Citation

Cleary E, Kelleher CC, Lane A, Malone KM. Ir. J. Psychol. Med. 2019; ePub(ePub): 1-5.

Affiliation

Department of Psychiatry & Mental Health Research, UCD School of Medicine,St Vincent's University Hospital,Elm Park, Dublin 4,Ireland.

Copyright

(Copyright © 2019, Irish Institute of Psychological Medicine)

DOI

10.1017/ipm.2019.25

PMID

31182176

Abstract

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.

Language: en

Keywords

Psychotropic medication; suicide; suicide risk