Neuroleptic medication and prescription practices with sheltered-care residents: a 12-year perspective.
OBJECTIVE
Most adult residents of sheltered-care facilities (board and care, family care, psychosocial rehabilitation, and other supported housing arrangements) for the chronically mentally ill receive neuroleptics. These facilities house over 300,000 mentally ill residents, but neuroleptic prescription practices with this population have not been studied.


METHODS
A probability sample (n = 393) of all adult former psychiatric patients in sheltered care in California was surveyed in 1973; 94% of the located survivors (n = 243) were reinterviewed 12 years later.


RESULTS
In 1973, 79% received neuroleptics; in 1985, 76%. Polypharmacy decreased, and the elderly remained less medicated than adults. Yet, mean daily neuroleptic doses doubled, more persons received higher doses, and 62% reported adverse effects. Furthermore, high dosing was attributed to psychiatrists rather than other physicians, even when controlling for residents clinical and sociodemographic characteristics.


CONCLUSIONS
Neuroleptic drugs became the staple pharmacological treatment for mentally ill sheltered-care residents. While physicians more cautiously medicated the elderly, they had not reduced doses by 1985, even after a decade of treatment. The specialty of the prescriber was an important factor in preference for high-dose treatment.
School of Social Welfare, University of California, Berkeley 94720.
S P
SP
Segal
D
D
Cohen
S R
SR
Marder
D000293:Adolescent; D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002140:California; D004359:Drug Therapy, Combination; D004522:Educational Status; D004651:Employment / Q000706:statistics & numerical data; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008297:Male; D008393:Marriage / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000188:drug therapy*; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data* / Q000639:trends; D011570:Psychiatry / Q000706:statistics & numerical data; D012044:Regression Analysis; D012114:Residential Treatment / Q000706:statistics & numerical data*; D013997:Time Factors
D014150:Antipsychotic Agents