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Aim: Previous research has documented the widespread use of antipsychotic drugs by nursing staff with older persons, although less is known about the knowledge that nurses actually have about these drugs. The purpose of this exploratory, descriptive study was to survey a sample of UK gerontological nurses from different work settings on their knowledge of antipsychotic drugs.Methods: An exploratory descriptive study design was utilised, whereby a sample of nursing staff was given a questionnaire developed to determine knowledge about antipsychotic drugs and their use with older persons. Questionnaires were distributed to 100 nursing staff, including registered general nurses, registered mental nurses, state enrolled nurses, nursing assistants and care assistants. Of the 100 questionnaires distributed, 62 were returned and 57 were completed substantially enough for data analysis.Results: Descriptive statistics including frequencies and means were calculated for demographic variables and the questionnaire responses. Results indicated that the use of antipsychotic drugs within the psychiatric hospital setting was substantial, with 43.7% of patients receiving antipsychotic drugs, for an average length of time of 1.8 years. Conclusions: Nursing staff participants from all three work settings revealed a number of significant knowledge gaps, particularly with regard to appropriate indications for antipsychotic drugs with older persons and the side‐effects of antipsychotic drugs. Summary: This paper adds new information regarding the use of antipsychotic drugs in the nursing care of older people.

The programme – Stopping the over-medication of people with an intellectual disability, Autism or Both (STOMP) is a three-year programme supported by NHS England. Concern about the overuse of antipsychotic drugs has been a constant theme since the 1970s. However, despite a multitude of guidelines the practice continues. The report into the events at Winterbourne View not only raised concerns about the overuse of antipsychotic drugs but of antidepressants and multiple psychotropic drug use. The purpose of this paper is twofold: Part 1 is to present the history and background to the use of psychotropic drugs in intellectual disabilities, autism or both; and Part 2 presents the progress with the STOMP programme.

The review tracks the various concerns, guidelines and attempts to tackle the issue of over medication of people with intellectual disability autism or both.

The review identifies that despite the many studies and guidelines associated with the prescribing of psychotropic drugs for people with an intellectual disability, autism or both the practice is common. Programmes that minimise the use of psychotropic drugs involve a full use of the multidisciplinary team and an availability of alternative methods of managing challenging behaviours.

STOMP is part of an English national agenda – Transforming care. The English Government and leading organisations across the health and care system are committed to transforming care for people with intellectual disabilities, autism or both who have a mental illness or whose behaviour challenges services. This review identifies many studies, programmes and guidelines associated with psychotropic drug use for people with an intellectual disability, autism or both.

One in 14 people over 65 years suffer from dementia in the UK. Over 25 per cent are receiving antipsychotics, which cause increases in mortality and cerebrovascular events. The need for a reduction and the use of alternative supportive strategies has been advocated. Risperidone at six‐week intervals is the only antipsychotic licensed for treatment with regular review. The majority of management occurs at primary care level and in care homes. The purpose of this paper is to investigate antipsychotic prescribing practices and patient review in these settings.

In total, two surveys comprising questions addressing prescribing practices were developed and distributed electronically to all GP practices and care homes in Coventry and Warwickshire, West Midlands, England.

The majority of GPs (75 per cent) reported only “occasional” discontinuation of antipsychotics due to concerns at reducing drugs on their own, expectations of regulation from secondary care and resistance from care home staff. Poor reduction levels were reported in care homes, attributing low numbers to reluctance among GPs. History of cardiovascular risk factors did not appear to influence withdrawal. Only 40 per cent of GP practices maintained sole use of risperidone. At least six‐monthly reviews were reported by 63 per cent of GPs and 64 per cent of care homes, with very few conducting reviews at least three‐monthly. The importance of non‐pharmacological alternatives was emphasized, yet access was limited and highly resource‐dependent.

This study reveals the perspectives of staff delivering healthcare for people with dementia and behavioural and psychological symptoms of dementia (BPSD). Potentially inappropriate antipsychotic principles were reported. A lack of communication and uncertainty of roles was evident. The development of understandable guidelines for healthcare workers and care home staff managing behavioural issues in patients with dementia is necessary.

Prison settings have limited resources, and it is of particular interest to analyze which antipsychotics are commonly prescribed in these conditions and to determine the prevalence of the adverse effects.

A cross-sectional, epidemiological survey was used to measure the prevalence of antipsychotic prescribing among adult prisoners in Sremska Mitrovica Prison in 2020.

The prevalence of antipsychotic use was 7.58%. The most commonly prescribed antipsychotic was clozapine (45.36%), but also olanzapine, haloperidol and risperidone were prescribed. The incidence of extrapyramidal adverse effects was nonexistent and the metabolic parameters did not differ between participants using metabolic syndrome–inducing antipsychotics and those who were prescribed metabolically inert medications. The prescribed doses were lower compared with the recommended.

This research includes certain points that should be cautiously considered. First, the data were cross-sectional and the findings did not provide causal interpretations. Second, the data are from a single penitentiary institution, albeit the largest in the country; however, that may affect the generalizability of the findings. Third, because the included subjects were not hospitalized, some laboratory analyses were not available, according to the local regulations, and thus the prevalence of metabolic syndrome could not be precisely determined.

The prevalence of the antipsychotic use in prison environment is significantly higher than in general population. The most frequently prescribed antipsychotics are clozapine and olanzapine. The prevalence of adverse effects is rare, however, that is possibly due to low doses of the prescribed antipsychotics. The list of therapeutic options available to the incarcerated persons in this facility is also limited. The list of available antipsychotics does not include some atypical antipsychotics with more favorable safety and tolerability profile, such as aripiprazole or cariprazine. Long-acting antipsychotic injectables were also not available to these patients. Laboratory analyses are not regularly conducted and do not include some essential parameters such as lipid status or differential blood count. Low-dose antipsychotics for behavioral symptoms appears to be well tolerated under prison conditions where adherence is assured. It is effective during the prison stay but long-term effects, especially after release from prison, had not been studied.

This paper advocates for better quality of health care in this correctional facility: more therapeutic options and better laboratory monitoring. The authors justify the use of clozapine in this settings due its benefits in reducing violence and aggression; however, further research would be necessary to clarify does the use of clozapine in incarcerated persons cause behavioral improvements that could result in shorter incarcerations, less recidivism and better quality of life.

To the best of the authors’ knowledge, this is the first insight of the antipsychotic prescribing practice in Serbia. There is very limited data on prisoners’ health care, especially mental health care, in Balkan countries. The antipsychotic prescribing pattern in this sample is characterized with higher than expected clozapine use, but without expected adverse effects.

This chapter uses Goffman’s concept of total institutions in a comparative case study approach to explore the role of psychotropic drugs in the process of transinstitutionalization.

This chapter interprets psychotropic drug use across four institutionalized contexts in the United States: the active-duty U.S. military, nursing homes and long-term care facilities, state and federal prisons, and the child welfare system.

This chapter documents a major unintended consequence of transinstitutionalization – the questionable distribution of psychotropics among vulnerable populations. The patterns of psychotropic use we synthesize suggest that total institutions are engaging in ethically and medically questionable practices and that psychotropics are being used to serve the bureaucratic imperatives for social control in the era of transinstitutionalization.

Psychotropic prescribing practices require close surveillance and increased scrutiny in institutional settings in the United States. The flows of mentally ill people through a vast network of total institutions raises questions about the wisdom and unintended consequences of psychotropic distribution to vulnerable populations, despite health policy makers’ efforts regulating their distribution. Medical sociologists must examine trans-institutional power arrangements that converge around the mental health of vulnerable groups.

This is the first synthesis and interpretive review of psychotropic use patterns across institutional systems in the United States. This chapter will be of value to medical sociologists, mental health professionals and administrators, pharmacologists, health system pharmacists, and sociological theorists.

Rabbit syndrome (RS) is an antipsychoticinduced rhythmic motion of the mouth/lips resembling the chewing movements of a rabbit. The movement consists of a vertical-only motion, at about 5 Hz, with no involvement of the tongue. Long-term exposure to typical antipsychotics has clearly been associated with RS, but little is known of the risk of RS due to exposure to newer atypical antipsychotics. There have been isolated reports of RS in patients treated with the atypical agents risperidone, aripiprazole, olanzapine, and clozapine. We present the case history of a 44-year old female patient treated for paranoid schizophrenia for 22 years and RS during her last 10-month clozapine treatment. Background information from the literature is also discussed.

About five per cent of ‐ generally very frail ‐ older people live in long‐term care in the UK; approximately a fifth of all deaths occur in care homes. Depression and dementia are prevalent mental health conditions in care homes; depression is reported in around a third of residents and dementia in two thirds. While there is some evidence about efficacy of medication in treating psychiatric and behavioural symptoms among residents, much less is known about the potential role of psychosocial interventions in enhancing mental health and quality of life. Quality of care varies widely across the carehome sector including support from primary and specialist health and quality and level of training. In terms of enhancing care quality, there is evidence that investing in staff training and conditions, establishing good links with healthcare providers, and developing care standards that genuinely promote good practice are likely to improve resident quality of life. This is an exciting area for research development and practice innovation for the future; taking account of users perspective, holds particular potential.

Antipsychotic drugs are frequently prescribed to people with intellectual disabilities (ID) to ameliorate psychotic symptoms and behavioural symptoms with and without mental condition. Guidelines recommend systematic evaluation of treatment effects and adverse effects, and limiting the treatment duration. Studies have shown that adherence to prescription guidelines is beneficial for clients’ outcomes. Therefore, the purpose of this paper is to investigate the adherence to antipsychotic drug prescription guidelines in two treatment settings.

A checklist, based on existing antipsychotic drug prescription guidelines, was used to evaluate the adherence of prescribers to guidelines in two settings in the Netherlands, i.e., in specialized intellectual disability (ID) care organizations and mental health care organizations. Data from medical records of clients who used antipsychotic drugs (n=299) were compared to the items of the checklist.

Treatment effects were measured with validated scales in both settings in only 2.7 per cent of cases. Prescriptions were for problem behaviour in the absence of a psychotic disorder or psychotic symptoms in 90 per cent (specialized ID care) and in 79 per cent (mental health care) of cases. In specialized ID care pipamperone (31.9 per cent) and in mental health care risperidone (48.5 per cent) was most often prescribed. Adverse effects were monitored more frequently in specialized ID care.

The adherence to guidelines for prescribing antipsychotic drug to people with ID is insufficient in the Netherlands, because of shortcomings in the evaluation of treatment and adverse effects.

The use of pharmacological interventions in the treatment of forensic psychiatric patients constitutes an important part of the day‐to‐day practice of mental health professionals working in this important psychiatric sub‐speciality. It involves not just the prescription of specific drugs, but also the regular monitoring of their effects and possible side effects. Such monitoring involves the collaboration of professionals working in very different fields such as medicine, nursing, occupational therapy, physiotherapy and pharmacy.

This paper aims to present an audit assessed compliance with NICE guidance on the concurrent use of different antipsychotic drugs.

Two explicit and evidence‐based standards were audited and a full audit cycle was completed.

The paper finds that although the number of people receiving only one regular antipsychotic increased over time, so did the number receiving more than one regular antipsychotic. Fewer people were receiving one regular antipsychotic and a different PRN antipsychotic in the re‐audit.

Clearer guidance about the limits and reviewing of multiple antipsychotics would be welcome.

The paper suggests that dissemination, re‐audit and clear documentation are needed to maintain standards of clinical practice.