Explicit versus implicit review to explore combination antipsychotic prescribing

Wheeler, Amanda

doi:10.1111/j.1365-2753.2008.01084.x

Cited by 9 publications

(8 citation statements)

References 47 publications

(53 reference statements)

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“…Furthermore, many cases of polytherapy in our study involved combinations of oral and LAI antipsychotics; rationale for this combination regimen were not explored. Whilst this practice is not uncommon [51, 52], there is little evidence to support this practice, especially if the LAI antipsychotic was introduced to manage adherence problems with an oral medication. This is worthy of further exploration to identify patients at risk of poor treatment outcomes [51].…”

Section: Discussionmentioning

confidence: 99%

“…Unlike the work by Kadra et al [53], the definition of antipsychotic polytherapy used did not include a time-frame; it may be that some patients were on two antipsychotics temporarily due to cross-titration, or were using an oral antipsychotic for short term use whilst commencing a long acting formulation. This information could not be identified from patient records alone in this audit; hence there is a possibility that the rates of polytherapy are over-estimated for both Cohorts [51]. With regards to additional psychotropic prescribing information, limited data regarding antidepressants, mood stabilisers and benzodiazepine medications was collected, however, it was beyond the scope of the study to widen the focus primarily because of the limited timeframes of postgraduate student research.…”

Section: Discussionmentioning

confidence: 99%

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Antipsychotic prescribing for vulnerable populations: a clinical audit at an acute Australian mental health unit at two-time points

et al. 2017

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BackgroundAntipsychotics are recognised as a critical intervention for schizophrenia and bipolar disorder. Guidelines globally endorse the routine practice of antipsychotic monotherapy, at the minimum effective dose. Even in treatment-resistant schizophrenia, clozapine use is endorsed before combining antipsychotics.This aim of this study was to review antipsychotic polytherapy alone, high-dose therapy alone, polytherapy and high-dose prescribing patterns in adults discharged from an inpatient mental health unit at two time-points, and the alignment of this prescribing with clinical guideline recommendations. Additionally, associations with polytherapy and high-dose antipsychotic prescribing, including patient and clinical characteristics, were explored.MethodsA retrospective clinical audit of 400 adults (200 patients at two different time-points) discharged with at least one antipsychotic. Preliminary findings and education sessions were provided to physicians between Cohorts. Outcomes (polytherapy alone, high-dose therapy alone, polytherapy and high-dose therapy) were compared between study Cohorts using chi-squared and rank-sum tests. Associations between outcomes and covariates were assessed using multivariable logistic regression.ResultsMost patients (62.5%) were discharged on a single antipsychotic within the recommended dose range. There was a clear preference for prescribing second generation antipsychotics, and in this respect, prescribing is aligned with current evidence-based guidelines. However, sub-optimal prescribing practices were identified for both Cohorts in relation to polytherapy and high-dose antipsychotic rates. Involuntary treatment, frequent hospitalisations and previous clozapine use significantly increased the risk of all three prescribing outcomes at discharge.ConclusionsIn a significant minority, antipsychotic prescribing did not align with clinical guidelines despite increased training, indicating that the education program alone was ineffective at positively influencing antipsychotic prescribing practices. Further consideration should be given when prescribing antipsychotics for involuntary patients, people with frequent hospitalisations, and those who have previously trialled clozapine.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Antipsychotic prescribing for vulnerable populations: a clinical audit at an acute Australian mental health unit at two-time points

et al. 2017

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“…Se recomienda hacer estudios que indaguen sobre las posibles explicaciones a este fenómeno. En otros informes se han observado cifras menores de asociaciones de antipsicóticos, práctica que no tiene una justificación comprobada para la mejoría del cuadro psicótico, y que aumenta el riesgo de efectos adversos y de interacciones medicamentosas e, incluso, un aumento del riesgo de mortalidad (23)(24)(25).…”

Section: Discussionunclassified

“…A pesar de esto, existen razones que justifican las asociaciones, como reducir al mínimo los eventos adversos al emplear dosis más bajas de cada uno de los medicamentos, en comparación con la dosis elevada de un antipsicótico solo. Sin embargo, se debe considerar que los esquemas de combinaciones pueden aumentar los problemas de observancia en las personas que necesitan de estos fármacos y pueden elevar los costos del tratamiento (23)(24)(25).…”

Section: Discussionunclassified

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Patrones de prescripción de antipsicóticos en pacientes afiliados al Sistema de Seguridad Social en Salud de Colombia

Machado‐Alba

Morales-Plaza

2013

biomedica

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Introducción. La esquizofrenia altera la percepción del individuo, el pensamiento, el afecto y el comportamiento. El tratamiento farmacológico puede mejorar estas manifestaciones. Objetivo. Determinar los patrones de prescripción de medicamentos antipsicóticos en un grupo de pacientes afilados al Sistema General de Seguridad Social en Salud de Colombia. Materiales y métodos. Se llevó a cabo un estudio descriptivo sobre base de datos de 6,2 millones de personas. Se seleccionaron los pacientes medicados con antipsicóticos, de ambos sexos, todas las edades, con tratamiento continuo de marzo a junio de 2012, y residentes de 57 ciudades colombianas. Se diseñó una base de datos sobre consumo de medicamentos, obtenidos por la empresa que dispensa dichos fármacos. Resultados. Se estudiaron 3.075 pacientes con edad promedio de 55,8±21,5 años; 50,3 % eran mujeres; 81,9 % recibían monoterapia y, 18,1 %, dos o más antipsicóticos. El orden de prescripción fue: atípicos, 77,1 %, y clásicos, 31,9 %. Los medicamentos más utilizados fueron: quetiapina (30,3 %), clozapina (23,7 %), levomepropamiza (18,4 %) y risperidona (14,9 %). Las combinaciones más frecuentes fueron: haloperidol más levomepromazina (n=67; 12,1 % de las asociaciones), clozapina más pipotiazina (n=54; 9,7 %) clozapina más risperidona (n=45; 8,1 %), quetiapina más levomepromazina (n=40; 7,2 %). Los medicamentos prescritos concomitantemente más frecuentes fueron: antidepresivos (n=998; 32,5 %); ansiolíticos (n=799; 26,0 %); hipolipemiantes (n=672; 21,9 %); antiparkinsonianos (341; 11,1 %) y antidiabéticos (n=327; 10,6 %). Conclusiones. Predominan los hábitos de prescripción de medicamentos de alto valor terapéutico, principalmente en la monoterapia antipsicótica. En la mayoría, se emplean en dosis superiores a las recomendadas. Se plantea la necesidad de diseñar estrategias educativas para corregir algunos hábitos de prescripción e investigaciones que evalúen la efectividad del tratamiento.Palabras clave: esquizofrenia, prescripciones de medicamentos, antipsicóticos, clozapina, haloperidol, farmacoepidemiología, Colombia. doi: http://dx.doi.org/10.7705/biomedica.v33i3.1529 Antipsychotic prescription patterns in patients affiliated to the Social Security Health System in ColombiaIntroduction: Schizophrenia alters individual perception, thought, affection and behavior. Drug therapy can improve these manifestations. Objective: To determine prescription patterns of antipsychotic drugs in a group of patients affiliated to the Social Security Health System in Colombia. Materials and methods:This was a descriptive study with a 6.2 million people database. We selected 3,075 patients medicated with antipsychotics, of both sexes, and all ages, with continuous treatment from March to June, 2012, and residing in 57 Colombian cities. We designed a database on drug consumption, obtained by the company that distributes the drugs to the patients. Results: A total of 3,075 patients were studied, with an age mean of 55.8 ± 21.5 years; 50.3% of the participants were women. Of all pa...

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Antipsychotic Polypharmacy in Schizophrenia. How to Counteract This Common Practice?

Suzuki

Uchida

Watanabe

et al. 2012

Polypharmacy in Psychiatry Practice, Volume II

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Explicit versus implicit review to explore combination antipsychotic prescribing

Cited by 9 publications

References 47 publications

Antipsychotic prescribing for vulnerable populations: a clinical audit at an acute Australian mental health unit at two-time points

Antipsychotic prescribing for vulnerable populations: a clinical audit at an acute Australian mental health unit at two-time points

Patrones de prescripción de antipsicóticos en pacientes afiliados al Sistema de Seguridad Social en Salud de Colombia

Antipsychotic Polypharmacy in Schizophrenia. How to Counteract This Common Practice?

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