Psychopharmacological Treatment in Older People: Avoiding Drug Interactions and Polypharmacy

Kratz, Torsten; Diefenbacher, Albert

doi:10.3238/arztebl.2019.0508

Cited by 28 publications

(28 citation statements)

References 62 publications

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“…1 Pharmacotherapy is also essential for the treatment of mental and behavioural disorders, [2][3][4][5][6] where more than 130 different drugs with proven efficacy are currently available. 7 The combination of multiple drugs is required in many clinical situations, 8 but this is associated with an increased risk of drug-drug interactions (DDI), 9 which enhances the risk of adverse drug reactions (ADR). 10 The simultaneous use of five or more different pharmaceuticals is defined as polypharmacy.…”

Section: Introductionmentioning

confidence: 99%

Predicting the risk of drug–drug interactions in psychiatric hospitals: a retrospective longitudinal pharmacovigilance study

et al. 2021

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ObjectivesThe aim was to use routine data available at a patient’s admission to the hospital to predict polypharmacy and drug–drug interactions (DDI) and to evaluate the prediction performance with regard to its usefulness to support the efficient management of benefits and risks of drug prescriptions.DesignRetrospective, longitudinal study.SettingWe used data from a large multicentred pharmacovigilance project carried out in eight psychiatric hospitals in Hesse, Germany.ParticipantsInpatient episodes consecutively discharged between 1 October 2017 and 30 September 2018 (year 1) or 1 January 2019 and 31 December 2019 (year 2).Outcome measuresThe proportion of rightly classified hospital episodes.MethodsWe used gradient boosting to predict respective outcomes. We tested the performance of our final models in unseen patients from another calendar year and separated the study sites used for training from the study sites used for performance testing.ResultsA total of 53 909 episodes were included in the study. The models’ performance, as measured by the area under the receiver operating characteristic, was ‘excellent’ (0.83) and ‘acceptable’ (0.72) compared with common benchmarks for the prediction of polypharmacy and DDI, respectively. Both models were substantially better than a naive prediction based solely on basic diagnostic grouping.ConclusionThis study has shown that polypharmacy and DDI can be predicted from routine data at patient admission. These predictions could support an efficient management of benefits and risks of hospital prescriptions, for instance by including pharmaceutical supervision early after admission for patients at risk before pharmacological treatment is established.

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Section: Introductionmentioning

confidence: 99%

Predicting the risk of drug–drug interactions in psychiatric hospitals: a retrospective longitudinal pharmacovigilance study

et al. 2021

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“…The possibly slower response in older patients might explain why the time to change IAD in our study was longer in older individuals. In addition, since polypharmacy is much more common in older patients, it is understandable that clinicians could be more reluctant to prescribe yet another drug, and it seems wise to wait longer before having to combine ADs or augment the AD medication with an antipsychotic drug [ 25 , 26 ]. This goes in line with international guidelines recommending monotherapy in older patients with MDD [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Prevalence, median time, and associated factors with the likelihood of initial antidepressant change: a cross-sectional study in Qatar

et al. 2021

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Background Major Depressive Disorder (MDD) requires therapeutic interventions during the initial month after being diagnosed for better disease outcomes. International guidelines recommend a duration of 4–12 weeks for an initial antidepressant (IAD) trial at an optimized dose to get a response. If depressive symptoms persist after this duration, guidelines recommend switching, augmenting, or combining strategies as the next step. Premature discontinuation of IAD due to ineffectiveness can cause unfavorable consequences. We aimed to determine the prevalence and the patterns of strategies applied after an IAD was changed because of a suboptimal response as a primary outcome. Secondary outcomes included the median survival time on IAD before any change; and the predictors that were associated with IAD change. Methods This was a retrospective study conducted in Mental Health Services in Qatar. A dataset between January 1, 2018, and December 31, 2019, was extracted from the electronic health records. Inclusion and exclusion criteria were defined and applied. The sample size was calculated to be at least 379 patients. Descriptive statistics were reported as frequencies and percentages, in addition, to mean and standard deviation. The median time of IAD to any change strategy was calculated using survival analysis. Associated predictors were examined using several cox regression models. Results A total of 487 patients met the inclusion criteria of the study, 431 (88%) of them had an occurrence of IAD change to any strategy before end of the study. Almost half of the sample (212 (49%); 95% CI [44–53%]) had their IAD changed less than or equal to 30 days. The median time to IAD change was 43 days with 95% CI [33.2–52.7]. The factors statistically associated with higher hazard of IAD change were: younger age, un-optimization of the IAD dose before any change, and comorbid anxiety. Conclusions Because almost half of the patients in this study changed their IAD as early as within the first month, efforts to avoid treatment failure are needed to ensure patient-treatment targets are met. Our findings offered some clues to help clinicians identify the high-risk predictors of short survival and subsequent failure of IAD.

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“…As microglia-specific direct conversion protocols and adaption of these cells into organoids advance, this will provide a unique opportunity to understand how the aging process impacts them and how neurotransmitters and psychiatric drugs would influence their immunophenotype. This is important as aberrant neurotransmitter changes mediated by psychiatric medications can be caused by age-related neurophysiological changes such as declines in neuronal density and neurotransmitter synthesis ( Kratz and Diefenbacher, 2019 ). What is also very exciting about direct conversion is the preservation of cellular epigenetic profiles ( Huh et al., 2016 ; Tang et al., 2017 ) that are erased in pluripotent cells ( Lo Sardo et al., 2017 ).…”

Section: Human-relevant Cell Model Systems For Understanding Basic Immunopharmacology Of Neurotransmitters and Psychiatric Drugsmentioning

confidence: 99%

Targeting neurotransmitter-mediated inflammatory mechanisms of psychiatric drugs to mitigate the double burden of multimorbidity and polypharmacy

Matt

2021

Brain, Behavior, & Immunity - Health

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The increased incidence of multimorbidities and polypharmacy is a major concern, particularly in the growing aging population. While polypharmacy can be beneficial, in many cases it can be more harmful than no treatment, especially in individuals suffering from psychiatric disorders, who have elevated risks of multimorbidity and polypharmacy. Age-related chronic inflammation and immunopathologies might contribute to these increased risks in this population, but the optimal clinical management of drug-drug interactions and the neuro-immune mechanisms that are involved warrants further investigation. Given that neurotransmitter systems, which psychiatric medications predominantly act on, can influence the development of inflammation and the regulation of immune function, it is important to better understand these interactions to develop more successful strategies to manage these comorbidities and complicated polypharmacy. I propose that expanding upon research in translationally relevant human in vitro models, in tandem with other preclinical models, is critical to defining the neurotransmitter-mediated mechanisms by which psychiatric drugs alter immune function. This will define more precisely the interactions of psychiatric drugs and other immunomodulatory drugs, used in combination, enabling identification of novel targets to be translated into more efficacious diagnostic, preventive, and therapeutic interventions. This interdisciplinary approach will aid in better precision polypharmacy for combating adverse events associated with multimorbidity and polypharmacy in the future.

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Psychopharmacological Treatment in Older People: Avoiding Drug Interactions and Polypharmacy

Cited by 28 publications

References 62 publications

Predicting the risk of drug–drug interactions in psychiatric hospitals: a retrospective longitudinal pharmacovigilance study

Predicting the risk of drug–drug interactions in psychiatric hospitals: a retrospective longitudinal pharmacovigilance study

Prevalence, median time, and associated factors with the likelihood of initial antidepressant change: a cross-sectional study in Qatar

Targeting neurotransmitter-mediated inflammatory mechanisms of psychiatric drugs to mitigate the double burden of multimorbidity and polypharmacy

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