The management of severe psychiatric disorder: A comparison of the use of neuroleptic medication in two intensive therapy units

Concern over the use of high dose neuroleptic medication has led to the introduction of guidelines for prescribing. This is of particular importance in the treatment of patients with severe psychiatric disorder. This study evaluates how physical security of the ward relates to prescribing in two close supervision units. A prospective analysis of 93 consecutive admissions to two wards, one locked and the other open, was undertaken. Data included patient characteristics, diagnosis and medication received. There was no difference in total neuroleptic dosage between the two wards, but mean daily dose (2,108 mg chlorpromazine equivalent) exceeded maxima specified in guidelines. In the early stages of admission, the open ward used higher regular doses, whereas the locked ward prescribed more on an as required basis. The high incidence of absconding from the open ward must be considered against the more custodial environment of the locked ward. The wider use of chlorpromazine equivalence calculations is recommended.