Home > Limiting psychotropic medication prescription on discharge from psychiatric inpatient care: a possible suicide intervention?

Cleary, Eimear and Kelleher, Cecily C and Lane, Abbie and Malone, Kevin (2019) Limiting psychotropic medication prescription on discharge from psychiatric inpatient care: a possible suicide intervention? Irish Journal of Psychological Medicine , Early online .


Objectives. Restricting access to lethal means is an effective suicide prevention strategy. However, there is little discussion in the literature about the potential contribution of prescribing practices on discharge from inpatient psychiatric care (which has been established as a high-risk period for suicide) to suicide deaths by overdose of prescribed medication. This study aimed to assess the quantity, toxicity and potential lethality of psychotropic medication being prescribed on discharge from psychiatric care to those with and without indices of suicidality.

 

Methods. Patient demographic, clinical and prescription data were collected from 50 randomly selected charts following discharge from inpatient psychiatric care. Psychotropic medications (dose × duration) on discharge were converted to their equivalent doses of neuroleptics, antidepressants and anxiolytics to rate toxicity and potential lethality, using the Maudsley Prescribing Guidelines. Mood stabilizing medications were also documented.

 

Results. 39% of prescriptions analysed contained toxic and potentially fatal doses of either neuroleptic or antidepressant equivalent medication.

 

Conclusions. Patient discharge from inpatient psychiatric care presents a golden opportunity to moderate access to potentially fatal psychotropic medication. Iatrogenic provision of lethal means for suicide during a period of increased risk and in a group at increased suicide risk may impact suicide prevention efforts and requires further in-depth research. Current prescribing practices may be a missed opportunity to intervene in this regard.

Item Type:Article
Date:June 2019
Publisher:Medmedia Group
Volume:Early online
EndNote:View
Subjects:E Concepts in biomedical areas > Substance by legal status > Prescription drug (medicine / medication)
F Concepts in psychology > Specific attitude and behaviour > self-destructive behaviour > suicidal behaviour / suicide
G Health and disease > State of health > Mental health
J Health care, prevention and rehabilitation > Risk and protective factors > Risk factors
J Health care, prevention and rehabilitation > Patient care management
J Health care, prevention and rehabilitation > Care by type of problem
VA Geographic area > Europe > Ireland

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