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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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References

Abou-Saleh, MT, Müller-Oerlinghausen, B, Coppen, AJ (2017). Lithium in the episode and suicide prophylaxis and in augmenting strategies in patients with unipolar depression. International Journal of Bipolar Disorders 5(1), 11.CrossRefGoogle ScholarPubMed
Andreasen, NC, Pressler, M, Nopoulos, P, Miller, D, Ho, BC (2010). Antipsychotic dose equivalents and dose-years: a standardized method for comparing exposure to different drugs. Biological Psychiatry 67(3), 255–262.CrossRefGoogle ScholarPubMed
Appleby, L, Kapur, N, Shaw, J, Windfuhr, K, Hunt, IM, Flynn, S, Tham, SG (2016). The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness Annual Report and 20 year review: England, Northern Ireland, Scotland and Wales. University of Manchester: Manchester.Google Scholar
Ashton, CH (2002). Benzodiazepines: How they Work and How to Withdraw. The Ashton Manual. Newcastle Upon Tyne. Newcastle University: England.Google Scholar
Buckley, NA, McManus, PR (2002). Fatal toxicity of serotoninergic and other antidepressant drugs: analysis of United Kingdom mortality data. British Medical Journal 325(7376), 1332–1333.CrossRefGoogle ScholarPubMed
Capel, MM, Colbridge, MG, Henry, JA (2000). Overdose profiles of new antipsychotic agents. The International Journal of Neuropsychopharmacology 3(1), 51–54.CrossRefGoogle ScholarPubMed
Ernst, CL, Goldberg, JF (2004). Antisuicide properties of psychotropic drugs: a critical review. Harvard Review of Psychiatry 12(1), 14–41.Google ScholarPubMed
Fernandes, V, Flak, E (2012). Safe and effective prescribing practices at the point of discharge from an inpatient psychiatry unit. Journal of Psychiatric Practice 18(1), 12–19.CrossRefGoogle ScholarPubMed
Hawton, K, Bergen, H, Simkin, S, Cooper, J, Waters, K, Gunnell, D, Kapur, N (2010). Toxicity of antidepressants: rates of suicide relative to prescribing and non-fatal overdose. The British Journal of Psychiatry 196(5), 354–358.CrossRefGoogle ScholarPubMed
Hayasaka, Y, Purgato, M, Magni, LR, Ogawa, Y, Takeshima, N, Cipriani, A, Furukawa, TA (2015). Dose equivalents of antidepressants: evidence-based recommendations from randomized controlled trials. Journal of Affective Disorders 180, 179–184.CrossRefGoogle ScholarPubMed
Lawrenson, RA, Tyrer, F, Newson, RB, Farmer, RDT (2000). The treatment of depression in UK general practice: selective serotonin reuptake inhibitors and tricyclic antidepressants compared. Journal of Affective Disorders 59(2), 149–157.CrossRefGoogle ScholarPubMed
Mental Health Commission (2009). Code of practice on admission, transfer and discharge to and from an approved centre (http://www.mhcirl.ie/for_H_Prof/codemha2001/Admission_transfer_Discharge/). Accessed 20 November 2016.Google Scholar
Minns, AB, Clark, RF (2012). Toxicology and overdose of atypical antipsychotics. Journal of Emergency Medicine 43(5), 906–913.CrossRefGoogle ScholarPubMed
Olfson, M, Marcus, SC, Bridge, JA (2014). Focusing suicide prevention on periods of high risk. Jama 311(11), 1107–1108.CrossRefGoogle ScholarPubMed
Olfson, M, Wall, M, Wang, S, Crystal, S, Liu, SM, Gerhard, T, Blanco, C (2016). Short-term suicide risk after psychiatric hospital discharge. JAMA Psychiatry 73(11), 1119–1126.CrossRefGoogle ScholarPubMed
Procyshyn, RM, Bezchlibnyk-Butler, KZ, Jeffries, JJ (editors) (2017). Clinical Handbook of Psychotropic Drugs. Hogrefe Publishing: London.CrossRefGoogle Scholar
Taylor, D, Paton, C, Kapur, S (2015). The Maudsley Prescribing Guidelines in Psychiatry. John Wiley & Sons: London.Google Scholar
Thomsen, LA, Winterstein, AG, Sondergaard, B, Haugbolle, LS, Melander, A (2007). Systematic review of the incidence and characteristics of preventable adverse drug events in ambulatory care. Annals of Pharmacotherapy 41(9), 1411–1426.CrossRefGoogle ScholarPubMed
While, D, Bickley, H, Roscoe, A, Windfuhr, K, Rahman, S, Shaw, J, Kapur, N (2012). Implementation of mental health service recommendations in England and Wales and suicide rates, 1997–2006: a cross-sectional and before-and-after observational study. The Lancet 379(9820), 1005–1012.CrossRefGoogle ScholarPubMed
Woods, SW (2003). Chlorpromazine equivalent doses for the newer atypical antipsychotics. The Journal of Clinical Psychiatry 64(6), 663–667.CrossRefGoogle ScholarPubMed