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Medical audit in an elderly depressed cohort

Published online by Cambridge University Press:  13 June 2014

Peter Donnelly
Peter Donnelly*
Affiliation:
Cefn Coed Hospital, Cockett, Swansea SA2 OGH. (Formerly Registrar in Old Age Psychiatry, Northern General Psychiatric Unit, Sheffield)
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Abstract

Medical audit was carried out to evaluate drug therapy in a cohort of depressed patients admitted to a functional ward for the elderly. A retrospective case note study was carried out in 61 consecutive admissions with a diagnosis of depression. Seventeen of the 41 patients (41%) with a diagnosis of Manic Depressive Psychosis were not taking antidepressant medication on admission. Of the 11 patients who received Electroconvulsive Therapy seven (64%) did so under Section 3 of the Mental Health Act. Four of the 41 patients (10%) with a diagnosis of Manic Depressive Psychosis were not on prophylactic antidepressants or lithium on discharge. Seventeen of the patients (28%) were taking benzodiazepine hypnotics on admission, and 14 of these were discharged on the same type and dosage. There were no patients on more than one type of antidepressant or antipsychotic at any one time. These findings reflect deficiencies in the general practice and specialist treatment of depressive illness in an elderly cohort. The need for on-going audit in this at risk group is emphasized.

Keywords

AuditPsychotropic drugsElderlyDepressive illnessAntidepressants
Type
Practice Reviews
Information
Irish Journal of Psychological Medicine , Volume 9 , Issue 1 , May 1992 , pp. 62 - 66
Copyright
Copyright © Cambridge University Press 1992

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References

1.Ayd, FJ. Rational pharmacotherapy: once a day drug dosage. Diseases of the Nervous System 1973; 34, 371–378.Google Scholar
2.Michel, K, Kolakowska, T. A survey of prescribing psychotropic drugs in two psychiatric hospitals. Br J Psychiatry 1981; 138, 217–221.CrossRefGoogle ScholarPubMed
3.Morgan, R, Gopalaswamy, AK. Psychotropic drugs: another survey of prescribing patterns. Br J Psychiatry 1984; 144. 298–302.CrossRefGoogle ScholarPubMed
4.Clark, AF, Holden, NL. The persistence of prescribing habits. A survey and follow-up of prescribing to chronic hospital in-patients. Br J Psychiatry 1987; 150: 88–91.CrossRefGoogle ScholarPubMed
5.Edwards, S, Kumar, V. A survey of prescribing of psychotropic drugs in a Birmingham psychiatric hospital. Br J Psychiatry 1984; 145: 502–507.CrossRefGoogle Scholar
6.Holloway, F. Prescribing for long-term mentally ill. A study of treatment practices. Br J Psychiatry 1988; 152: 511–515.CrossRefGoogle ScholarPubMed
7.Wing, JK, Cooper, JE, Sartorius, N. The measurement and classification of psychiatric symptoms. London: Cambridge University Press, 1974.Google Scholar
8.Garden, G, Oyebode, F, Cummella, S. Audit in psychiatry. Psychiatric Bulletin 1989; 13: 278–281.CrossRefGoogle Scholar
9.World Health Organisation. Mental disorders: glossary and guide to their classification in accordance with the ninth revision of the international classification of diseases (ICD-9). Geneva: WHO, 1978.Google Scholar
10.British Medical Association, Royal Pharmaceutical Society of Great Britain. British National Formulary Number 15 (1986). London: BMA, and Pharmaceutical Press, 1986.Google Scholar
11.Keller, MB, Klerman, GL, Lavori, PW, Fawcett, JA, Coryell, W, Endicott, J. Treatment received by depressed patients. JAMA 1982; 248: 1848–1855.CrossRefGoogle ScholarPubMed
12.Spitzer, RL, Endicott, J, Robins, E. Research diagnostic criteria: rationale and reliability. Arch Gen Psych 1978; 35: 773–782.CrossRefGoogle ScholarPubMed
13.MacDonald, AJD. Do general practitioners “miss” depression in the elderly patients? BMJ 1986; 292: 1365–1367.CrossRefGoogle Scholar
14.Mental Health Act. London: HMSO, 1983.Google Scholar
15.Pippard, J, Ellam, L. Electroconvulsive treatment in Great Britain, 1980. A report of the Royal College of Psychiatrists. London: Gaskell Books, 1981.Google Scholar
16.Mindham, RHS, Rowland, C, Shepherd, M. An evaluation of continuation therapy with tricyclic antidepressants in depressive illness. Psychol Med 1973; 3: 5–17.CrossRefGoogle ScholarPubMed
17.Finch, EJL, Katona, CLE. Lithium augmentation in the treatment of refactory depression in old age. International Journal of Geriatric Psychiatry 1989; 4: 41–49.CrossRefGoogle Scholar
18. Anonymous. Treating depression in the elderly. Drugs and Therapeutics Bulletin 1989; 27: 37–39.CrossRefGoogle Scholar
19.Greenblatt, DJ, Allen, MD. Toxicity of nitrazepam in the elderly: a report from the Boston Collaborative Drug Surveillance Program. Br J Clin Pharmacol 1978; 5: 407–413.CrossRefGoogle ScholarPubMed
20.Catalan, J, Gath, DH, Bond, A, Edmonds, G, Martin, P, Ennis, J. General practice patients on long-term psychotropic drugs. Br J Psychiatry 1988; 152: 399–405.CrossRefGoogle ScholarPubMed
21.Murphy, DJ, Gannon, MA, Fitzpatrick, D, Kumar, R, Doyle, H, O'Boyle, JH, McGennis, A. A study of the prescribing of psychotropic drugs in a Dublin psychiatric hospital. Ir J Psychol Med 1990; 7: 26–30.CrossRefGoogle Scholar
22.McClelland, HA, Blessed, G, Bhate, S, Ali, N, Clarke, PA. The abrupt withdrawal of antiparkinsonian drugs in schizophrenic patients. Br J Psychiatry 1974; 124: 151–159.CrossRefGoogle ScholarPubMed
23.Rifkin, A, Quitken, F, Kane, J, Struve, F, Klein, D F. Are prophylactic antiparkinsonian drugs necessary? Arch Gen Psychiatry 1978; 35: 483–489.CrossRefGoogle ScholarPubMed