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Community treatment orders, ethnicity, conditions and psychotropic medication: the first six months (N=126)

Community treatment orders, ethnicity, conditions and psychotropic medication: the first six months (N=126)

Patel, Maxine X., Matonhodze, Jane, Gilleen, James, Boydell, Jane, Taylor, David, Szmukler, George, Lambert, Tim and David, Anthony S. (2010) Community treatment orders, ethnicity, conditions and psychotropic medication: the first six months (N=126). Schizophrenia Research, 117 (2-3). pp. 493-494. ISSN 0920-9964 (doi:

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Background: Community treatment order (CTO) legislation was initiated in November 2008 in England and Wales. Due to high rates of uptake, a shortage of second opinion appointed doctors (SOADs) to complete authorization of medication within the given timeframe for CTOs was soon identified. A strong link in the use of CTOs in combination with antipsychotic long acting injections (LAIs) has been previously identified. LAI use for patients with schizophrenia is 35% on UK acute inpatient wards. The aims of this cross-sectional observational study in the first year of CTO legislation were to (i) identify patient characteristics for those commenced on a CTO; (ii) identify the nature of psychotropic medication prescribing at CTO initiation. Hypothesis: patients with schizophrenia have higher than average rates of LAI use as compared with national prescribing data.

Methods: The setting was the South London and Maudsley NHS Foundation Trust in London, United Kingdom, which provides secondary care level psychiatric services for a local population of 1.1million people, plus specialist tertiary referral inpatient facilities and forensic wards. Consecutive sampling was conducted for all patients whose CTO was registered in the Trust. Only the first CTO for each patient was included. Data for 126 patients from the first six months of data collection is presented (03/11/08-30/04/09). Measures included: sociodemographic variables, psychiatric diagnosis, CTO date of initiation, statutory reasons and stated conditions, psychotropic medication and date of Second Opinion Appointed Doctor (SOAD) authorization for medication.

Results: There was geographical variability in rates of CTO use between the 4 geographical sub-regions. 52% of the 126 patients were of black ethnic origin. 52% had stated conditions regarding their place of residence and 37% were required to allow access into their homes. 99% were prescribed an antipsychotic, 27% a mood stabilizer, 8% an antidepressant, 5% a benzodiazepine. First generation antipsychotic LAIs were the most commonly prescribed group of antipsychotics (40%). 69% of those with schizophrenia on a CTO were prescribed an antipsychotic LAI. Regarding antipsychotic doses, the mean BNF% dose was 60.6% (sd 39.1 range 2.5%-183.3%). 8% of the total sample had antipsychotic (combined) doses exceeding 100%BNF dose limits. 10% were prescribed two antipsychotics. Prior to CTO initiation, 21% were LAI-naïve and 78% were clozapine naïve. SOAD certification of medication occurred approximately 2 months after CTO initiation (mean 59.9 days, sd 39.1, range 1-175 days). For 24% of the sample, SOAD certification was not completed within the first 6 months.

Discussion: Variation in CTO use exists for geographical areas but not for ethnic diversity once other factors such as rates of hospital detention are considered. Conditions of CTOs may not follow the least restrictive principle, particularly for requirements regarding a patient's place of residence; clearer guidance for setting of conditions is required. The finding of 69% of those with schizophrenia on a CTO being prescribed an LAI is double that reported in national prescribing data. SOAD authorization of medication commonly occurs after the legal deadline and a small proportion did not achieve SOAD certification before the CTO expired.

Item Type: Article
Additional Information: [1] This is a meeting abstract included in 2nd Biennial Schizophrenia International Research Conference - special issue of Schizophrenia Research, Volume 117, Issues 2–3, April 2010, Pages 493–494. [2] The poster session was given at the 2nd Biennial Schizophrenia International Research Conference, organised by the Schizophrenia International Research Society (SIRS), held 10-14 April 2010, in Florence, Italy (see [3] This paper was also given as a poster session at the ECNP Workshop on Neuropsychopharmacology for Young Scientists in Europe, held 4–7 March 2010, Nice, France (see also
Uncontrolled Keywords: community treatment orders, medication
Subjects: R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
Pre-2014 Departments: School of Health & Social Care
School of Health & Social Care > Family Care & Mental Health Department
Related URLs:
Last Modified: 14 Oct 2016 09:13

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