Polypharmacy in Psychiatry: Patterns of Differential Treatment

Merlis, Sidney; Sheppard, Charles; Collins, Lois; Fiorentino, Diane

doi:10.1176/ajp.126.11.1647

Cited by 33 publications

(12 citation statements)

References 2 publications

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“…Antipsychotic polypharmacy in Japan was largely due to the combination of first‐ and second‐generation drugs. Occasionally, polypharmacy resulted in the combination of up to seven or eight similar drugs, a practice that needs closer scrutiny 28 . With the introduction of second‐generation antipsychotic drugs, a review of the practice of high‐dose prescribing and antipsychotic polypharmacy is suggested 29 .…”

Section: Discussionmentioning

confidence: 99%

Antipsychotic drug prescription for schizophrenia in East Asia: rationale for change

Chong¹,

Tan

Fujii

et al. 2003

Psychiatry Clin Neurosci

134

118

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The purpose of this international collaborative study was to investigate the prescription patterns of antipsychotic drugs for schizophrenia in East Asia and to analyze factors that affect these patterns. Prescription patterns for patients admitted for treatment of schizophrenia were surveyed using a standardized protocol from six East-Asian region/countries: China, Hong Kong, Japan, Korea, Singapore and Taiwan. Patients' social and clinical characteristics, psychiatric symptoms, course of illness, and adverse effects of medications were systematically assessed and recorded. Prescriptions of the first-and second-generation antipsychotic drugs were compared. A total of 2399 patients were recruited. The second-generation drugs comprised 28.1% of all prescribed antipsychotics, and 46% of the antipsychotic prescriptions were in the context of polypharmacy. The mean dosage of antipsychotics for the whole sample was 675.3 + 645.1 mg chlorpromazine equivalents. Japan had a high frequency of prescribing high doses and polypharmacy; Singapore had a high utilization of depot injections while China had a higher prescription of clozapine. Using multiple logistic regression analysis, distinctions in the prescription patterns of antipsychotic drugs were found: first-generation drugs were mainly for controlling aggressive behavior, while second-generation drugs were targeted at the alleviation of positive, negative psychotic symptoms as well as disruptive behavior in schizophrenia. The present collaborative study highlighted differences in the prescription patterns, especially the under-utilization of second-generation antipsychotic drugs in East Asia. The pattern of antipsychotic medication use varied from country to country and is likely to be influenced by the prevailing health-care system, the availability and cost of the drugs.

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Section: Discussionmentioning

confidence: 99%

Antipsychotic drug prescription for schizophrenia in East Asia: rationale for change

Chong¹,

Tan

Fujii

et al. 2003

Psychiatry Clin Neurosci

134

118

View full text Add to dashboard Cite

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“…Previous studies showing successful reduction in polypharmacy have largely been uncontrolled and have focused on special populations, such as epileptic, 14,23–25,29 psychiatric, 26 , 27 , 30 or nursing home patients 9 , 19 , 20 . Two controlled trials involving outpatients have shown that simply providing physicians a list of their patients' current medications does not decrease the number of drugs prescribed 31 , 32 .…”

mentioning

confidence: 99%

Reducing Polypharmacy in the Elderly

Kroenke¹,

Pinholt²

1990

J American Geriatrics Society

119

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A prospective, controlled trial to reduce polypharmacy in patients 65 years or older was carried out in the residents' clinic of a teaching hospital. Of 272 elderly patients surveyed, 89 (33%) were taking five or more prescription drugs. Recommendations to discontinue medications or to simplify regimens were formulated for 79 polypharmacy patients. Compared to 41 controls, the 38 patients whose physicians were informed of the recommended changes demonstrated a small but significant reduction in the mean number of drugs, the complexity, and the cost of their regimens. Physicians complied with eight (100%) of eight recommendations to simplify a dosage schedule, eight (62%) of 13 recommendations to substitute a new drug for the old one, and only eight (40%) of 20 recommendations to stop a medication (P = .04). Noncompliance usually resulted from patient refusal or from medications being prescribed by another provider. Whereas feedback to the primary physician is beneficial, more substantial reductions in outpatient polypharmacy may require overcoming patient barriers and limiting the number of prescribing physicians.

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“…Use of only one psychoactive drug. This third guideline attempts to identify the primary drug the patient responds to, minimizes the potential adverse reactions of multiple drugs and maximizes patient compliance with drug therapy (Merliss et al, 1970).…”

Section: Introductionmentioning

confidence: 99%

Impact of team approach on reducing drug costs

Karki

Chandra²,

Holden

et al. 1988

Int J Geriat Psychiatry

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SUMMARYAfter partial success of traditional methods (closed formulary, use of generic drugs, retrospective drug usage review and continuing education) to reduce drug costs, a new-approach 'team approach' was tried. This involved a clinical pharmacist and psychiatrists jointly reviewing patient drug therapies in view of a previously agreed set of guidelines. These guidelines were formulated to optimize patient therapy after a thorough review of clinical pharmacology and pharmacokinetics of drugs and pathophysiology of different psychiatric disorders. Drug cost savings of 49% and 16% were achieved in two different wards. The clinical pharmacist's active involvement accounted for a difference of 33% between the two wards.K E Y worn-Costs, prescribing, psychogeriatric patients.

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Polypharmacy in Psychiatry: Patterns of Differential Treatment

Cited by 33 publications

References 2 publications

Antipsychotic drug prescription for schizophrenia in East Asia: rationale for change

Antipsychotic drug prescription for schizophrenia in East Asia: rationale for change

Reducing Polypharmacy in the Elderly

Impact of team approach on reducing drug costs

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