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Corvaisier M, Brangier A, Annweiler C, Spiesser-Robelet L. Preventable or potentially inappropriate psychotropics and adverse health outcomes in older adults: systematic review and meta-analysis. J Nutr Health Aging 2024; 28:100187. [PMID: 38341965 DOI: 10.1016/j.jnha.2024.100187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 01/31/2024] [Accepted: 01/31/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVE To systematically review and quantitatively synthetize evidence on the use of PIPs linked to adverse health outcomes in older adults. METHODS A Medline, Embase® and Opengrey libraries search was conducted from 2004 to February 2021, using the PICO model: older people, psychotropic drugs, inappropriate prescribing, and adverse drug events. Fixed-effects and random-effects meta-analysis were performed from 3 eligible studies using an inverse-variance method. RESULTS Of the 1943 originally identified abstracts, 106 met the inclusion criteria and 7 studies were included in this review. All were of good quality. The number of participants ranged from 318 to 383,150 older adults (54.5-74.4% women). Associations were found between PIPs use and decreased personal care activities of daily living (ADL), unplanned hospitalizations, falls and mortality. In the pooled analysis, association with falls was confirmed (1.23 [95%CI: 1.15;1.32]). CONCLUSIONS Participants of 65 years and older treated with PIPs were more at risk of adverse health outcomes than those using no PIPs, including greater risks of falls, functional disabilities, unplanned hospitalizations, and mortality. Results of the present systematic review and meta-analysis provide additional evidence for an appropriate and safe use of psychotropics in older adults.
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Affiliation(s)
- Mathieu Corvaisier
- UNIV ANGERS, School of Pharmacy, Health Faculty, University of Angers, 49045 Angers, France; UNIV ANGERS, EA4638, University of Angers, 49100 Angers, France; Department of Geriatric Medicine, Research Center on Autonomy and Longevity, University Hospital, 49933 Angers, France; Department of Pharmacy, Angers University Hospital, 49933 Angers, France.
| | - Antoine Brangier
- Department of Geriatric Medicine, Research Center on Autonomy and Longevity, University Hospital, 49933 Angers, France
| | - Cédric Annweiler
- UNIV ANGERS, EA4638, University of Angers, 49100 Angers, France; Department of Geriatric Medicine, Research Center on Autonomy and Longevity, University Hospital, 49933 Angers, France; UNIV ANGERS, School of Medicine, Health Faculty, University of Angers, 49045 Angers, France; Gerontopôle of Pays de la Loire, 44000 Nantes, France
| | - Laurence Spiesser-Robelet
- UNIV ANGERS, School of Pharmacy, Health Faculty, University of Angers, 49045 Angers, France; Department of Pharmacy, Angers University Hospital, 49933 Angers, France; EA 3412 Health Education and Promotion Laboratory, University of Sorbonne Paris Nord, 93017 Bobigny, France
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Koomen L, van de Meent I, Elferink F, Wilting I, Cahn W. Prevalence and predictors of inappropriate prescribing in outpatients with severe mental illness. Ther Adv Psychopharmacol 2023; 13:20451253231211576. [PMID: 38022837 PMCID: PMC10666674 DOI: 10.1177/20451253231211576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Background Potentially inappropriate prescribing (PIP) is frequent in geriatrics and results in an increased risk for adverse effects, morbidity, mortality and reduced quality of life. Research on PIP in psychiatry has mainly focused on elderly patients and inpatients. Objectives To determine the prevalence and the predictors of PIP of psychotropic medication in outpatients with severe mental illness. Design This study is part of the Muva study, a pragmatic open Stepped Wedge Cluster Randomized Trial of a physical activity intervention for patients (age ⩾ 16 years) with severe mental illness. Methods A structured medication interview, questionnaires on social functioning, quality of life and psychiatric symptoms, and BMI and waist circumference measurements were performed followed by a structured medication review. Patients were divided into groups: PIP versus no PIP. Between-group differences were calculated and a multivariate binary logistic regression was performed to examine predictors for PIP. A receiver operating characteristics analysis was performed to determine the area under the curve (AUC). Results In 75 patients, an average of 5.2 medications of which 2.5 psychotropic medication was used. 35 (46.7%) patients were identified with PIP. Unindicated long-term benzodiazepine use was the most frequently occurring PIP (34.1%). Predictors of PIP were female gender [odds ratio (OR) = 4.88, confidence interval (CI) = 1.16-20.58, p = 0.03], number of medications (OR = 1.41, CI = 1.07-1.86, p = 0.02) and lower social functioning (OR = 1.42, CI = 1.01-2.00, p = 0.05). The AUC was 0.88 for the combined prediction model. Conclusion The prevalence of PIP of psychotropic medication in outpatients with severe mental illness is high. It is therefore important to identify, and where possible, resolve PIP by frequently performing a medication review with specific attention to females, patients with a higher number of medications and patients with lower social functioning. Trial registration This trial was registered in The Netherlands Trial Register (NTR) as NTR NL9163 on 20 December 2020 (https://trialsearch.who.int/Trial2.aspx?TrialID=NL9163).
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Affiliation(s)
- Lisanne Koomen
- UMC Utrecht, Psychiatry, Heidelberglaan 100, Utrecht, 3584CX, The Netherlands
| | | | | | | | - Wiepke Cahn
- UMC Utrecht, Psychiatry, Utrecht, The Netherlands
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Yaghi G, Chahine B. Potentially inappropriate medications use in a psychiatric elderly care hospital: A cross-sectional study using Beers criteria. Health Sci Rep 2023; 6:e1247. [PMID: 37234198 PMCID: PMC10206279 DOI: 10.1002/hsr2.1247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/27/2023] [Accepted: 04/22/2023] [Indexed: 05/27/2023] Open
Abstract
Background and Aims Potentially inappropriate medications (PIMs) carry risks that outweigh any potential benefits when compared to safer or more effective alternative treatments. Adverse drug events are more likely to occur in older adults with psychiatric diseases due to multimorbidity, polypharmacy, and age-related changes in drug pharmacokinetics and pharmacodynamics. The aim of this study was to assess the prevalence and risk factors of PIM use in an aged care hospital's psychogeriatric division, using the American Geriatrics Society Beers criteria 2019. Methods This cross-sectional study was conducted on all current inpatients, having a mental disorder and aged ≥65 years, in one elderly care hospital in Beirut, from March to May 2022. Medications, sociodemographic and clinical characteristics were collected from patients' medical records. PIMs were evaluated based on Beers criteria 2019. Independent variables were described using descriptive statistics. Factors associated with PIM use were identified by bivariate analysis followed by binary logistic regression. A two-sided p value <0.05 was considered statistically significant. Results The study included 147 patients, with a mean age of 76.3 years, 46.9% of them having schizophrenia, 68.7% using 5 or more drugs and 90.5% taking at least 1 PIM. The most prescribed PIMs were antipsychotics (40.2%), anticholinergics (16%), and antidepressants (7.8%). PIM use was significantly associated with polypharmacy (AOR = 20.88, 95% CI: 1.22-357.87, p = 0.04) and anticholinergic cognitive burden (ACB) score (AOR = 7.25, 95% CI: 1.13-46.52, p = 0.04). Conclusion PIMs were highly prevalent among hospitalized Lebanese psychiatric elderly. Polypharmacy and ACB score were the determinants of PIM use. A multidisciplinary medication review led by a clinical pharmacist could reduce PIM use.
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Affiliation(s)
- Gracia Yaghi
- School of PharmacyLebanese International UniversityBeirutLebanon
| | - Bahia Chahine
- School of PharmacyLebanese International UniversityBeirutLebanon
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Burke A, O'Driscoll M, Crowley EK, Dhubhlaing CN. Implementation and evaluation of STOPP/START criteria to address polypharmacy in older adults in an inpatient psychiatric setting. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 9:100245. [PMID: 37065779 PMCID: PMC10091114 DOI: 10.1016/j.rcsop.2023.100245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 02/13/2023] [Accepted: 03/14/2023] [Indexed: 03/29/2023] Open
Abstract
Background There is a scarcity of research in applying the Screening Tool of Older Person's Prescriptions/Screening Tool to Alert to Right Treatment (STOPP/START) criteria to older adults admitted to a psychiatric hospital. Objectives The primary aim of this study was to determine the extent of polypharmacy in older adults admitted to a psychiatric hospital and to assess the number of STOPP/START triggers detected and recommended by pharmacists. Secondary objectives include evaluating if the STOPP/START criteria is a useful tool to improve prescribing in this setting by assessing the implementation rates of STOPP/START triggers. Methods This was a prospective, longitudinal study in a psychiatry inpatient setting. Data were collected over a 7-week period. Explicit informed consent was obtained from participants. Medication reconciliation was completed and participants' medications were reviewed using STOPP/START criteria. The number of STOPP/START triggers detected, recommended and implemented was recorded. Results Sixty-two patients were included in the study. Ninety-four percent were prescribed ≥5 medications and 55% were prescribed ≥10 medications on admission. The mean number of medications prescribed per patient increased from 10 on admission to 12 at follow-up. Of 174 Potential Inappropriate Medications (PIMs) detected, 41% were recommended for review and, of these only 31% were implemented. 27% of the 77 Potential Prescribing Omissions (PPOs) detected were recommended for review and only 23% of those were implemented. Conclusion STOPP/START did not reduce the prevalence of polypharmacy in this setting. The implementation rates observed in this study were much lower than those observed in non-psychiatric settings.
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Potential Risk Factors of Drug-Related Problems in Hospital-Based Mental Health Units: A Systematic Review. Drug Saf 2023; 46:19-37. [PMID: 36369457 PMCID: PMC9829611 DOI: 10.1007/s40264-022-01249-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Reducing the occurrence of drug-related problems is a global health concern. In mental health hospitals, drug-related problems are common, leading to patient harm, and therefore understanding their potential risk factors is key for guiding future interventions designed to minimise their frequency. OBJECTIVE The aim of this systematic review was to explore the potential risk factors of drug-related problems in mental health inpatient units. METHODS Six databases were searched between 2000 and 2021 to identify studies that investigated the potential risk factors of drug-related problems in adults hospitalised in mental health inpatient units. Data extraction was performed by two authors independently and Allan and Barker's criteria were used for study quality assessment. Studies were categorised based on drug-related problem types and potential risk factors were stratified as patient, medication, and hospital related. RESULTS A total of 22 studies were included. Studies mostly originated in Europe (n = 19/22, 86.4%), and used a multivariable logistic regression to identify potential risk factors (n = 13, 59%). Frequently investigated factors were patient age (n = 14/22), sex (n = 14/22) and the number of prescribed medications (n = 14/22). Of these, increasing the number of prescribed medications was the only factor consistently reported to be significantly associated with the occurrence of most types of drug-related problems (n = 11/14). CONCLUSIONS A variety of patient, medication and hospital-related potential risk factors of drug-related problems in mental health inpatient units were identified. These factors could guide the development of interventions to reduce drug-related problems such as pharmaceutical screening tools to identify high-risk patients for timely interventions. Future studies could test a wider range of possible factors associated with drug-related problems using standardised approaches. CLINICAL TRIAL REGISTRATION PROSPERO: CRD42021279946.
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Delusional Disorder in Old Age: A Hypothesis-Driven Review of Recent Work Focusing on Epidemiology, Clinical Aspects, and Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137911. [PMID: 35805570 PMCID: PMC9265728 DOI: 10.3390/ijerph19137911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 11/17/2022]
Abstract
The theme, strength, and duration of a delusion are considered important in distinguishing one psychosis of old age from another. Research results, however, are mostly based on studies conducted on one form of psychosis, namely schizophrenia. The aim of this hypothesis-driven narrative review is to gather clinically important information about the psychosis identified as delusional disorder (DD), as it affects persons of senior age. We hypothesized that DD becomes relatively prevalent in old age, especially in women; and that it is associated with demonstrable brain changes, which, in turn, are associated with cognitive defects and poor pharmacological response, thus increasing the risk of aggression and suicide. Computerized searches in PubMed and ClinicalTrials.gov were conducted using the following search terms: (delusional disorder) AND (elderly OR old OR aged OR psychogeriatrics). A total of 16 recent studies (including case reports) were reviewed. Our hypotheses could not be definitively confirmed because research evidence is lacking. In order to improve eventual outcomes, our literature search demonstrates the need for more targeted, well-designed studies.
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Kirilochev OO. Assessment of Drug Therapy in Psychiatric Elderly Patients Based on the Beers Criteria of the American Geriatrics Society. ADVANCES IN GERONTOLOGY 2020. [DOI: 10.1134/s2079057020040098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Torres-Bondia F, de Batlle J, Galván L, Buti M, Barbé F, Piñol-Ripoll G. Trends in the consumption rates of benzodiazepines and benzodiazepine-related drugs in the health region of Lleida from 2002 to 2015. BMC Public Health 2020; 20:818. [PMID: 32487058 PMCID: PMC7268471 DOI: 10.1186/s12889-020-08984-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 05/24/2020] [Indexed: 12/16/2022] Open
Abstract
Background The high prevalence and long-term use of benzodiazepines (BZDs) treatment are debated topics because of the risk they can cause to the patients. Despite the current information on the risk-benefit balance of these drugs, their consumption remains particularly high. We determined the trend in the consumption prevalence of benzodiazepines (BZDs) and drugs related to BZDs (Z-drugs) in the population of the Health Region of Lleida to explore patterns of use and the associated characteristics associated between 2002 and 2015. Methods An analysis of secular trends was carried out between 2002 and 2015; the databased included all individuals from the Health Region of Lleida, which had 358,157 inhabitants in 2015, that consumed BZDs. The consumption of BZDs was evaluated using prescription billing data from the Public Health System. All types of BZDs and BZD analogues that had been approved by the drug agency were included. Trends by age and sex were investigated. Results Over the whole study period, a total of 161,125 individuals accounted for 338,148 dispensations. Overall, 59% were women, and the mean age was 56 years. The dispensing prevalence of BZDs use in 2015 was 14.2% overall —18.8% in women and 9.6% in men—and was 36% in those over 65 years. According to the half-life of BZDs, the prevalence of short-intermediate BZD use, intermediate-long BZD use, and Z-drugs use was 9.7, 5.5 and 0.8%, respectively. The evolution of the annual prevalence of BZD dispensing showed a progressive decline, from 15.3% in 2002 to 14.2% in 2015, which was attributed to a decrease in the consumption of intermediate-long half-life BZDs (8.0% vs. 5.5%) and Z-drugs (1.4% vs. 0.8%). Conclusion The dispensing prevalence of BZDs and Z-drugs was high, although a small reduction was observed during this time period. The dispensing prevalence was especially high in the population over 65, despite the risk of cognitive decline and falls. Integral actions are required to lower the BZD prescription rate.
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Affiliation(s)
- F Torres-Bondia
- Pharmacy Department, Clinical Neuroscience Research, IRBLleida, Arnau de Vilanova University Hospital, Lleida, Spain
| | - J de Batlle
- Biomedical Research Networking Center in Respiratory Diseases (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, CIBERES), Madrid, Spain.,Group of Translational Research in Respiratory Medicine, Arnau de Vilanova University Hospital and Santa Maria University Hospital, IRBLleida, Lleida, Spain
| | - L Galván
- Pharmacy Department, Servei Català de la Salut (Catalan Health Services), Lleida, Spain
| | - M Buti
- Unitat d'Avaluació Clínica (Clinical Evaluation Unit), Institut Català de la Salut (Catalan Institute of Health), Lleida, Spain
| | - F Barbé
- Biomedical Research Networking Center in Respiratory Diseases (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, CIBERES), Madrid, Spain.,Group of Translational Research in Respiratory Medicine, Arnau de Vilanova University Hospital and Santa Maria University Hospital, IRBLleida, Lleida, Spain
| | - G Piñol-Ripoll
- Unitat Trastorns Cognitius (Cognitive Disorders Unit), Clinical Neuroscience Research, IRBLleida, Santa Maria University Hospital, Rovira Roure n° 44, 25198, Lleida, Spain.
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Franchi C, Rossio R, Ardoino I, Mannucci PM, Nobili A. Inappropriate prescription of benzodiazepines in acutely hospitalized older patients. Eur Neuropsychopharmacol 2019; 29:871-879. [PMID: 31221501 DOI: 10.1016/j.euroneuro.2019.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/06/2019] [Accepted: 05/29/2019] [Indexed: 12/31/2022]
Abstract
Benzodiazepines (BDZs) are widely prescribed in older people. The aims of the study are to assess the prevalence of inappropriate prescription of BZDs and the associated factors in acutely hospitalized older patients. Patients aged 65 years or more hospitalized from 2010 to 2017 in more than 100 Italian internal medicine and geriatric wards in the frame of the REPOSI register were included if prescribed with BDZs at hospital admission or discharge. Appropriateness of prescription was assessed according to the 2015 Beers criteria and their modified French and German versions. Among 4681 patients discharged from hospital, 15% (N = 710) were discharged with BDZs, and 62% of them (N = 441, 95% CI: 58.5%-65.6%) were inappropriately prescribed, being prescribed with BDZ to be always avoided in the elderly (45%), at higher doses than recommended (31%) or with no appropriate clinical conditions (19%). From admission to discharge the prevalence of inappropriate BDZ prescription decreased by 4%, but 62% of patients inappropriately prescribed at admission were still inappropriately prescribed at discharge. Among the 179 patients first prescribed at the time of discharge, half were inappropriately prescribed. Being female (OR 1.32, 95%CI 0.95-1.85), enrolled in REPOSI during the years 2016 and 2017 (OR 1.94, 95%CI 1.10-3.39; OR 1.57, 95%CI 0.95-2.58) and living in nursing homes (OR 2.04, 95%CI 0.95-4.37) were associated with an increased risk to be inappropriately prescribed. This study shows a high prevalence of inappropriate use of BDZ in acutely hospitalized older patients both at hospital admission and discharge.
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Affiliation(s)
- C Franchi
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy.
| | - R Rossio
- Department of Pathophysiology and Transplantation, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - I Ardoino
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - P M Mannucci
- Scientific Direction, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - A Nobili
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
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Santos NSD, Marengo LL, Moraes FDS, Barberato Filho S. Interventions to reduce the prescription of inappropriate medicines in older patients. Rev Saude Publica 2019; 53:7. [PMID: 30726488 PMCID: PMC6390643 DOI: 10.11606/s1518-8787.2019053000781] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 04/06/2018] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE: Identify and critically evaluate systematic reviews addressing the effectiveness of interventions to reduce the number of prescriptions of potentially inappropriate medication to older patients. METHODS: This is an overview of systematic reviews. The studies were searched and selected from Medline, Cochrane Library, Embase, CINAHL, Virtual Health Library, and Web of Science databases, combining the terms aged, prescriptions, inappropriate prescribing and potentially inappropriate medication list with their entry terms and other related descriptors, published by June 2017. This study included systematic reviews with or without meta-analysis that addressed the effectiveness of any intervention or combined interventions to reduce the number of prescriptions of potentially inappropriate medications to older patients, without restriction in terms of design, language or date of publication of primary studies. AMSTAR – A MeaSurement Tool to Assess systematic Reviews – was used to evaluate the methodological quality of selected systematic reviews. Study selection and the methodological quality evaluation were performed by two independent evaluators, who resolved any divergence by consensus. The main findings were grouped into thematic categories, defined after a content analysis and discussed qualitatively as narrative synthesis. RESULTS: This study analyzed 24 systematic reviews. In terms of study design and methodological quality evaluation, most were systematic reviews of randomized controlled clinical trials and studies of moderate quality, respectively. The interventions were analyzed in five thematic categories: medication review services, pharmaceutical interventions, computerized systems, educational interventions, and others. The interventions analyzed showed good results and most of them helped reduce the number of prescriptions of potentially inappropriate medication to older patients. CONCLUSIONS: The systematic reviews included in this overview showed potential benefits of different interventions. However, it was not possible to determine the most effective intervention. Combined interventions are likely to provide better results than isolated interventions.
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Affiliation(s)
| | - Lívia Luize Marengo
- Universidade de Sorocaba. Programa de Pós-Graduação em Ciências Farmacêuticas. Sorocaba, SP, Brasil
| | - Fabio da Silva Moraes
- Universidade de Sorocaba. Programa de Pós-Graduação em Ciências Farmacêuticas. Sorocaba, SP, Brasil
| | - Silvio Barberato Filho
- Universidade de Sorocaba. Programa de Pós-Graduação em Ciências Farmacêuticas. Sorocaba, SP, Brasil
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Deprescribing Benzodiazepines in Older Patients: Impact of Interventions Targeting Physicians, Pharmacists, and Patients. Drugs Aging 2018; 35:493-521. [PMID: 29705831 DOI: 10.1007/s40266-018-0544-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Benzodiazepines (BZDs; including the related Z-drugs) are frequently targets for deprescribing; long-term use in older people is harmful and often not beneficial. BZDs can result in significant harms, including falls, fractures, cognitive impairment, car crashes and a significant financial and legal burden to society. Deprescribing BZDs is problematic due to a complex interaction of drug, patient, physician and systematic barriers, including concern about a potentially distressing but rarely fatal withdrawal syndrome. Multiple studies have trialled interventions to deprescribe BZDs in older people and are discussed in this narrative review. Reported success rates of deprescribing BZD interventions range between 27 and 80%, and this variability can be attributed to heterogeneity of methodological approaches and limited generalisability to cognitively impaired patients. Interventions targeting the patient and/or carer include raising awareness (direct-to-consumer education, minimal interventions, and 'one-off' geriatrician counselling) and resourcing the patient (gradual dose reduction [GDR] with or without cognitive behavioural therapy, teaching relaxation techniques, and sleep hygiene). These are effective if the patient is motivated to cease and is not significantly cognitively impaired. Interventions targeted to physicians include prescribing interventions by audit, algorithm or medication review, and providing supervised GDR in combination with medication substitution. Pharmacists have less frequently been the targets for studies, but have key roles in several multifaceted interventions. Interventions are evaluated according to the Behaviour Change Wheel. Research supports trialling a stepwise approach in the cognitively intact older person, but having a low threshold to use less-consultative methods in patients with dementia. Several resources are available to support deprescribing of BZDs in clinical practice, including online protocols.
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Fond G, Boyer L, Andrianarisoa M, Godin O, Bulzacka E, Berna F, Brunel L, Coulon N, Aouizerate B, Capdevielle D, Chereau I, D'amato T, Denizot H, Dubertret C, Dubreucq J, Faget C, Leignier S, Mallet J, Misdrahi D, Rey R, Lancon C, Passerieux C, Schandrin A, Urbach M, Vidailhet P, Leboyer M, Schurhoff F, Llorca PM. Self-reported pain in patients with schizophrenia. Results from the national first-step FACE-SZ cohort. Prog Neuropsychopharmacol Biol Psychiatry 2018; 85:62-68. [PMID: 29678770 DOI: 10.1016/j.pnpbp.2018.04.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/11/2018] [Accepted: 04/15/2018] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Little is known about perception of physical pain in schizophrenia (SZ). Some studies have suggested that patients with SZ may have an increased pain threshold, while others have suggested that patients with SZ may suffer from undetected and untreated high physical pain levels. The objectives of this study were (i) to investigate the prevalence of self-reported physical pain in stabilized SZ subjects, and (ii) to determine whether physical pain was associated with psychiatric characteristics and somatic comorbidities (iii) to determine whether antidepressants and benzodiazepine administration were associated with lower self-reported pain. METHOD 468 community-dwelling stable SZ subjects (73% men, mean aged 32 years) were recruited in the Schizophrenia Expert Center national network. Patients with moderate to extreme pain, assessed with the EQ5D-5L questionnaire, were classified as belonging to the "pain group". RESULTS 104 (22.2%) reported moderate to extreme pain levels. In multivariate analysis, pain has been associated with headache (OR = 2.63 [1.04-6.63], p = 0.04), higher anxiety (OR = 1.61 [1.18-2.21], p = 0.003), higher current depressive symptoms (OR = 1.09 [1.01-1.17], p = 0.03), history of childhood trauma (1.03 [1.01-1.06], p = 0.01) and older age (OR = 1.04 [1.01-1.07], p = 0.03), independently of current psychotic severity, sociodemographic variables, antipsychotic, antidepressant and benzodiazepine treatments. No association with addictive behaviors or illness characteristics has been found. CONCLUSION The present findings suggest that community-dwelling SZ outpatients report a high rate of self-reported physical pain, associated with headache, depression and anxiety and history of childhood trauma. Physical pain should be systematically assessed and specifically treated, when needed, in patients with SZ.
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Affiliation(s)
- Guillaume Fond
- Fondation FondaMental, Créteil, France; Aix-Marseille Univ, School of MEDICINE - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13005 Marseille, France.
| | - Laurent Boyer
- Fondation FondaMental, Créteil, France; Aix-Marseille Univ, School of MEDICINE - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13005 Marseille, France
| | - Meja Andrianarisoa
- Fondation FondaMental, Créteil, France; INSERM U955, Translational Psychiatry Team, Créteil, France; Paris Est University, DHU Pe-PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France
| | - Ophelia Godin
- Fondation FondaMental, Créteil, France; Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013 Paris, France; INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013 Paris, France
| | - Ewa Bulzacka
- Fondation FondaMental, Créteil, France; INSERM U955, Translational Psychiatry Team, Créteil, France; Paris Est University, DHU Pe-PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France
| | - Fabrice Berna
- Fondation FondaMental, Créteil, France; Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Lore Brunel
- Fondation FondaMental, Créteil, France; INSERM U955, Translational Psychiatry Team, Créteil, France; Paris Est University, DHU Pe-PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France
| | - Nathalie Coulon
- Fondation FondaMental, Créteil, France; INSERM U955, Translational Psychiatry Team, Créteil, France; Paris Est University, DHU Pe-PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France
| | - Bruno Aouizerate
- Fondation FondaMental, Créteil, France; Centre Hospitalier Charles Perrens, Université de Bordeaux, F-33076 Bordeaux, France; Inserm, Neurocentre Magendie, Physiopathologie de la Plasticité Neuronale, U862, F-33000 Bordeaux, France
| | - Delphine Capdevielle
- Fondation FondaMental, Créteil, France; Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, Université Montpellier 1, Inserm, 1061, Montpellier, France
| | - Isabelle Chereau
- Fondation FondaMental, Créteil, France; CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69 63003 Clermont-Ferrand Cedex 1, France
| | - Thierry D'amato
- Fondation FondaMental, Créteil, France; Université Claude Bernard Lyon 1, Centre Hospitalier Le Vinatier, Pole Est, BP 300 39-95 bd Pinel, 69678 Bron Cedex, France
| | - Hélène Denizot
- Fondation FondaMental, Créteil, France; CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69 63003 Clermont-Ferrand Cedex 1, France
| | - Caroline Dubertret
- Fondation FondaMental, Créteil, France; AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, Inserm U894, Université Paris Diderot, Sorbonne Paris Cité, Faculté de médecine, France
| | - Julien Dubreucq
- Fondation FondaMental, Créteil, France; Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France
| | - Catherine Faget
- Fondation FondaMental, Créteil, France; Assistance Publique des Hôpitaux de Marseille (AP-HM), pôle universitaire de psychiatrie, Marseille, France
| | - Sylvain Leignier
- Fondation FondaMental, Créteil, France; Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France
| | - Jasmina Mallet
- Fondation FondaMental, Créteil, France; AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, Inserm U894, Université Paris Diderot, Sorbonne Paris Cité, Faculté de médecine, France
| | - David Misdrahi
- Fondation FondaMental, Créteil, France; Centre Hospitalier Charles Perrens, Université de Bordeaux, F-33076 Bordeaux, France; CNRS UMR 5287-INCIA, France
| | - Romain Rey
- Fondation FondaMental, Créteil, France; Université Claude Bernard Lyon 1, Centre Hospitalier Le Vinatier, Pole Est, BP 300 39-95 bd Pinel, 69678 Bron Cedex, France
| | - Christophe Lancon
- Fondation FondaMental, Créteil, France; Assistance Publique des Hôpitaux de Marseille (AP-HM), pôle universitaire de psychiatrie, Marseille, France
| | - Christine Passerieux
- Fondation FondaMental, Créteil, France; Service de psychiatrie d'adulte, Centre Hospitalier de Versailles, UFR des Sciences de la Santé Simone Veil, Université Versailles Saint-Quentin en Yvelines, Versailles, France
| | - Aurélie Schandrin
- Fondation FondaMental, Créteil, France; Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, Université Montpellier 1, Inserm, 1061, Montpellier, France
| | - Mathieu Urbach
- Fondation FondaMental, Créteil, France; Service de psychiatrie d'adulte, Centre Hospitalier de Versailles, UFR des Sciences de la Santé Simone Veil, Université Versailles Saint-Quentin en Yvelines, Versailles, France
| | - Pierre Vidailhet
- Fondation FondaMental, Créteil, France; Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Marion Leboyer
- Fondation FondaMental, Créteil, France; INSERM U955, Translational Psychiatry Team, Créteil, France; Paris Est University, DHU Pe-PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France
| | - Franck Schurhoff
- Fondation FondaMental, Créteil, France; INSERM U955, Translational Psychiatry Team, Créteil, France; Paris Est University, DHU Pe-PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France
| | - Pierre-Michel Llorca
- Fondation FondaMental, Créteil, France; CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69 63003 Clermont-Ferrand Cedex 1, France
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Najjar MF, Sulaiman SAS, Al Jeraisy M, Balubaid H. The impact of a combined intervention program: an educational and clinical pharmacist's intervention to improve prescribing pattern in hospitalized geriatric patients at King Abdulaziz Medical City in Riyadh, Saudi Arabia. Ther Clin Risk Manag 2018; 14:557-564. [PMID: 29588595 PMCID: PMC5859904 DOI: 10.2147/tcrm.s157469] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background There is a difference between evidence-based guidelines for geriatric patients and clinical practice of physicians. Prescribing potentially inappropriate medications (PIMs) can be attributed to the fact that many physicians are not aware of PIMs usage. Aim The aim of this study was to assess the effectiveness of a combined intervention program comprising an educational and clinical pharmacist intervention to reduce the incidence of PIMs among hospitalized geriatric patients. Methods This was a prospective pre-test versus post-test design study. The screening tool of older persons’ prescriptions, 2nd version, and 2015 American Geriatric Society Beers’ criteria were used to assess the appropriateness of medications prescribed for geriatric inpatients. The study was carried out in the medical wards of the Department of Medicine at King Abdulaziz Medical City in Riyadh, Saudi Arabia. Results Four hundred geriatric patients were enrolled in the study: 200 in a pre-intervention group (control) and 200 in the intervention group. After the combined intervention, the incidence rate of PIMs decreased significantly from 61% to 29.5% (p<0.001). Out of 317 recommendations given by the clinical pharmacist, the physicians accepted a total of 196 (61.83%) recommendations. The most common PIMs to avoid regardless of diagnosis of geriatric patients before interventions were first-generation antihistamines (46%), sliding scale insulin (18.5%), antipsychotics (6.5%), benzodiazepines (9.5%), and antiarrhythmic drugs (15%). Conclusion Using a combined intervention program that comprises an educational intervention of updated evidence-based guidelines and clinical pharmacist intervention would add a significant value to improve prescribing patterns in hospitalized geriatric patients.
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Affiliation(s)
- Muath Fahmi Najjar
- King Abdullah International Medical Research Centre, King Saud bin Abdulaziz University for Health Science, College of Pharmacy, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.,Pharmaceutical Sciences School, Clinical Pharmacy Discipline, Universiti Sains Malaysia, Penang, Malaysia
| | - Syed Azhar Syed Sulaiman
- Pharmaceutical Sciences School, Clinical Pharmacy Discipline, Universiti Sains Malaysia, Penang, Malaysia
| | - Majed Al Jeraisy
- King Abdullah International Medical Research Centre, King Saud bin Abdulaziz University for Health Science, College of Pharmacy, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Hashim Balubaid
- King Abdullah International Medical Research Centre, King Saud bin Abdulaziz University for Health Science, College of Medicine, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
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