018. Search parameters included prescriptions of:
Patients ‘ CHI numbers were collated and each patient ‘s computerised outpatient letters were reviewed in order to ascertain when these antipsychotic medications were commenced and the reason for their prescription.
During the first six months of 2018, 173 patients were prescribed the above antipsychotic medication. Of these, 100 patients (58%) received antipsychotic medication off-label. Twenty-seven of the fifty Olanzapine prescriptions (54%) were without a ‘ psychotic ‘ diagnosis and sixty-six of the eighty-eight Quetiapine prescriptions (75%) were in the absence of a confirmed psychotic diagnosis. Reasons for their prescription include; ‘ anxiety ‘, ‘ distress ‘, ‘ sleep ‘, ‘ paranoia ‘, non-psychotic ‘ voices/hallucinations ‘, ‘ anger ‘ and ‘ mood stabilisation ‘.
This highlights the dilemma faced by many psychiatrists treating patients with substance misuse; that although there are less diagnoses of psychosis/psychotic illnesses than antipsychotic prescriptions, the benefit of sedative antipsychotics to reduce distress, promote sleep and settle some of the chaos in a harm reduction approach, does appear to outweigh the clinical aspect of off-label prescribing.
Medical staff however, should continue to balance the delicate line of substance misuse harm reduction strategies with regular reviews of the requirement for off-label antipsychotic prescriptions, and attempt to reduce and stop these as soon as is clinically possible.
Dr Anne-Marie Grew, ST5 doctor, NHS Greater Glasgow and Clyde
Conflicts of interest:
No conflict of interest