THE MANAGEMENT OF SEVERE PSYCHIATRIC-DISORDER - A COMPARISON OF THE USE OF NEUROLEPTIC MEDICATION IN 2 INTENSIVE THERAPY UNITS

Concern over the use of high dose neuroleptic medication has led to th e introduction of guidelines for prescribing. This is of particular im portance in the treatment of patients with severe psychiatric disorder . This study evaluates how physical security of the ward relates to pr escribing in two close supervision units. A prospective analysis of 93 consecutive admissions to two wards, one locked and the other open, w as undertaken. Data included patient characteristics, diagnosis and me dication received. There was no difference in total neuroleptic dosage between the two wards, but mean daily dose (2,108 mg chlorpromazine e quivalent) exceeded maxima specified in guidelines. In the early stage s of admission, the open ward used higher regular doses, whereas the l ocked ward prescribed more on an as required basis. The high incidence of absconding from the open ward must be considered against the more custodial environment of the locked ward. The wider use of chlorpromaz ine equivalence calculations is recommended.