High-dose antipsychotic medication in routine clinical practice: an audit of the SOAD experience.

Aims and Methods This audit study investigates the experience of Second Opinion Appointed Doctors who were asked to provide Certification under the Mental Health Act for requests for “high dose” antipsychotic medication. SOADs completed a pro-forma about each request, which provided both quantitative and qualitative data. Results The first 100 audit pro-formas received were analysed. Participants largely met the audit standards. SOADs reported many difficulties in their role. These included lack of clarity over what constitutes “high dose” medication, deciding when certification should be time-limited and how to respond to requests for treatment outside licensed indications. Implications There is a gap between what is recommended in Guidelines and clinical practice. It would be good practice for prescribers to be explicit about the rationale for and the expected outcomes of ‘high dose” treatment.