Postcode prescribing for schizophrenia [Editorial].

Data on antipsychotic drug expenditure in primary care for all English health authorities (total pop 52,072,048) during the 2nd quarter of 1999 was released by the Prescription Pricing Authority (PPA) after permission was obtained from each health authority to access this information. Data on typical antipsychotics excluded depot preparations (5% of total antipsychotic expenditure in 1999). Expenditure data was normally distributed. Adjusted spending figures showed an 11-fold variation in per capita atypical spending across English health authorities. The highest atypical to typical spending ratio was 7.64 : 1 and the lowest ratio 0.97 : 1. The variation in per capita atypical expenditure was three times higher than that for per capita typical expenditure. Population need was hypothesised to explain this variation, with drug use reflecting varying rates and severity of psychotic illness between different communities. The expenditure data was set against that health anthority's York Psychiatric Need Index score. As predicted, population-adjusted antipsychotic spending correlated significantly with the health authorities' level of psychiatric need. Significant correlations were found between population-adjusted atypical spending and psychiatric need (r=.49, p <.001); population-adjusted typical spending and psychiatric need (r=.33, p <.001); and between population-adjusted total antipsychotic spending and psychiatric need (r=.51, p <.001). This significant relationship remained when outliers were removed. The York Psychiatric Need Index explained 23.7% of the variance of per capita atypical expenditure. Local population need is known to be a predictor ofresource use in other aspects of mental health care and it appears also to account for about a quarter of the variance in per capita antipsychotic expenditure

The ANNSERS (Antipsychotic Non-Neurological Side Effects Rating Scale): Validation of sexual side effect measurement.

Antipsychotic nonneurological side effects, such as sexual dysfunction, can adversely affect the quality of patients’ relationships, their treatment adherence and their quality of life. In the UK CUtLASS (Cost Utility of the Latest Antipsychotics in Severe Schizophrenia) study, nonneurological side effects were assessed using the ANNSERSv1 (Antipsychotic Non-Neurological Side Effects Rating Scale version 1), a new scale to assess the side effects associated with both first- and second-generation antipsychotic drugs. A total of 26 participants also completed the Derogatis Interview for Sexual Functioning (self-report version, DISF-SR). A statistically significant, and specific, correlation was found between scores on the DISF-SR and the sexual side-effect section of the ANNSERS at baseline. The sexual side-effects subscale of the ANNSERS is a valid measure of sexual dysfunction in the treatment of schizophrenia