Prevalence of High-dose Antipsychotic Prescribing in Schizophrenia: A Clinical Audit in a Regional Queensland Mental Health Service

BACKGROUND: Antipsychotic medication is widely recognized as a critical intervention in both acute and ongoing treatments of schizophrenia. Guidelines endorse the routine practice of monotherapy with antipsychotic medication at the minimum effective dose. Despite the recommendations, high-dose antipsychotic prescribing and polytherapy appear to be common practice. OBJECTIVE: The objective of this study was to determine the prevalence of high-dose antipsychotic prescribing in adult patients with schizophrenia in a regional Queensland hospital and to know if the prescribing practices are in keeping with the international guidelines and with the local policy introduced in December 2017. METHODS: This was a cross-sectional survey/clinical audit of 358 adult patients with schizophrenia open to the service in both community and inpatient settings. The individual prescribing practices of psychiatrists were also examined. RESULTS: A minority (15%) were prescribed high doses (high-dose single agent and high dose by polytherapy) and 20% were prescribed polytherapy (including high dose and within normal dose range). CONCLUSION: Eighty-five percent of the patients with the diagnosis of schizophrenia open to the service were prescribed antipsychotic within the dose range. In this respect, prescribing was aligned with current evidence-based guidelines.