title: Increased use of antipsychotic long-acting injections with community treatment orders.
abstract: BACKGROUND
  Community treatment orders (CTOs) are increasingly being used, despite a weak evidence base, and problems continue regarding Second Opinion Appointed Doctor (SOAD) certification of medication.
  
  
  OBJECTIVE
  The aim of the current study was to describe current CTO usage regarding patient characteristics, prescribed medication and CTO conditions.
  
  
  METHODS
  A 1-year prospective cohort study with consecutive sampling was conducted for all patients whose CTO was registered in a large mental health trust. Only the first CTO for each patient was included. Measures included sociodemographic variables, psychiatric diagnosis, CTO date of initiation and conditions, psychotropic medication and date of SOAD certification for medication. This study was conducted in the first year of CTO legislation in England and Wales.
  
  
  RESULTS
  A total of195 patients were sampled (mean age 40.6 years, 65% male, 52% black ethnic origin). There was significant geographical variability in rates of CTO use (χ(2) = 11.3, p = 0.012). A total of 53% had their place of residence specified as a condition and 29% were required to allow access into their homes. Of those with schizophrenia, 64% were prescribed an antipsychotic long-acting injection (LAI). Of the total group, 7% received high-dose antipsychotics, 10% were prescribed two antipsychotics and only 15% received SOAD certification in time.
  
  
  CONCLUSIONS
  There was geographical and ethnic variation in CTO use but higher rates of hospital detention in minority ethnic groups may be contributory. Most patients were prescribed antipsychotic LAIs and CTO conditions may not follow the least restrictive principle.
authors: South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK.
authors: Maxine X
authors: MX
authors: Patel
authors: Jane
authors: J
authors: Matonhodze
authors: Mirza K
authors: MK
authors: Baig
authors: James
authors: J
authors: Gilleen
authors: Jane
authors: J
authors: Boydell
authors: Frank
authors: F
authors: Holloway
authors: David
authors: D
authors: Taylor
authors: George
authors: G
authors: Szmukler
authors: Tim
authors: T
authors: Lambert
authors: Anthony S
authors: AS
authors: David
keywords: antipsychotic agents; community treatment order; delayed action preparations; ethnicity; legislation; schizophrenia
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