A retrospective study of psychotropic drug use among individuals with mental illness issued a community treatment order

Background: Community treatment orders (CTOs) are legal orders which require individuals with mental illness to accept treatment in the community. Previous studies report that long-acting injectable (LAI) antipsychotics are associated with CTOs, however, little is known about the specific treatment plans prescribed in CTOs. The objective of this study was to describe the patterns of psychotropic drugs prescribed to individuals issued a CTO, focusing on LAI antipsychotics, antipsychotic polypharmacy and high-dose antipsychotics. Methods: This was a retrospective cross-sectional study of 378 individuals randomly selected from a sample of 1317 individuals with a CTO expiry date up to and including 30 April 2010, taken from all 2856 individuals issued a CTO by the New South Wales Mental Health Review Tribunal, Australia, in 2009. De-identified information relating to individuals treatment plans, demographic and clinical details were systematically extracted. Results: A total of 377 (99.7 ) individuals were prescribed at least one antipsychotic. Of these, 310 (82 ) were prescribed a LAI antipsychotic, either alone (45 ), or in combination with, an oral antipsychotic (37 ). Risperidone was the most prevalent antipsychotic, prescribed to 164 (43 ) individuals. Antipsychotic polypharmacy was prescribed to 121 (32 ) individuals and between 20 and 27 of individuals were prescribed high-dose antipsychotics. Antipsychotic polypharmacy accounted for 74-80 of individuals prescribed high-dose antipsychotics. Conclusions: The results from this study confirm that LAI antipsychotics are commonly prescribed in CTOs. Antipsychotic polypharmacy was also common, and accounted for the majority of individuals prescribed high-dose antipsychotics. Further research is needed to determine the potential outcomes and implications of the patterns observed.