Risk factors of psychotropic polypharmacy in the treatment of children and adolescents with psychiatric disorders

Medhekar, Rohan; Aparasu, Rajender R.; Bhatara, Vinod S.; Johnson, Michael L.; Alonzo, Joy; Schwarzwald, Heidi; Chen, Hua

doi:10.1016/j.sapharm.2018.06.005

Cited by 17 publications

(15 citation statements)

References 27 publications

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“…Related to this, the risk of DDIs, polypharmacy, adverse drug events (ADEs), morbidity, mortality, and costs increase day by day 4 . Although clinical guidelines recommend monotherapy as the preferred therapy for the treatment of paediatric disorders, the use of psychotropic polypharmacy (≥2 medications) is quite common in clinical practice 5 . Overall the prevalence of psychotropic polypharmacy ranges from 14% to 73% amongst the paediatric population 6 .…”

Section: Introductionmentioning

confidence: 99%

“…According to a recent systematic review, anticonvulsant (60.4%), antipsychotic (30.2%), and antidepressant (26.1%) drugs were identified as the most commonly studied pharmacological classes in paediatric polypharmacy studies 7 . Medhekar et al determined that the number of hospitalisations, number of prescribers, and number of comorbidities were risk factors for psychotropic polypharmacy 5 . DDIs between psychotropic and/or non‐psychotropic drugs should be assessed as pharmacodynamic (additive, synergistic, or antagonistic) and pharmacokinetic (absorption, distribution, metabolism, or elimination) interactions to prevent before it occurs 8 .…”

Section: Introductionmentioning

confidence: 99%

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Potential drug‐drug interactions with psychotropic drugs in paediatric inpatients: A cross‐sectional study

et al. 2021

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Aims Polypharmacy and drug‐drug interactions (DDIs) are important problems that necessitate more attention in paediatric inpatients. This study aimed to determine and evaluate DDIs in paediatric inpatients using psychotropic drugs. Methods It was conducted as a retrospective cross‐sectional study. Inpatients consulted by child and adolescent psychiatrists (CAPs) and had at least one psychotropic drug‐using between January 2016 and September 2017 were retrospectively included. To determine the clinical significance of DDIs by Micromedex® and DDI Predictor online databases. DDIs between psychotropic and other drugs, the type, severity, and duration of potential DDIs were evaluated. Results During the study period, 564 patients’ records were reviewed and 200 patients were considered eligible and included in the study. The median (min‐max) age was 13.70 (1.5‐17.83) years. The mean (SD) number of psychotropics used during hospitalisation was 1.29 (0.55) and the total number of drugs was 7.39 (4.45). A total of 336 potential DDIs were detected (2.19 DDIs/patient) in all patients. The most common potential outcome of psychotropic DDIs was drug‐induced QTc prolongation (67.56%). While 92.85% of the potential DDIs were “contraindicated” or “major,” only 18.46% had a “good” or “excellent” strength of evidence. The risk of psychotropic polypharmacy (OR:0.73, 95% CI 0.59‐0.92; p:0.006) and DDIs (OR:0.69, 95% CI 0.35‐0.76; p:0.033) was significantly higher in patients without primary psychiatric disorders. When the total number of drugs and the total number of potential DDIs were compared amongst all inpatient units, significant differences were found between paediatric hematology‐general paediatrics (mean difference: 2.002; P < .001) and paediatric hematology‐paediatric ICU (mean difference: 1.650; P = .012), respectively. Conclusion Psychotropic drug‐related DDI is a major problem in the paediatric population and the clinical significance of the potential DDIs’ risk should be determined in patient‐centred care and managed by the multidisciplinary team.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Potential drug‐drug interactions with psychotropic drugs in paediatric inpatients: A cross‐sectional study

et al. 2021

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“…For full impact, a follow up comparison study would establish the value of monitoring questionable practices at the state level. In a somewhat similar fashion, Medhekar et al ( 35 ) assessed the impact of physician specialty (psychiatry or primary care) on polypharmacy in a southern state managed care population ( N = 24,147). The findings on polypharmacy (2 or more classes for 60 or more days) were 5.3 and 3.6 times more likely for single or multiple providers that included psychiatrists.…”

Section: Resultsmentioning

confidence: 99%

“…Because the data on 332 youth managed by 189 treating psychiatrists originated at physician offices, a precise profile of psychotropic medication treatment was possible: monotherapy (40%); 2 concomitant medications (30.5%); 3 concomitant medications (10.2%); 4 or more medications (2.9%), and no medication (16.2%). The data were collected in 1997 and 1999 and findings from a later Medicaid source support patterns of polypharmacy in psychiatric specialty care exceeding that of primary care ( 35 ).…”

Section: Resultsmentioning

confidence: 99%

Psychotropic Polypharmacy in the US Pediatric Population: A Methodologic Critique and Commentary

2021

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Background: Psychotropic concomitant medication use for the treatment of youth with emotional and behavioral disorders has grown significantly in the U.S. over the past 25 years. The use of pharmacy claims to analyze these trends requires the following: age of the selected population, overlapping days of use, and precision of the outcome itself. This review will also address the gaps in reporting of pediatric psychotropic polypharmacy.Methods: An electronic literature search was undertaken for the period 2000 through 2020 using keywords such as “pediatric,” “concomitant,” “polypharmacy,” “multiple medications,” and “concurrent psychotropic”; Relevant references in textbooks were also used. Only English language and U.S. studies were included, resulting in 35 inter-class studies.Results: Studies were organized into seven groups according to data sources and clinical topics: (1) population surveys; (2a) multi-state publicly insured populations; (2b) single/two state studies; (3) privately insured populations; (4) diagnosed populations; (5) foster care populations; (6) special settings. Across 20 years it is apparent that pediatric psychotropic polypharmacy affects substantially more children and adolescents today than had been the case. As many as 300,000 youth now receive 3 or more classes concomitantly. The duration of concomitant use is relatively long, e.g., 69–89% of annual medicated days. Finally, more adverse event reports were associated with 3-class compared with 2-class drug regimens.Discussion: Factors that contribute to the growth of pediatric psychotropic polypharmacy include: (1) predominance of the biological model in psychiatric practice; (2) invalid assumptions on efficacy of combinations, (3) limited professional awareness of metabolic and neurological adverse drug events, and (4) infrequent use of appropriate deprescribing.Conclusion: A review of publications documenting U.S. pediatric psychotropic polypharmacy written over the last 20 years supports the need to standardize the methodologies used. The design of population-based studies should maximize information on the number of youth receiving regimens of 3-, 4-, and 5 or more concomitant classes and the duration of such use. Next, far more post-marketing research is needed to address the effectiveness, safety and tolerability of complex drug regimens prescribed for youngsters.

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“…Medhekar et al [50] Community detection -"Pediatric psychotropic polypharmacy" is necessary and its prescription by providers is well justified.…”

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confidence: 99%

A Systematic Review of Network Studies Based on Administrative Health Data

Karim

Uddin

Imam

et al. 2020

IJERPH

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Effective and efficient delivery of healthcare services requires comprehensive collaboration and coordination between healthcare entities and their complex inter-reliant activities. This inter-relation and coordination lead to different networks among diverse healthcare stakeholders. It is important to understand the varied dynamics of these networks to measure the efficiency of healthcare delivery services. To date, however, a work that systematically reviews these networks outlined in different studies is missing. This article provides a comprehensive summary of studies that have focused on networks and administrative health data. By summarizing different aspects including research objectives, key research questions, adopted methods, strengths and weaknesses, this research provides insights into the inherently complex and interlinked networks present in healthcare services. The outcome of this research is important to healthcare management and may guide further research in this area.

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Risk factors of psychotropic polypharmacy in the treatment of children and adolescents with psychiatric disorders

Cited by 17 publications

References 27 publications

Potential drug‐drug interactions with psychotropic drugs in paediatric inpatients: A cross‐sectional study

Potential drug‐drug interactions with psychotropic drugs in paediatric inpatients: A cross‐sectional study

Psychotropic Polypharmacy in the US Pediatric Population: A Methodologic Critique and Commentary

A Systematic Review of Network Studies Based on Administrative Health Data

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