Common Use of Antipsychotic Polypharmacy in Older Asian Patients With Schizophrenia (2001–2009)

Xiang, Yu Tao; Dickerson, Faith; Kreyenbuhl, Julie; Ungvári, Gábor S.; Wang, Chuanyue; Tian, Mei; H, Lee; He, Yan; Chiu, Helen F.K.; Yang, Shu Yu; Chong, Mian Yoon; Tan, Chay Hoon; Kua, Ee Heok; Fujii, Senta; Sim, Kang; Yong, Michael; Jk, Trivedi; Chung, Eun Kee; Udomratn, Pichet; Chee, Kok Yoon; Sartorius, Norman; Shinfuku, Naotaka

doi:10.1097/jcp.0b013e3182726623

Cited by 16 publications

(19 citation statements)

References 34 publications

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“…In special circumstances where the use of a single medication has failed, polypharmacy may be c o n s i d e r e d w i t h a n u n d e r s t a n d i n g o f pharmacodynamics, pharmacokinetics, animal and human research. Elderly females are more at risk of using polypharmacy 3 . As the courses of different diseases continue, the chance of using polypharmacy increases 3,4 .…”

Section: Introductionmentioning

confidence: 99%

“…Elderly females are more at risk of using polypharmacy 3 . As the courses of different diseases continue, the chance of using polypharmacy increases 3,4 . Polypharmacy is also defined as using two or more medications in treating diseases, which all share the same mechanism of action; however, using sertraline for depression, along with metformin for diabetics in the same patient, is not considered to be polypharmacy 5,6 .…”

Section: Introductionmentioning

confidence: 99%

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Antipsychotic Polypharmacy Versus Monotherapy in Elderly Patients with Chronic Schizophrenia: A Clinical Trial

Mirabzadeh

Shemshadi

Khodaei

et al. 2014

Klinik Psikofarmakoloji Bülteni-Bulletin of Clinical Psychophar

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Objective: Antipsychotic polypharmacy in the elderly usually results in higher rates of interactions, side effects and increased cost. This research was designed to observe the benefits of replacing polypharmacy with a single medication in elderly patients with chronic schizophrenia. Methods: This was a quasi-experimental, prospective, descriptive and analytical clinical trial. A survey was performed at the long stay public and academic Tehran Razi Mental Hospital. From the initial 157 conveniently access patients, 59 cases were selected based on inclusion and exclusion criteria. Before intervention, 7 patients did not participate in the study due to the recent diagnosis of new medical conditions. Fifty-two (52) cases (males=13 and females= 39) entered and completed the 36 week research time period. At baseline 40 patients were receiving two types of antipsychotics, whereas, 11 patients were receiving three types and only 1 patient was receiving four types of antipsychotic drugs. In the pre-intervention period, the approval of the University`s ethics committee and the informed consents of the patients' relatives were obtained. Systematically, the patients` multiple antipsychotics were switched to a single medication, risperidone. After determining the equivalent dose of risperidone, it was started at 1 mg/day for all patients. After a 3-6 week cross-titration period, the patients reached the previously determined equivalent risperidone doses and completed 36 weeks until the end of the study. Clinical assessments including the Brief Psychotic Rating Scale (BPRS), Global Assessment of Functioning (GAF), and Extra-Pyramidal Syndrome (EPS) Scale were applied on a weekly basis for a 36 week period. Results: The mean BPRS scores of the participants showed statistically significant improvement after the 9 th week of intervention. Improvements were observed in all symptom dimensions of the BPRS (positive, negative and general schizophrenic symptoms). At the end of 36 weeks of risperidone use, 90.1% of the patients achieved at least a 50% reduction in their symptoms. Additionally, functional improvement and a lower incidence of extrapyramidal side effects were also achieved after 36 weeks of risperidone use in the study population. Conclusion: Risperidone may be considered safe as a monotherapy alternative for elderly patients with chronic schizophrenia who are being treated with multiple concomitant antipsychotics. This replacement may result in some clinical benefits and fewer side effects.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Antipsychotic Polypharmacy Versus Monotherapy in Elderly Patients with Chronic Schizophrenia: A Clinical Trial

Mirabzadeh

Shemshadi

Khodaei

et al. 2014

Klinik Psikofarmakoloji Bülteni-Bulletin of Clinical Psychophar

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“…In these cases, physicians would not consider changing the prescription pattern and would continue prescribing FGA. APP involving SGA in older patients with schizophrenia may be driven by the assumed favourable effects on refractory symptoms and a lower risk of EPS . The association between SGA and FGA could be also due to the attempt to optimize dopamine‐2 receptor occupancy and to target a variety of receptors beyond the dopamine‐2 receptor, although this practice lacks strong evidence …”

Section: Discussionmentioning

confidence: 99%

“…Year of admission, length of hospital stay, age, gender, psychiatric diagnosis, PMDD/DDD ratio for antipsychotic drugs, and the prescription of antidepressants, mood stabilizers, anxiolytics, hypnotics and sedatives, or anti‐Parkinson drugs were entered into the regression analysis. These predictors were chosen based on the results of previous studies . We used SPSS version 20 for Windows (SPSS Inc., Chicago, Illinois, USA) for all analyses.…”

Section: Methodsmentioning

confidence: 99%

“…Although late‐life schizophrenia and dementia are different conditions and have different indications for antipsychotic medications, numerous studies have reported the advantages of second‐generation antipsychotics (SGA) in terms of safety, tolerability, and efficacy compared to first‐generation antipsychotics (FGA) in the treatment of older patients with schizophrenia and patients with dementia experiencing psychosis or behaviour disturbances . While some polypharmacy studies have included older adults, very limited information exists regarding APP in older adults with dementia . Gaining an understanding of APP in older patients, especially those with dementia or schizophrenia, in clinical practice is important because of the high rates of medication intolerability, drug interactions, and adverse drug events in this population …”

Section: Introductionmentioning

confidence: 99%

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Antipsychotic polypharmacy among elderly patients with schizophrenia and dementia during hospitalization at a Taiwanese psychiatric hospital

Lai

Chang

2014

Psychogeriatrics

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FGA are still commonly used for the late-life schizophrenia at our hospital. Given their potentially hazardous side effects, FGA must be employed with caution. The use of APP involving SGA increased over the 6 years of the study period, especially among patients with dementia. However, the use of SGA in dementia began to decline after the US Food and Drug Administration's 2005 warning about SGA being associated with increased mortality in dementia patients, which contrasts with the trends examined in this study. Further controlled trials exploring the efficacy, safety, and tolerability of APP in this population are warranted to gain an additional insight into this practice.

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Epidemiology of Mental Disorders (Including Cross-Cultural Comparisons)

Kua

Mahendran

2016

Mental Health and Illness Worldwide

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Common Use of Antipsychotic Polypharmacy in Older Asian Patients With Schizophrenia (2001–2009)

Cited by 16 publications

References 34 publications

Antipsychotic Polypharmacy Versus Monotherapy in Elderly Patients with Chronic Schizophrenia: A Clinical Trial

Antipsychotic Polypharmacy Versus Monotherapy in Elderly Patients with Chronic Schizophrenia: A Clinical Trial

Antipsychotic polypharmacy among elderly patients with schizophrenia and dementia during hospitalization at a Taiwanese psychiatric hospital

Epidemiology of Mental Disorders (Including Cross-Cultural Comparisons)

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