| Sumario: | There has been increasing public concern about the risks of high dose antipsychotic treatment which has partly been due to the association of high dose treatment and death in a small number of patients, although this has as yet been unproven. (Hirsch and Barnes,1994; Brown and Kocsis,1984; Simpson, et al., 1987). In patients with learning disabilities, antipsychotic medication is used not only for defined psychiatric illness but also for the control of aggressive and disturbed behaviour, hyperactivity and stereotypical behaviour in the absence ofmental illness for which there is no consensus among psychiatrists (Santosh and Baird,1999; Fernando, et.al., 1997). Learning disabled patients pose further problems in that they may lack capacity and hence be unable to give informed consent for the use of high dose antipsychotic medication and the treatment response may be difficult to evaluate.Diagnosis of psychosis becomes a specialist task as there are special difficulties of communication. In addition, these patients may be particularly sensitive to side effects as a result of previous cerebral dysfunction or damage and hence the thresh-old for 'high doses' is lower. It may be difficult to recognise these side effects and the presence of cardiac and renal problems may be missed as a complete medical history may not be available. Antipsychotic medication reduces the seizure threshold and this may result in worsening of seizures or an increase in the required dose of the antiepileptic, as a high proportion of learning disabled patients suffer from epilepsy.In view of all these problems, particularly in patients with learning disability, it is important that when prescribing high dose antipsychotics, the guidelines de-scribed in this audit should be adhered to. This audit highlights those standards which were poorly complied with and suggests that the use of a checklist would greatly improve current practice. It is planned to repeat the audit in 6 months time to elicit if the authors' recommendations have improved clinical practice.
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