Objectives: In the UK, nine different compounds are available as long-acting antipsychotic injections (LAIs). There are few clinical guidelines for determining which LAIs are most effective in specific patient groups. To measure the clinical effectiveness of LAIs we aimed to determine the now-established concept of antipsychotic discontinuation rates and measure Clinical Global Impression (CGI) outcomes. Method: The population (n was approximately 560,000) was a secondary care NHS adult mental health service in Lanarkshire, Scotland, UK. This was a retrospective, electronic case note search of LAI-naïve patients commenced on paliperidone palmitate (n = 31), risperidone long-acting injection (RLAI) (n = 102) or zuclopenthixol decanoate (n = 105), with an 18-month follow up. Kaplan-Meier survival statistics for discontinuation rates and hospital admission were calculated. CGI severity and improvement scores were retrospectively assigned by the investigating team. Results: Paliperidone palmitate performed less favourably than risperidone longacting injection (RLAI) or zuclopenthixol decanoate. Paliperidone palmitate had higher discontinuation rates due to any cause, inefficacy and increased hospitalization risk. Paliperidone palmitate had the smallest proportion of patients assigned a clinically desirable CGI-I score of 1 (very much improved) or 2 (much improved). Conclusions: Paliperidone palmitate had less favourable discontinuation and CGI outcomes compared with RLAI and zuclopenthixol decanoate. This could not be adequately explained by patients in the paliperidone group being more chronically or severely unwell, nor by the presence of comorbidities such as alcohol or substance misuse, or by the use of lower mean dosages compared with RLAI or zuclopenthixol decanoate. We considered that prescribers are familiarizing themselves with paliperidone and outcomes may improve over time.

For RLAI and zuclopenthixol decanoate, APP had some favourable outcomes when examining discontinuation rates for any cause, and adverse effects. This was unexpected as we had considered APP would signal illness chronicity and severity and be associated with increased adverse effects resulting in early discontinuation. APP had no adverse outcomes on assigned CGI improvement or mean end-point severity ratings for RLAI and zuclopenthixol decanoate.

Aims and method To discern changes in body mass index (BMI) in patients on long-term antidepressant treatment in a general practice population and establish BMI changes in patients with and without a diagnosis of diabetes. We used a retrospective observational method and identified patients on four antidepressants of interest. We excluded those who did not have start and current BMI readings within the past 3 years and noted whether or not patients had a diagnosis of diabetes.Results Long-term treatment with citalopram, fluoxetine, mirtazapine and sertraline was associated with increased BMI in two-thirds of patients. There was reduction in BMI in patients with diabetes and an increase in BMI for patients who did not have diabetes.Clinical implications Awareness of environmental factors and their impact on individuals is important. Medication is not the only cause of abnormal metabolic effects. Overall monitoring of physical health is important in all groups of patients.

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AimsStudies have been done to suggest an increased risk of mortality in patients with mental illness, from cardiovascular diseases. This may be a result of factors ranging from lifestyle choices in the patient group, access to health-care facilities, side-effects of antipsychotic use etc. As a suitable predictor of cardiovascular risk, this audit reviews and attempts to improve the management of cholesterol levels in this patient group based on local trust guidelines.Methods116 and 120 patients from general adult psychiatry wards were included in two cycles of the audit respectively. Blood results, discharge letters were obtained from the Clinical portal database; drug prescriptions from the ‘Hospital Electronic Prescribing and Medicines Administration (HEPMA)’ database. As per local trust guidelines, it was verified if ‘ASSIGN’ (indicator of cardiovascular risk developed in Scotland) scores were calculated and a statin was prescribed accordingly, lifestyle modification advice provided or blood results communicated to GP in the discharge letter. An email with a flyer was distributed among doctors with trust guidelines, as intervention after the first cycle of the audit, and the results were presented in internal teaching. This was followed by a reaudit in a few months.ResultsIn the first cycle, 85 out of 116 patients had a lipid profile done on admission out of which 29 had abnormal levels without a prescription of statin. 6 patients had their abnormal lipid results mentioned in their discharge letter in the absence of an ASSIGN score calculation or lifestyle modification advice. In the second cycle, it was noted that only 35 patients out of 120 had a lipid profile done on admission and a total of 12 patients had abnormal lipid results without a statin prescription. Only 1 patient had their ASSIGN score calculated and 7 patients had their abnormal lipid results documented to the GP.ConclusionUnfortunately, considering both cycles of the audit, only a minority of patients had been managed in accordance with trust guidelines and no significant improvement was noted in the results of the reaudit. The importance of efficient management of cholesterol can be highlighted in a relevant forum and any barriers to change in practice may be explored. QRISK3, an alternative to ASSIGN may be suggested, which includes factors like severe mental illness and atypical antipsychotic use.