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Limiting psychotropic medication prescription on discharge from psychiatric inpatient care: a possible suicide intervention?

Published online by Cambridge University Press:  11 June 2019

Eimear Cleary ,
Cecily C. Kelleher ,
Abbie Lane  and
Kevin M. Malone
Eimear Cleary
Affiliation:
Department of Psychiatry & Mental Health Research, UCD School of Medicine, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland
Cecily C. Kelleher
Affiliation:
Department of Public Health, Physiotherapy and Sports Sciences, College of Health & Agricultural Sciences, University College Dublin, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland
Abbie Lane
Affiliation:
Department of Psychiatry & Mental Health Research, UCD School of Medicine, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland
Kevin M. Malone*
Affiliation:
Department of Psychiatry & Mental Health Research, UCD School of Medicine, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland
*
*Address for correspondence: K. M. Malone, Department of Psychiatry & Mental Health Research, UCD School of Medicine, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland. (Email: k.malone@svuh.ie)
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Abstract

Objectives

Restricting access to lethal means is an effective suicide prevention strategy. However, there is little discussion in the literature about the potential contribution of prescribing practices on discharge from inpatient psychiatric care (which has been established as a high-risk period for suicide) to suicide deaths by overdose of prescribed medication. This study aimed to assess the quantity, toxicity and potential lethality of psychotropic medication being prescribed on discharge from psychiatric care to those with and without indices of suicidality.

Methods

Patient demographic, clinical and prescription data were collected from 50 randomly selected charts following discharge from inpatient psychiatric care. Psychotropic medications (dose × duration) on discharge were converted to their equivalent doses of neuroleptics, antidepressants and anxiolytics to rate toxicity and potential lethality, using the Maudsley Prescribing Guidelines. Mood stabilizing medications were also documented.

Results

39% of prescriptions analysed contained toxic and potentially fatal doses of either neuroleptic or antidepressant equivalent medication.

Conclusions

Patient discharge from inpatient psychiatric care presents a golden opportunity to moderate access to potentially fatal psychotropic medication. Iatrogenic provision of lethal means for suicide during a period of increased risk and in a group at increased suicide risk may impact suicide prevention efforts and requires further in-depth research. Current prescribing practices may be a missed opportunity to intervene in this regard.

Keywords

Psychotropic medicationsuicidesuicide risk
Type
Short Report
Information
Irish Journal of Psychological Medicine , Volume 37 , Issue 1 , March 2020 , pp. 43 - 47
Copyright
© College of Psychiatrists of Ireland 2019

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