Adjunctive use of atypical antipsychotics and anticholinergic drugs among patients with schizophrenia

Ren, Xinhua S.; Huang, Yuhui; Lee, A. F.; Miller, Donald R.; Qian, Shirley; Kazis, Lewis E.

doi:10.1111/j.1365-2710.2004.00610.x

Cited by 14 publications

(14 citation statements)

References 19 publications

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“…However, considering the inappropriateness of the conventional approach in measuring treatment persistence as well as the limitations of the present study, more research is needed to examine the extent to which adjunctive use of other agents, a common practice among patients with schizophrenia (Ren et al 2004), will influence levels of treatment persistence. Future research should also assess the impact of poor treatment persistence on a wide spectrum of patient outcomes (Ren et al 2005b). A more comprehensive assessment using appropriate analytic methods should provide physicians with a better knowledge about treatment persistence associated with different antipsychotic agents and help them make prescription choices that will ultimately improve the care of schizophrenia.…”

Section: Discussionmentioning

confidence: 99%

An alternative approach to measuring treatment persistence with antipsychotic agents among patients with schizophrenia in the Veterans Health Administration

Ren¹,

Qian²,

Kazis³

2007

Neuropsychiatric Disease and Treatment

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Prior studies have demonstrated the importance of treatment persistence with antipsychotic agents in sustaining control of schizophrenic symptoms. However, the conventional approach in measuring treatment persistence tended to use only the fi rst prescription episode even though some patients received multiple prescriptions (or multiple treatment episodes) of the same medication within one year following the initiation of the index drug. In this study, we used data from the Veterans Health Administration in the United States to assess the extent to which patients received multiple prescriptions. The study found that about a quarter of the patients had two or more treatment episodes and that levels of treatment persistence tended to vary across treatment episodes. Based on these results, we offered an alternative approach in which we calculated treatment persistence with typical and atypical antipsychotic agents separately for patients with one, two, or three treatment episodes. Considering that patients with different number of treatment episodes might differ in disease profi les, this treatment episode-specifi c approach offered a fair comparison of the levels of treatment persistence across patients with different number of treatment episodes. Future research needs to extend the analyses beyond two antipsychotic classes to individual antipsychotic agents. A more comprehensive assessment using appropriate analytic methods should help physicians make prescription choices that will ultimately improve the care of patients with schizophrenia.

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Section: Discussionmentioning

confidence: 99%

An alternative approach to measuring treatment persistence with antipsychotic agents among patients with schizophrenia in the Veterans Health Administration

Ren¹,

Qian²,

Kazis³

2007

Neuropsychiatric Disease and Treatment

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“…In a third study, Ren et al [2005b] reported that risperidone initiators had significantly more use of at least one anticholinergic agent adjunctively compared to those initiated on olanzapine, and that those on either olanzapine or risperidone stayed on the targeted medication significantly longer than those who were not prescribed any anti-cholinergic agent (Po0.05). Results were important for understanding clinical practices for future development of medication guidelines.…”

Section: Utilization Of Services and Medication Therapymentioning

confidence: 95%

“…In other medication studies involving patients diagnosed with schizophrenia and their anti-psychotic use, Ren et al [2002bRen et al [ , 2004Ren et al [ , 2005b merged patientreported HRQoL data (VR-36) and utilization of psychiatric services with medication history that includes dosage and duration of use on the basis of 89,107 subjects. Using a cohort design, results show that olzanzapine and risperidone users were associated with different sociodemographic characteristics; those on olanzapine compared to those on risperidone were younger (Po0.001), Hispanic (Po0.001), with fewer medical co-morbidities and a lower body mass index (Po0.05).…”

Section: Utilization Of Services and Medication Therapymentioning

confidence: 99%

Medication effectiveness studies in the United States Veterans Administration health care system: a model for large integrated delivery systems

Kazis

Nethercot

Ren

et al. 2006

Drug Development Research

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The Veterans Administration health care system (VA) is one of the largest integrated delivery systems in the United States. The VA provides a rich central data base repository that includes detailed medication data, historical information about patient morbidities, clinical data, and inpatient and outpatient utilization information from claims data and health status information derived directly from the patient. The Veterans Health Study (VHS), a large-scale prospective study following patient's health outcomes for up to six years, derived and validated a number of patient questionnaires for wide-scale use in the VA as part of its quality monitoring and research programs. Chief among these assessments are the Veterans Rand 36 item and 12 item health surveys (VR-36 and VR-12); other assessments include measures of illness and their associated severity, health-related quality of life, and utilization of health care services. This report reviews the methodologies developed in the VHS and their subsequent applications in the VA system for conducting medication effectiveness studies based upon non-randomized prospective quasiexperimental designs that approximate real world clinical conditions. Study cohorts are described that link the patient questionnaire data with administrative, clinical, and pharmacy data to address questions about medication effectiveness. Statistical models include comprehensive risk adjustments in order to better understand the association between medications that are being compared and their associated patient outcomes. Applications of this approach are presented for medication studies in those diagnosed with hypertension, osteoarthritis, low back pain, depression, and schizophrenia. Future implications of this work are described for purposes of quality improvement. Drug Dev. Res. 67:217-226, 2006. r

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“…Similar observation was observed in a study by Ren et al where when anti-C agents were used concomitantly with atypical anti-Ps, patients tend to stay on target drug significantly longer than those who did not use any anticholinergic agents. 12 The average number of drugs per prescription is an important index of the scope for review and educational intervention in prescribing practices. The average number of drugs per prescription in our study is 4.02, higher compared to studies by Shankar and Roy, Piparva et al and Dutta et al…”

Section: 9mentioning

confidence: 99%

Role of pharmaco-epidemiology in psychopharmacology: a study in psychiatric out-patient department of a tertiary care teaching hospital at Dehradun, Uttarakhand

Dutta¹,

Beg²,

Sindhu³

et al. 2014

Int J Basic Clin Pharmacol

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INTRODUCTIONPhysicians/medical professionals are continuously exposed to newly introduced drugs that are claimed to be safer and more efficacious. Their utilization and consequences on real-life effectiveness and safety in actual clinical practice need continuous study.1 Rational drug prescribing is defined as the use of the least number of drugs to obtain the best possible effect in the shortest period and at a reasonable cost. Measurement of drug use in health facilities not only describes drug use patterns and prescribing behavior, but also helps in the identification of factors responsible for the practice of polypharmacy and the problems associated with it.2 Drug utilization study has been defined by the World Health Organization (WHO) as "the marketing, distribution, prescription and uses of drugs in a society with special emphasis on the resulting medical and social and economical consequences." 3Studies on the process of drug utilization focus on the factors related to the prescribing, dispensing, administering, and taking of medication, and its associated events, covering the medical and non-medical determinants of drug utilization, the effects of drug utilization, as well as studies of how drug ABSTRACT Background: Prescription auditing studies are a part of drug utilization studies, are beneficial in clinical practice for rational prescribing of drugs and helpful for minimizing the medication errors. They are important tool to promote rational prescribing. Methods: This was a prospective drug utilization study conducted by the Department of Pharmacology in Psychiatry out-patient department at Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun for a period of 6 months. A total of 311 prescriptions were evaluated for prescribing pattern using World Health Organization drug indicators and National Essential Medicine List (NEML) 2011. Results: A total of 311 prescriptions were evaluated, 157 (50.48%) were females, and 154 (49.52%) were males, mean age was 37.14±0.8 years. Majority of patients were married 207 (66.56%), housewife 116 (37.30%) and belong to middle socioeconomic group 205 (65.92%). A total of 1250 drugs were prescribed, anti-anxiety (anti-A) 379 (30.32%), anti-depressants (anti-Ds) 348 (27.84%), anti-psychotics (anti-Ps) 118 (9.44%), anti-epileptics (anti-Es) 64 (5.12%), mood stabilizer 20 (1.6%), anticholinergics 28 (2.24%) and others 293 (23.44%). Oral formulations 1247 (99.76%), 4.02 drugs/prescription, 100% drugs were prescribed by brand names. 220 (17.6%) fixed dose combinations were prescribed. Most frequently prescribed among anti-A drugs were propranolol 160 (42.22%) and diazepam 105 (27.70%), among anti-Ds drugs were amitriptyline 65 (18.68%) and escitalopram 59 (16.95%) and among anti-Ps risperidone 49 (41.53%) and olanzapine 38 (32.20%), respectively. About 51.36% drugs were prescribed from the NEML 2011. Result has revealed polypharmacy in the practice. Conclusions: Anti-A drugs were the most commonly prescribed drugs followed by anti-Ds, anti-Ps and anti-Es res...

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Adjunctive use of atypical antipsychotics and anticholinergic drugs among patients with schizophrenia

Cited by 14 publications

References 19 publications

An alternative approach to measuring treatment persistence with antipsychotic agents among patients with schizophrenia in the Veterans Health Administration

An alternative approach to measuring treatment persistence with antipsychotic agents among patients with schizophrenia in the Veterans Health Administration

Medication effectiveness studies in the United States Veterans Administration health care system: a model for large integrated delivery systems

Role of pharmaco-epidemiology in psychopharmacology: a study in psychiatric out-patient department of a tertiary care teaching hospital at Dehradun, Uttarakhand

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