Specialist Perinatal Mental Health Services (SPMHS) are a new development in Ireland. This service evaluation examined the impact of the introduction of a SPMHS multidisciplinary team (MDT) on prescribing practices and treatment pathways in an Irish maternity hospital.

Clinical charts were reviewed to collect data on all referrals, diagnoses, pharmacological and non-pharmacological interventions delivered in a SPMHS over a 3-week period in 2019. The findings were compared to the same 3-week period in 2020 following the expansion of the SPMHS MDT.

In 2019 (n = 32) and 2020 (n = 47), most (75 and 79%, respectively) assessments were antenatal. The proportion of patients prescribed psychotropic medication within the SPMHS was not significantly different from 2019 (31%) to 2020 (23%), though more patients were already prescribed psychotropic medications at the time of referral (22% in 2019 v. 36% in 2020). There was an increase in MDT interventions in 2020 with more input from psychology, clinical nurse specialist (CNS), and social work intervention. Adherence to prescribing standards improved from 2019 to 2020.

Prescribing patterns remained unchanged between 2019 and 2020. Improvement was observed in adherence to prescribing standards and there was increased provision of MDT interventions in 2020. Broader diagnostic categories were also used in 2020, possibly suggesting that the service is now providing more individualized care.

As all first line options in treating First Episode Psychosis (FEP) are similarly effective there is a consensus among prescribing guidelines that clinicians and patients should consider side-effect profile as the ‘driver’ of initial choice of antipsychotic. Anecdotally it has been observed that different care teams prescribe particular medications preferentially.

To evaluate the patterns of antipsychotic prescribing in patients with FEP at the time of initial treatment and over the first year with the Early Intervention Service (EIS).

Medical records of all patients who had completed 1 year of follow-up with EIS in Sussex Partnership Foundation Trust (n=274) were reviewed. The first antipsychotic prescribed and antipsychotic prescribed at 12-months was recorded alongside initiating care team (EIS, non-EIS community services, inpatient services).

99% (n=272) of patients were prescribed an antipsychotic. 46% were initiated by inpatient serves, 40% non-EIS community services and 14% EIS. Aripiprazole, olanzapine, quetiapine and risperidone accounted for 95% of initial prescriptions. Different care teams prescribed antipsychotics preferentially (p=<0.005) (Fig.1). Rates at which initial medication was continued at 12-months varied according to initial prescription (P=<0.05) (Fig.2).

The frequency that specialist EIS services prescribed aripiprazole as initial treatment contrasts the preference for olanzapine in other services. Olanzapine has a significant metabolic side effect profile, is sedating and was least likely to be continued at 12 months. This raises questions about why non-FEP specialist services prefer olanzapine and whether EIS services can support these services around initial medication choices more likely to be continued throughout the key first year of treatment.

No significant relationships.

Coronavirus disease 2019 (COVID-19) has had a disproportionate impact on people with intellectual disability (PwID). PwID are at higher risk of mental illness and receive psychotropic prescribing ‘off licence' also, to manage distress behaviour. The lockdown and reduction of multidisciplinary face-to-face appointments had an impact on care delivery, the recourse possibly being psychotropic prescribing. It is imperative to comprehend the influence the pandemic had on psychotropic prescribing patterns to enable future planning.

The aim was to understand the impact of the pandemic by comparing psychotropic prescribing patterns during the England lockdown with the prescribing patterns before lockdown in specialist urban and rural psychiatric services for PwID.

Data was collected from Cornwall (rural) and London (urban) intellectual disability services in England as a service evaluation project to rationalise psychotropic prescribing. PwID in both services open across January 2020 to January 2021 were included. Baseline patient demographics including age, gender, ethnicity, intellectual disability level and neurodevelopmental and psychological comorbidities were collected. Baseline psychotropic prescribing and subsequent % change for each psychotropic group for the two services was compared using Pearson's chi-square and z-statistic (two tailed) with significance taken at P < 0.05.

The two centres London (n = 113) and Cornwall (n = 97) were largely comparable but for baseline differences in terms of presence of severe mental illness (37 v. 86, P < 0.001), challenging behaviour (44 v. 57, P < 0.05) and attention-deficit hyperactivity disorder (37 v. 3, P < 0.001). There was an overall increase in psychotropic prescribing during lockdown in urban as compared with rural settings (11% v. 2%).

The pandemic caused an increase in psychotropic prescribing associated with lockdown severity and urban settings. Team structures could have played a role.

The most frequently prescribed analgesic drugs in primary care centers in Turkey are diclofenac and paracetamol, respectively. In this study, we aimed to compare paracetamol-included prescriptions (PIP) and diclofenac-included prescriptions (DIP) generated for adult patients in primary care.

In this cross-sectional study, PIPs (n = 280 488) and DIPs (n = 337 935) created for adults by systematic sampling among primary care physicians working in Istanbul in 2016 (n = 1431) were examined. The demographic characteristics, diagnoses, and additional drugs in PIPs and DIPs were compared.

Women constituted the majority in both groups (69.8% and 67.9%, respectively; P < 0.05), and mean age at PIP (52.6 ± 18.8 years) was lower compared to DIP (56.3 ± 16.1 years), (P < 0.05). In single-diagnosis prescriptions, 11 of the 15 most common diagnoses in PIP were respiratory tract infections (47.9%); three pain-related diagnoses formed 4.6% of all these prescriptions. In DIP, the number of pain-related diagnoses, mostly of musculoskeletal origin, was eight (28.5%); four diagnoses (7.8%) were upper respiratory tract infections. While hypertension was the third most common diagnosis in PIP (6.1%), it was ranked first in DIP (8.0%). The percentage of prescriptions with additional analgesic (14.0% versus 18.3%, P < 0.001), proton-pump inhibitor (13.8% versus 18.4%; P < 0.001), and antihypertensive (22.0% versus 24.8%, P < 0.001) was lower in PIP compared to DIP. However, the percentage of prescriptions with antibiotics (31.3% versus 14.7%, P < 0.001) was higher in PIP.

Paracetamol appears to be preferred mostly in upper respiratory tract infections compared to the preference of diclofenac rather in painful/inflammatory musculoskeletal conditions. The presence of hypertension among the most commonly encountered diagnoses for these analgesic drugs points to challenges in establishing the diagnosing-treatment match and indicates potential irrational prescribing practice, especially for interactions.

Benzodiazepines (BZD) are psychotropic drugs prescribed in psychiatry for their anxiolytic, hypnotic and sedative properties. Several guidelines aimed to limit the chronic use of BZDs. However, BZDs prescribing that does not comply with international recommendations remains widespread, estimated in France at 20% for hypnotic BZDs.

The aims of our study were to evaluate BZDs prescribing practices in the treatment of insomnia and to assess their compliance with international recommendations.

This is a cross-sectional study conducted through a Google-forms self-administered questionnaire,intended for psychiatrists and psychiatric residents, over a period of two months, from April 1 to May 31, 2019.

One hundred physicians practicing in psychiatry answered our questionnaire. The response rate was 28%. Four BZDs are recommended for the treatment of insomnia, none of which is available in Tunisia. Almost the third of the participants did not systematically look for signs of sleep apnea syndrome before treating an insomnia (30.5%). For treating insomnia, the majority of the participants began by indicating hygieno-dietetic rules (64%), 4% prescribed directly a BZD. Cognitive behavioral therapy was not indicated at all by the particiants. The maximum duration of prescribing BZDs in insomnia was 4 weeks in 20% of cases, and more than 4 weeks in 38% of cases. Among the participants, 41% prescribed BZDs for the treatment of chronic insomnia.

Insomnia appear to be badly managed and early drug prescribing is frequent. These practices do not comply with the recommendations of good practice and increase the risk of dependance and other side effects.

Benzodiazepines (BZD) are psychotropic drugs prescribed in psychiatry for their anxiolytic, hypnotic and sedative properties. Several guidelines aimed to limit the chronic use of BZDs. However, BZDs prescribing that does not comply with international recommendations remains widespread, estimated in France at 30% for anxiolytic BZDs.

The aims of our study were to evaluate BZDs prescribing practices in the treatment of anxiety and to assess their compliance with international recommendations.

This is a cross-sectional study conducted through a Google-forms self-administered questionnaire,intended for psychiatrists and psychiatric residents, over a period of two months, from April 1 to May 31, 2019.

One hundred physicians practicing in psychiatry answered our questionnaire. The response rate was 28%. The most prescribed BZD for anxiolytic purposes was Prazepam (76.2%). Clonazepam was prescribed for anxiolytic purposes in 10.5% of cases. Of the 105 participants, 48 indicated that they prescribed BZDs for anxiolytic purposes in states of acute stress (45.7%), 28.6% prescribed them for the treatment of mild to moderate anxiety manifestations in anxiety disorders. For the treatment of anxiety without panic attacks, 20% indicated that they prefer a short half-life BZD, 80% a long half-life BZD. The maximum duration of BZDs prescription for anxiolytic purposes was 12 weeks (62%), and 6 months in 10% of cases.

BZDs are often prescribed in psychiatry for their anxiolytic property, sometimes in a way that does not comply with the recommendations of good practice, with regard to the prescribed molecules, their indications and the duration and modalities of prescription.

Prescribing benzodiazepines (BZD) in patients over 65 years old requires special precautions in view of the frequency and the severity of their side effects, especially in this age group.

The objectives of our work were to evaluate the modalities of BZDs prescribing in elderly patients in psychiatry and to assess their compliance with international recommendations.

This is a descriptive cross-sectional study conducted through a Google-forms self-administered questionnaire, intended for psychiatrists and psychiatric residents, over a period of two months, from April 1 to May 31, 2019.

One hundred physicians practicing in psychiatry answered our questionnaire. The response rate was 28%. Special precautions were taken in elderly patients by 96.5% of the participants. In eldery patients, long half-life BZDs were prescribed in 15% of cases. The majority of the participants indicated that the risk of falls (98.1%) and memory impairments (75.2%) were the main risks to which they were particularly vigilant during the prescribing of BZDs in eldery patients. In the elderly, 20% of the participants said they did not take special precautions when stopping BZDs.

The frequency and severity of side effects associated with BZDs in the elderly are the cause of strict prescribing rules in this age group. According to the results of our study and to the literature data, the prescribing practices of these molecules in the elderly remain insufficiently in accordance with the guidelines.

Benzodiazepines (BZDs) are psychotropic drugs that are predominantly prescribed in psychiatry and that can have serious side effects. BZDs prescribing is well codified by several guidelines, yet the epidemiological data on their prescribing remains alarming.

Our study aimed to evaluate the general modalities of BZDs prescribing in psychiatry in Tunisia.

This is a descriptive cross-sectional study conducted through a Google-forms self-administered questionnaire, intended for psychiatrists and psychiatric residents, over a period of two months, from April 1 to May 31, 2019.

One hundred physicians practicing in psychiatry answered our questionnaire. The response rate was 28%. The purpose of treatment with BZDs was explained to the patient at its initiation in 98.2% of cases and the risks associated with it in 87.7% of cases. Special precautions were taken in elderly patients (96.5%), at risk of respiratory failure (94.7%), and in cases of personality disorders (80.7%). Only three quarters of physicians took precautions before prescribing BZDs to a pregnant woman (77.9%). In cases of rebellious or refractory symptoms, 14.4% of the participants stated that they combine two BZDs. Before reproducing/repeating a BZD prescription, 18.4% of the participants indicated that they did not systematically and regularly assess its necessity.

The severity of the side effects associated with BZDs, especially those of tolerance and dependence, are at the origin of strict prescribing rules, dictated by several guidelines. According to the results of our study and to the literature data, the prescribing practices of these molecules remain nonetheless in many cases non-compliant with the recommendations.