A look back review of South Kerry Child and Adolescent Mental Health Services (CAMHS) in Ireland, known as the ‘Maskey report’ (MR), highlighted substandard prescribing practices. The aim of this ‘Maskey Impact Study’ (MIS) was to explore changes to child and adolescent psychiatrists’ prescribing practices following the MR.

The study was cross-sectional and mixed method. A study specific questionnaire was distributed electronically to psychiatrists working in CAMHS (n = 160).

102 psychiatrists participated in the study (response rate 63.8%). Perceived improvement in prescribing practices included improved medical record keeping (63.7%), consent documentation (53.9%), medication information provision (41.2%) and physical health monitoring (60.8%). However, 43.1% of psychiatrists reported a reluctance to prescribe medication even when clinically indicated and 50% were more likely to avoid off-label use. Most respondents reported increased stress levels (80.4%) with higher stress being significantly associated with reticence in prescribing (χ2 = 11.746, p < .001) and avoiding off-label use (χ2 = 15.392, p < 0.001). Thematic analysis highlighted increased medication hesitancy, enforced ‘meaningless’ bureaucracy and medication mistrust among families.

Although improvements reported are welcomed, the increased hesitancy of medication use, avoidance of prescribing more than one medication, and avoidance of off-label use, is of concern with potential unintended adverse consequences. Reluctance in prescribing may deprive youth of access to evidence-based treatments and limit exposure of NCHDs to the safe practice of consultant-initiated psychopharmacology. Further research will be important to determine if this impacts clinical care. Continued education in psychopharmacology is essential along with increased public awareness of the evidence for medication, to help restore public confidence and trust in psychopharmacology.

This study describes the attitudes, knowledge and prescribing of psychotropic medication in children.

A study-specific questionnaire was mailed to all child psychiatrists, paediatricians and a group of registered general practitioners (GPs) from a selected Child and Adolescent Mental Health Services catchment area.

In the 116 respondents who replied (39% response rate), psychotropic medication was generally valued and used by all groups (70.1%). Respondents believed that the majority (61.9%) of their non-medical colleagues would also value/support the use of medication and this endorsement influenced the respondents’ prescribing rates. Initiating medication was viewed as the province of child psychiatry (78.6%). Medication is felt to be justified in a wide variety of mental health disorders, their use being reserved for severe presentations, with psychostimulants and selective serotonin reuptake inhibitors being most used. A significant number of GPs (60.9%) and paediatricians (63.4%) were felt to be lacking in competence in psychotropic prescribing, with a general request for more seminars in this area (61.5%) with almost half (45%) of them believing that they would prescribe more often.

The use of psychotropic medication in children remains a valued and common practice in Ireland. Attitudinal and practice differences across professional groups exist, and although the experience is one of relative safety there was a strong desire for further education leading to a perceived increase in utilisation. The impact of perceived public opinion regarding psychotropic prescribing along with a lack of competence may represent a major barrier to effective prescribing, thus highlighting the importance of ongoing professional development and increased public health initiatives to increase knowledge and understanding in this increasingly important area.

The purpose of this study was to investigate the circumstances of opioid prescription among general practitioners (GPs) in the UK.

Prescription of opioids for chronic pain, particularly non-malignant chronic pain, remains controversial. In the midst of this controversy, patterns of actual prescription and influences on these patterns are not well understood.

A mail survey was posted to 1192 GPs and it was returned by 414 (35.0%). The survey addressed the frequency and reluctance in GP prescription of opioids for chronic pain. It also sampled their attitudes and concerns about opioids, including their views on appropriateness and effectiveness, adverse effects and potential social pressures presumed to impact on prescribing.

Overall, 57.9% of GPs reported they sometimes, frequently, or always, prescribe strong opioids for chronic pain, which was of significantly lower frequency than for prescribing of weak opioids, non-steroidal anti-inflammatory drugs (NSAIDs) or tricyclic antidepressant medications. Similarly, 69.1% reported a reluctance to prescribe strong opioids for chronic non-malignant pain, which was a significantly greater reluctance than for cancer pain, for example. GPs who were men, younger, had fewer years experience and worked full time (as opposed to part time), were more likely to prescribe opioids. Practice guideline use was unrelated to prescribing but those with specialty training were more likely to prescribe. Interestingly, a majority of GPs (83.0%) felt that opioids are effective for chronic non-malignant pain; however, they worry about long-term commitment (such as managing dosing and repeat prescriptions), addiction and other adverse events.

Based on multivariate analyses, both frequency of prescribing and reluctance were predicted by a combination of concerns about effects on patient behaviour, professional competency concerns and degree of belief in opioids as an effective option. These results may suggest a need for additional GP training in the management of analgesics for chronic non-malignant pain.

To describe physicians' observations and perceptions of patients with schizophrenia and to obtain information about antipsychotic prescribing practices.

Psychiatrists in the United States and five European countries (France, Germany, Italy, Spain, and the United Kingdom) who prescribed antipsychotics for ≥15 patients with schizophrenia within the preceding 3 months provided data on their patients' demographic and clinical characteristics and their antipsychotic prescribing practices and drug attributes influencing treatment choice.

Data were collected from 872 physicians on 6523 patients (85% European, 15% US). Most patients were aged 25–44 years, 63% were men, and 66% were outpatients. About 50% of patients were moderately to grossly dysfunctional; about 50% were unemployed; 34% and 75% were taking conventional or atypical antipsychotics, respectively. Frequently identified positive symptoms included delusions (73%), disordered thought (59%), and hallucinations (59%); common negative symptoms included social withdrawal (54%), impoverished thought (39%), and blunted affect (38%). Reasons for antipsychotic selection included efficacy for positive (90%) or negative symptoms (62%) and tolerability (47%). Inadequate control was reported more frequently for negative (71–77%) than positive (47–60%) symptoms. Adverse events included sedation, weight gain, and extrapyramidal symptoms.

In this large, multinational, cross-sectional survey, physicians reported that positive symptoms were more common than negative symptoms. Treatment for positive symptoms was more successful than that for negative symptoms, with physicians considering treatment inadequate for >70% of patients with negative symptoms.