CASE STUDIES OF QUESTIONABLE PRACTICE (posted October 2010.)

https://www.youtube.com/user/Humanagement2011 

For more information on this topic and the BBC Radio programmes on over-prescrition for kids.

These examples of bad practice were collated whilst being involved in co-writing this resource for parents from around the West Midlands.

1) In one very alarming case one of colleague in the West Midlands supported a parent who had had a prescription turned down by a pharmacist.When the mother took in a prescription for twice the maximum dose of methylphenidate (144mg), a maximum dose of an S.R.I. antidepressant and a commonly used antipsychotic drug the pharmacist made several phone calls and the refused to issue the triple prescription saying,"this is a life-threatening combination of drugs,you must go back to the prescribing psychiatrist."

2) In another case a mother asked for an additional SRI antidepressant to be prescribed when the child was already on twice the maximum dose advised of methylphenidate. This was given without the locum psychiatrist seeing the child which is against the GMC and NICE guidelines.A senior psychiatrist was very shocked by this and took the matter up with her managers  and discussed with her professional bodies.

3) Top Up doses are regularly administered across the West Midlands with a "kick-start dose" first thing in the morning and a "booster dose" at lunch time despite the child already being on at least the maximum the manufacturer recommends.Many professionals including some peadiatricians are alarmed by this practice as slow release methylphenidate already has a proportionate dose built into the outer casing in the drugs design.

4) In one local authority without a child psychiatrist a senior health authority colleague regularly took a batch of commonly used checklists to a neighbouring authority"s psychiatrist and the drugs were issued without the children being seen.This is clearly against NICE guidelines.

5) Doctors regularly say they do not have the manpower to regularly monitor the childrens weight every six months despite this being a clearly stipulated in NICE guidelines.


6)Relying on parental evidence alone has been criticised by many academics such as Professor Steven Rose (O.U.) as untenable.In one local authority in only 47% of cases did the prescribing doctor contact the school to see if the pattern of behaviour identified existed there as well.
Many headteachers have great concern about this practice as they perceive children as "Vibrant,energetic,full of joie de vie and dramatic" who then go on to be medicated and seemingly lose their enthususiasm for learning and sadly for life in general.

7)Many children who become medicated are felt by a range of colleagues to have the main presenting factor of very high anxiety levels brought about by a number of interactive variables. N.I.C.E. see this as a contraindicator to the use of amphetamines which as they are stimulants can exacerbate the anxiety further.

There are a huge number of similar stories and case examples emerging from colleagues and parents who share these concerns around the country.

Please let me know of other examples that you have come across by leaving a comment.

Let's help children cartwheel for joy without fear of medication!