Antipsychotic prescribing for vulnerable populations: a clinical audit at an acute Australian mental health unit at two-time points

Background: Antipsychotics are recognised as a critical intervention for schizophrenia and bipolar disorder. Guidelines globally endorse the routine practice of antipsychotic monotherapy, at the minimum effective dose. Even in treatmentresistant schizophrenia, clozapine use is endorsed before combining antipsychotics. This aim of this study was to review antipsychotic polytherapy alone, high-dose therapy alone, polytherapy and highdose prescribing patterns in adults discharged from an inpatient mental health unit at two time-points, and the alignment of this prescribing with clinical guideline recommendations. Additionally, associations with polytherapy and high-dose antipsychotic prescribing, including patient and clinical characteristics, were explored. Methods: A retrospective clinical audit of 400 adults (200 patients at two different time-points) discharged with at least one antipsychotic. Preliminary findings and education sessions were provided to physicians between Cohorts. Outcomes (polytherapy alone, high-dose therapy alone, polytherapy and high-dose therapy) were compared between study Cohorts using chi-squared and rank-sum tests. Associations between outcomes and covariates were assessed using multivariable logistic regression. Results: Most patients (62.5%) were discharged on a single antipsychotic within the recommended dose range. There was a clear preference for prescribing second generation antipsychotics, and in this respect, prescribing is aligned with current evidence-based guidelines. However, sub-optimal prescribing practices were identified for both Cohorts in relation to polytherapy and high-dose antipsychotic rates. Involuntary treatment, frequent hospitalisations and previous clozapine use significantly increased the risk of all three prescribing outcomes at discharge. Conclusions: In a significant minority, antipsychotic prescribing did not align with clinical guidelines despite increased training, indicating that the education program alone was ineffective at positively influencing antipsychotic prescribing practices. Further consideration should be given when prescribing antipsychotics for involuntary patients, people with frequent hospitalisations, and those who have previously trialled clozapine

Recommendations for a uniform assessment of publication bias related to funding source

Contains fulltext : 125836.pdf (publisher's version ) (Open Access)BACKGROUND: Numerous studies on publication bias in clinical drug research have been undertaken, particularly on the association between sponsorship and favourable outcomes. However, no standardized methodology for the classification of outcomes and sponsorship has been described. Dissimilarities and ambiguities in this assessment impede the ability to compare and summarize results of studies on publication bias. To guide authors undertaking such studies, this paper provides recommendations for a uniform assessment of publication bias related to funding source. METHODS AND RESULTS: As part of ongoing research into publication bias, 472 manuscripts on randomised controlled trials (RCTs) with drugs, submitted to eight medical journals from January 2010 through April 2012, were reviewed. Information on trial results and sponsorship was extracted from manuscripts. During the start of this evaluation, several problems related to the classification of outcomes, inclusion of post-hoc analyses and follow-up studies of RCTs in the study sample, and assessment of the role of the funding source were encountered. A comprehensive list of recommendations addressing these problems was composed. To assess internal validity, reliability and usability of these recommendations were tested through evaluation of manuscripts submitted to journals included in our study. CONCLUSIONS: The proposed recommendations represent a first step towards a uniform method of classifying trial outcomes and sponsorship. This is essential to draw valid conclusions on the role of the funding source in publication bias and will ensure consistency across future studies