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Objective: Sodium valproate’s teratogenicity has prompted increasing restriction in its use. It is still widely prescribed to women of childbearing age in New Zealand. To examine this problem, we audited the prescribing pattern of sodium valproate in a psychiatric inpatient unit in New Zealand. Method: We reviewed the clinical records of women admitted over a 2-year period (2016–2018). Results were analysed and compared with local and international guidelines. Results: Five hundred and thirty-four women of child-bearing age were admitted over the sampling period, 96 of whom (18%) were prescribed valproate on discharge. Half of these patients had diagnoses other than bipolar affective disorder, valproate’s only approved psychiatric indication in New Zealand. Pregnancy testing and contraception status were documented in a minority (29 and 10 cases, respectively). Teratogenic risk discussion was documented in only 11 cases. Conclusions: Prescription of valproate to women of childbearing age in our sample currently falls well short of best practice. Urgent action at both clinician and organisational levels is required to address this risk.

Objective: We examined the extent to which ethnicity, cannabis and alcohol use could predict prevalence of violence and self-harm in an inpatient psychiatric sample. Method: We collected demographic and clinical data in a series of 141 adult psychiatric inpatients in Hamilton, New Zealand. The Alcohol Use Disorders Identification Test (AUDIT) and Cannabis Use Disorders Identification Test, Revised (CUDIT-R) were used to measure substance use. Clinical assessment and file review were used to verify histories of self-harm and violence. Results: It was found that 66% had a history of violence, 54% of self-harm, and 40% of both; only 20% had neither. Cannabis use was found to significantly predict lifetime history of violence ( p = 0.02); other independent variables (gender, age, ethnicity, alcohol use, psychiatric diagnosis) did not. Self-harm was strikingly predicted by female gender ( p < 0.001), as well as by measures both of cannabis ( p = 0.025) and alcohol use ( p = 0.036); age, ethnicity and diagnosis did not reach significance. Less than 10% of patients were engaged with drug or alcohol services. Conclusions: Cannabis use is a significant predictor of lifetime violence among the severely mentally ill, while both alcohol and cannabis use predict self-harm. Few affected patients receive specific treatment for substance use comorbidity.

Objectives: Antipsychotics are the cornerstone of schizophrenia management. There is substantial literature on their efficacy and optimal use. Doubts remain, however, regarding the translation of this knowledge into day-to-day practice. This study aimed to investigate antipsychotic prescribing in three New Zealand regions and its relationship to clinical guidelines and patient characteristics. Methods: We studied 451 patients discharged from inpatient units with a diagnosis of schizophrenia or a related disorder (International Classification of Disease, version 10) between July 2009 and December 2011. Available information included patient demography, legal status, prescribed medications, duration of index admission and prescriber’s country of postgraduate training and years of postgraduate experience. Results: There was a high rate (33.7%) of multiple antipsychotic prescription, and lower than expected clozapine use (20%); Maori were prescribed clozapine more frequently than non-Maori (24% vs. 13%, respectively). Compulsory treatment was associated with more use of injectable medication and increased length of stay in hospital. Clinician characteristics did not significantly influence prescribing. Conclusions: Observed prescribing practice aligned with existing guidelines except for antipsychotic polypharmacy and clozapine under-utilisation.

Objective: To elucidate patterns of substance misuse, across diagnoses and demographic variables, in patients with severe mental illness. Method: We studied 141 adults admitted to an acute psychiatric unit in Hamilton, New Zealand. Semi-structured interviews, including the Alcohol Use Disorders Identification Test (AUDIT) and Cannabis Use Disorders Identification Test – Revised (CUDIT-R), were used to assess substance use. Results: Seventy-six participants were of European origin (56%), 59 were Maori (42%). Tobacco smoking was noted in 81% overall, with a higher frequency (93%) among Maori. A majority of patients had alcohol use disorder, with greater prevalence in bipolar and schizoaffective disorder compared to schizophrenia. By contrast, cannabis use disorder was strikingly associated with schizophrenia. Younger patients and Maori were disproportionately affected by both alcohol and cannabis use. Conclusions: Substance misuse in New Zealand patients with severe mental illness is common, particularly among younger patients and Maori, and differentially distributed across diagnoses.