Background and importance An increasingly widespread practice in psychiatry is the use of antipsychotic combination therapy, not supported in the first line by any evidence-based clinical practice guideline. In this practice, the use of daily doses higher than those recommended in the technical data sheet is usually appreciated.
Aim and objectives To describe the use of antipsychotics (APs) in a psychiatric hospital, as well as to analyse whether the doses used exceed the maximum recommended daily doses.
Material and methods Descriptive cross-sectional study of all the prescriptions of hospitalised patients.
Information collected: sex, age, diagnosis, prescribed APs and its dose percentage (sum of the percentage of total daily dose of one or more APs with respect to the maximum dose of the card technique for the age of the patient and indication treated). The ‘if needed’ doses of APs were also taken into account. SPSS program (p≤0.05).
Results 150 patients, 101 (67.3%) men and 49 (32.7%) women; mean age of 42.7 (range 64–17) years.
10 patients (6.7%) had been prescribed first generation APs, 119 (79.3%) second generation APs and 31 (20.7%) had a combination of first and second generation APs.
30.7% (n=46) received antipsychotic monotherapy, and 70.7% (n=106) a combination of more than one AP (χ2=12.9; p<0.01).
Number of prescriptions with doses of APs within the technical sheet (≤100%) was 62 (41.3%), and outside (>100%) was 89 (59.3%), of which even 29 (19.3%) prescriptions presented doses of APs ≥200%. Of the APS >100%, 95.3% corresponded to the sum of different APs and only 4.7% to a single APs.
Percentage of patients who have exceeded 100% of the dose is significantly higher among those who have been prescribed >1 APs (χ2=39.4; p<0.05).
Percentage mean APs dose per patient: 127.7% (range 28–379).
Conclusion and relevance More than half (59.3%) of the APs prescriptions exceed the sum of 100% doses; of these, >90% are due to the sum of the percentage doses of the different APs. Although it may reflect the complexity and resistance of the pathologies treated, it does not agree with the recommendations of the national and international guidelines regarding the management of APs.
Current electronic prescription systems do not alert when the maximum dose is exceeded due to the sum of the combination of APs, which opens a possible way of improvement.
Conflict of interest No conflict of interest
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