[e-drug] Request for help on antipsychotics prescription practice

["Valeria Frighi" <Valeria.Frighi@psych.ox.ac.uk>]

E-DRUG: Request for help on antipsychotics prescription practice
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Dear all,

I am writing a chapter on the physical side effects of antipsychotics (deadline first week of February) for a multi-authored UK book on schizophrenia. 

I want to give it a wider breadth than we normally have in UK by writing a short paragraph of pattern of use (by drug, and doses) both in industrialized and developing countries (including middle income). The only papers I could find searching with a variety of keywords were 5 from Nigeria dated 1979 to 1983, 2 of which excellent (and confirming the particular attention to mental health problems the population of this country has enjoyed for decades, since the days of the Aro villages I suppose- the brainchild of an enlightened president).

Could anyone answer to my questions?

1) What type of antipsychoticcs are available in your country?

2) What are the indications of use beside schizophrenia? (in my world, these are bipolar mood disorder- acute and maintenance treatment- major unipolar depression and challenging behaviour associated with learning disabilities and dementia. All in selected patients, obviously)

3) What is the awareness of the major physical side effects of these drugs?

a) Diabetes (including ketoacidosis- which is 10 times the rate of US general population-, hyperosmolar coma and very high fatality rates with these comas)

b) Obesity

c) Dyslipidaemia

d) Hyperprolactinaemia, causing sexual dysfunction (and bone loss. NB: even  in US and UK very few psychiatrists are aware of the osteoporotic consequences of loss of sex steroids due to raised prolactin)

3) Do any screening/management protocols exist? In US and UK we have had guidelines since 2003, but the use of management protocols is extremely patchy in these countries as well as other Western European.

NB Antipsychotics have been a major advance in psychiatry, allowing schizophrenics to "have a life" which they did not have before and many learning disabled patients to stop banging their heads on the wall, injuring themselves and others, or screaming half their  time. 
I do not mean to scare anyone in using these very useful drugs. Just want to know which type of drugs and when are used and if patients are screened for their physical side effects.

Thanks a million  to whoever can spare a bit of time to help me. I DO NOT EXPECT ANY PRECISE ANSWERS, your own clinical experience (and which settings you practice in) will be more than enough.

Best wishes,

Valeria

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Dr Valeria Frighi
University Dept. of Psychiatry
Neurosciences Building
Warneford Hospital
Oxford
OX3 7JX
UK
Tel. -44 -1865 -223779
Fax -44 -1865 251076
Mobile phone 07974920013
"Valeria Frighi" <Valeria.Frighi@psych.ox.ac.uk>