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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.

Great controversy surrounds the prescribing of antipsychotics for people with an intellectual disability. This stems from a lack of research to support their use in this specific population together with their “off label” use to treat behaviour problems. This paper aims to review prescribing practice of antipsychotics by the Salford Intellectual Disability Psychiatry Department in accordance with standards adapted from nationally recognised guidelines.

Data was collected from all 178 patients under this department including patient demographics, severity of intellectual disability, co‐morbid diagnoses and details of any antipsychotic drug use. Main standards of prescribing measured: indication of antipsychotic prescribing; documented review of medications; documentation of side effects; documentation of physical health parameters including weight, blood pressure, blood glucose, lipids.

In total, 126 (72 per cent) were prescribed antipsychotics. 42 (33 per cent of these were for challenging behaviour. 91 (72 per cent) had indication documented. 123 (98 per cent) of prescriptions had been reviewed. There was not very regular documentation of side effects and physical parameters for monitoring metabolic syndrome.

Data was taken from all patients under the care of Salford Intellectual Disability Psychiatric team therefore eliminating sampling bias. The audit findings will be of value to other UK urban psychiatry departments as they should be highly representative of a wider population of patients. The authors are already aware of lack of evidence in use of antipsychotic medication for treating challenging behaviours in patients with learning disability.

This study confirms the use of antipsychotics in management of challenging behaviours in this population as a third of the sample population was being treated with antipsychotics for behaviour problems. The study also shows that there was lack of documentation of physical health and side effect monitoring. It highlights that there should be regular monitoring of physical and side effects with careful documentation.

Review of antipsychotic prescribing practices, rationale and follow-up using an internationally standardized audit can be an effective tool to encourage and monitor best practices. The purpose of this study is to audit the current prescribing pattern for people with intellectual disabilities and challenging behaviours in Qatar.

This study was based on the challenging behaviour management guidelines recommended by the Royal College of Psychiatrists. All current electronic medical records in the Mental Health Service-Hamad Medical Corporation were examined to identify patients with intellectual disabilities who received antipsychotics for challenging behaviour. Demographic variables, such as age, sex and nationality, were collected. In addition, details of psychiatric diagnoses, prescribed psychotropic medications and diagnoses of epilepsy were also collected. For patients who were prescribed antipsychotic medication, the clinical rationale for such medication was collected along with evidence of side effect monitoring to allow performance against the audit standards to be measured.

This is the first audit on prescribing practices in people with intellectual disability and challenging behaviour in the state of Qatar. The results of this study regarding the pattern of prescribing practices for patients with intellectual disability and challenging behaviour reflect the limitation in knowledge and experience among non-specialist practitioners within mental health service. The result may be helpful to support the development of specialist service provision to improve the care for such vulnerable group. The result may also help other medical centres and clinicians by providing an improved understanding of possible deviations from the best medical practices.

This is the first audit on prescribing practices in people with intellectual disability and challenging behaviour in the state of Qatar. The study is also noteworthy as, to the best of the authors’ knowledge, it is one of only a few studies on antipsychotic prescribing for patients with intellectual disability and challenging behaviour in the Middle East; therefore, it will be useful in raising awareness and promoting the best practices in the Middle East region. This study is also among the first few studies that were designed based on the four audit standards by the Royal College of Psychiatrists in this area.

The purpose of this paper is to identify the training needs of the next generation of psychiatrists, and barriers in prescribing first-generation antipsychotics (FGAs), long-acting injectable (LAIs) antipsychotics and clozapine.

An electronic survey was sent to psychiatry residents (N= 75/288, 26 percent) at four Canadian residency programs in late December 2017. The survey was based on an instrument originally developed at the University of Cambridge and consisted of 31 questions in 10 content domains.

Nearly 80 percent of residents were aware that FGAs and second-generation antipsychotics (SGAs) have similar efficacy. However, extra-pyramidal symptoms and lack of training experience were the leading concerns associated with the prescribing of FGAs. Although over 90 percent of residents felt confident about initiating an oral SGA as a regular medication, only 40 percent did so with FGAs. Confidence with initiating LAIs and clozapine was 60 and 61 percent, respectively.

The survey highlights the need for better training in the use of FGAs, clozapine and LAIs. These medications can be effectively used in providing patients with the most appropriate evidence-based treatment options to improve treatment outcomes, while ensuring that these resources are not lost to the future generations of psychiatrists.

The survey may be the first of its kind to assess antipsychotic prescribing attitudes in Canadian psychiatry residents in multiple sites.

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.

The purpose of this paper is to examine the prescribed psychotropic medications taken by newly referred people with a range of substance use disorders (SUD) who attend a specialist community addiction service.

Anonymised data on newly referred people (n=1,537) with SUD attending a specialist community addiction service for their first episode of treatment between August 2007 and July 2010 were obtained from the database of the service. Data were cleaned and the percentage of people taking prescribed psychotropic medications at their first episode of treatment was calculated.

More than half (56.1 percent) of people attending the service were taking prescribed antidepressants and anxiolytics at their first episode of treatment whilst 15.2 percent of people were taking prescribed antipsychotics. Alcohol and opioids were the primary referral substances for 77.4 percent and 15.2 percent of people respectively. People referred for “other” substances (cannabis, stimulants, sedatives, hallucinogens, solvents and polydrug use) made up the remaining 7.5 percent and had the highest percentage of prescribed psychotropics (antipsychotics=47 percent, antidepressants and anxiolytics=64.3 percent) compared to those referred for alcohol and opioids (p<0.0005).

To the best of the authors’ knowledge, this is the first study of psychotropic prescribing among people with a range of SUD in the UK. The high prevalence of psychotropic prescribing raises questions about the appropriateness of these prescriptions and calls for scrutiny of prescribing practice in this group of people.

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.

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.

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.

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.