Polypharmacy and high-dose antipsychotics at the time of discharge from acute psychiatric wards

Çilli

et al. 2017

CPEMH

Background:This study investigates the antipsychotic use patterns of patients with schizophrenia and its correlations in their daily drug use patterns.Methods:Patients with schizophrenia who have regular records at two different community counselling centres (CCS) were included in the study. Information about their medications and sociodemographic data was recorded through face-to-face interviews and supporting information about their drug use patterns was obtained from their relatives/caregivers/nurse. The Clinical Global Impression Scale (severity of illness) and the General Assessment of Functionality scales were also administered.Results:Patients with schizophrenia used 2.0 ± 0.81 antipsychotics daily and 3.52 ± 2.55 pills (1–18). Seventy-one percent of the patients used two or more kinds of psychotropic drugs. The most frequently used antipsychotics were quetiapine, a second generation antipsychotic, and haloperidol, a typical antipsychotic. Clinical severity, regular visits to a CCS and use of depot antipsychotics were independent predictors for polypharmacy.Conclusion:The rate of polypharmacy use is high in Turkey. There are multiple risk factors related with polipharmacy. New studies should focus risk factors for preventing polypharmacy.

Section: Discussionsupporting

confidence: 92%

Antipsychotic Use Pattern in Schizophrenia Outpatients: Correlates of Polypharmacy

Çilli

et al. 2017

CPEMH

“…Of concern, however, is that overall 20% of patients were prescribed a high antipsychotic dose, placing these patients at a higher risk of adverse effects. While there are variable definitions of ‘high dose,’ the prevalence of solely high-dose prescribing in this audit was higher than that of discharged patients from a UK psychiatric ward (6.8%) [ 50 ] and Hong Kong inpatients (9.2%) [ 47 ].…”

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

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.

Therapeutic Advances in Psychopharmacology

“…However, patients in this present study were all attendees in a specialist psychiatric hospital facility. Specialist or tertiary care facilities care for clientele that are usually more severely ill at baseline compared with those in general hospital settings [Sim et al 2004] warranting prescription of multiple antipsychotics which are retained even after symptoms remit [Tapp et al 2003;Tungaraza et al 2011].…”

Section: Discussionmentioning

confidence: 99%

“…2004] warranting prescription of multiple antipsychotics which are retained even after symptoms remit [Tapp et al . 2003; Tungaraza et al . 2011].…”

Section: Discussionmentioning

confidence: 99%

“…Factors associated with higher rates of APP among patients with schizophrenia include treatment resistance, 'arrested' medication switching, attempts at avoiding high-dose monotherapy, insomnia and utilization of antipsychotics in the control of acute exacerbations of psychosis [Langan and Shajahan, 2010]. Other reports have associated APP with in-patient care, severity of illness, physician preference and use of depot antipsychotic preparations [Xiang et al 2007;Gallego et al 2012;Tungaraza et al 2011].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Prevalence and correlates of antipsychotic polypharmacy among outpatients with schizophrenia attending a tertiary psychiatric facility in Nigeria

Igbinomwanhia

Olotu

James

2016