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Bahta M, Ogbaghebriel A, Russom M, Tesfamariam EH, Berhe T. Impact of adverse reactions to first-generation antipsychotics on treatment adherence in outpatients with schizophrenia: a cross-sectional study. Ann Gen Psychiatry 2021; 20:27. [PMID: 33894789 PMCID: PMC8070289 DOI: 10.1186/s12991-021-00348-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/14/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Antipsychotics are well-known to cause potentially serious and life-threatening adverse drug reactions (ADRs) that have been reported to be also one of the major reasons for non-adherence. In Eritrea, shortage of psychiatrists and physicians, inadequacy of laboratory setups and unavailability of second-generation antipsychotics in the national list of medicines would seem to amplify the problem. This study's objective is to determine the impact of adverse effects of first-generation antipsychotics on treatment adherence in outpatients with schizophrenia at Saint Mary Neuro-Psychiatric National Referral Hospital. METHODS A cross-sectional study design was employed. All eligible adult patients with diagnosed schizophrenia (n = 242) who visited the hospital during the study period were enrolled. Data on ADRs, adherence and other variables were collected from patients using a self-administered questionnaire, interview and through medical cards review. The collected variables were analyzed using SPSS 22.0 with descriptive and multivariable logistic regression analysis. Statistical significance was tested at p value < 0.05. RESULTS Greater than one-third (35.5%) of the patients with schizophrenia were non-adherent to treatment. The odds of non-adherence increased 1.06 times for each unit increase in the total ADR score (AOR = 1.06, 95% CI 1.04, 1.09). Patients with extrapyramidal (AOR = 44.69, 95% CI 5.98, 334.30), psychic (AOR = 14.90, 95% CI 1.90, 116.86), hormonal (AOR = 2.60, 95% CI 1.41, 4.80), autonomic (AOR = 3.23, 95% CI 1.37, 7.57) and miscellaneous reactions (AOR = 2.16, 95% CI 1.13, 4.13) were more likely to be non-adherent compared to their counterparts. CONCLUSION Poor treatment adherence was found to be substantial which was attributed to total ADR score, extrapyramidal, hormonal, psychic, autonomic and miscellaneous categories of reactions of the LUNSERS. To improve treatment adherence, early detection and management of adverse effects and inclusion of second-generation antipsychotics are recommended.
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Affiliation(s)
- Merhawi Bahta
- School of Pharmacy, Asmara College of Health Sciences, Asmara, Eritrea.
| | - Azieb Ogbaghebriel
- Department of Pharmaceutical Sciences, College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
| | - Mulugeta Russom
- Eritrean Pharmacovigilance Centre, National Medicines and Food Administration, Asmara, Eritrea
| | | | - Tzeggai Berhe
- Department of Addictions and Mental Health, University of Alberta, Edmonton, Canada.,Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
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Bahta M, Berhe T, Russom M, Tesfamariam EH, Ogbaghebriel A. Magnitude, Nature, and Risk Factors of Adverse Drug Reactions Associated with First Generation Antipsychotics in Outpatients with Schizophrenia: A Cross-Sectional Study. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2020; 9:205-217. [PMID: 33117667 PMCID: PMC7569056 DOI: 10.2147/iprp.s271814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/10/2020] [Indexed: 12/14/2022] Open
Abstract
Background ADRs to antipsychotics are amongst the major challenges in the treatment of patients with psychotic disorders. The extent of patient-reported ADRs assessed in many studies using standardized scales is found to be inconsistent. However, there is a paucity of such research in Eritrea. The aim of the study is therefore to determine the magnitude, nature, and the possible risk factors associated with ADRs of the first generation antipsychotics in outpatients with schizophrenia at Saint Mary Neuro-Psychiatric National Referral Hospital in Asmara, Eritrea, using the LUNSERS self-rating scale. Methods A cross-sectional, descriptive and analytical study design utilizing a quantitative approach was employed. Data were collected from patients' self-administered questionnaires, interviews, and medical records. The collected variables were analyzed using SPSS 22.0 with descriptive statistics, correlation, t-tests, ANOVA, and multiple regression. Statistical significance was tested at P-value<0.05. Results In this study, 93.8% of the research participants experienced at least one ADR. LUNSERS total mean score of the relevant items was 28.01 (SD=18.46) with 24.7% of the study participants scoring medium-to-high. The prevalence of the categories of ADRs was psychic (91.3%), autonomic (78.1%), extra-pyramidal (76.9%), miscellaneous (66.5%), hormonal (58.3%), anti-cholinergic (44.2%), and allergic reactions (44.2%). At multivariate level, factors significantly and positively associated with total ADR score were smoking (P=0.028) and being at secondary educational level (P=0.015). Conclusion There was high prevalence of ADRs with moderate-to-high overall ADR scores in a significant number of patients. The most frequently reported ADRs were psychic, autonomic, extra-pyramidal, hormonal, and miscellaneous. Smoking and secondary level of education were found to be the main determinants of ADRs.
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Affiliation(s)
- Merhawi Bahta
- School of Pharmacy, Asmara College of Health Sciences, Asmara, Eritrea
| | - Tzeggai Berhe
- Department of Addictions and Mental Health, University of Alberta, Edmonton, Canada
| | - Mulugeta Russom
- Eritrean Pharmacovigilance Centre, National Medicines and Food Administration, Asmara, Eritrea
| | - Eyasu H Tesfamariam
- Biostatistics and Epidemiology Unit, Department of Statistics, College of Science, Eritrean Institute Technology, Asmara, Eritrea
| | - Azieb Ogbaghebriel
- College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
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Reutfors J, Cesta CE, Cohen JM, Bateman BT, Brauer R, Einarsdóttir K, Engeland A, Furu K, Gissler M, Havard A, Hernandez-Diaz S, Huybrechts KF, Karlstad Ø, Leinonen MK, Li J, Man KKC, Pazzagli L, Schaffer A, Schink T, Wang Z, Yu Y, Zoega H, Bröms G. Antipsychotic drug use in pregnancy: A multinational study from ten countries. Schizophr Res 2020; 220:106-115. [PMID: 32295750 PMCID: PMC7306443 DOI: 10.1016/j.schres.2020.03.048] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/13/2020] [Accepted: 03/23/2020] [Indexed: 12/15/2022]
Abstract
AIM To compare the prevalence and trends of antipsychotic drug use during pregnancy between countries across four continents. METHODS Individually linked health data in Denmark (2000-2012), Finland (2005-2014), Iceland (2004-2017), Norway (2005-2015), Sweden (2006-2015), Germany (2006-2015), Australia (New South Wales, 2004-2012), Hong Kong (2001-2015), UK (2006-2016), and the US (Medicaid, 2000-2013, and IBM MarketScan, 2012-2015) were used. Using a uniformed approach, we estimated the prevalence of antipsychotic use as the proportion of pregnancies where a woman filled at least one antipsychotic prescription within three months before pregnancy until birth. For the Nordic countries, data were meta-analyzed to investigate maternal characteristics associated with the use of antipsychotics. RESULTS We included 8,394,343 pregnancies. Typical antipsychotic use was highest in the UK (4.4%) whereas atypical antipsychotic use was highest in the US Medicaid (1.5%). Atypical antipsychotic use increased over time in most populations, reaching 2% in Australia (2012) and US Medicaid (2013). In most countries, prochlorperazine was the most commonly used typical antipsychotic and quetiapine the most commonly used atypical antipsychotic. Use of antipsychotics decreased across the trimesters of pregnancy in all populations except Finland. Antipsychotic use was elevated among smokers and those with parity ≥4 in the Nordic countries. CONCLUSION Antipsychotic use during pregnancy varied considerably between populations, partly explained by varying use of the typical antipsychotic prochlorperazine, which is often used for nausea and vomiting in early pregnancy. Increasing usage of atypical antipsychotics among pregnant women reflects the pattern that was previously reported for the general population.
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Affiliation(s)
- Johan Reutfors
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
| | - Carolyn E Cesta
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Jacqueline M Cohen
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Brian T Bateman
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States of America; Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's, Harvard Medical School, Boston, MA, United States of America
| | - Ruth Brauer
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
| | - Kristjana Einarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Anders Engeland
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway; Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Kari Furu
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Mika Gissler
- Finnish Institute for Health and Welfare, Helsinki, Finland; Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Alys Havard
- Centre for Big Data Research in Health, Faculty of Medicine, UNSW, Sydney, Australia
| | | | - Krista F Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Øystein Karlstad
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Jiong Li
- Aarhus University, Aarhus, Denmark
| | - Kenneth K C Man
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Laura Pazzagli
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Andrea Schaffer
- Centre for Big Data Research in Health, Faculty of Medicine, UNSW, Sydney, Australia
| | - Tania Schink
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Zixuan Wang
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
| | | | - Helga Zoega
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Centre for Big Data Research in Health, Faculty of Medicine, UNSW, Sydney, Australia
| | - Gabriella Bröms
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Internal Medicine, Danderyd Hospital, Stockholm, Sweden
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Wubeshet YS, Mohammed OS, Desse TA. Prevalence and management practice of first generation antipsychotics induced side effects among schizophrenic patients at Amanuel Mental Specialized Hospital, central Ethiopia: cross-sectional study. BMC Psychiatry 2019; 19:32. [PMID: 30658604 PMCID: PMC6339381 DOI: 10.1186/s12888-018-1999-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 12/26/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND First-generation antipsychotics (FGAs) are associated with a range of adverse events which can significantly reduce patients' quality of life and contribute to non-adherence. The aim of this study was to assess the prevalence and management practice of first generation antipsychotics induced side effects among schizophrenic patients. METHODS The study was conducted at Amanuel Mental Specialized Hospital from March to June, 2017. Data from patients were collected using a pretested structured questionnaire. Demographics and side effects of antipsychotics were collected by face to face interview. Clinical characteristics, medications and previous history of adverse drug events were extracted from medical records using data abstraction format. The data were analyzed using statistical software for social sciences (SPSS) version 20. Descriptive statistics and chi-square tests were done. Statistical significance was considered at p < 0.05. RESULTS Out of 356 participants, 300 of them had complete data and were included in the study. The mean age of participants was 33.71 ± 10.2 years. The majority, 195(65.0%), of participants were males. Most of the participants, 293(97.7%), developed FGA medication induced side effects. One hundred sixty three (54.3%) participants were treated with Trihexyphenidyl for FGAs induced side effects. Dose reduction of antipsychotics was done for 51(17.0%) participants. Most of the participants' side effects were not managed according to American Psychiatric Association guideline; 178 (82.4%). The most common types of FGAs induced side effects were cardiovascular side effects 169(56.3%); sedation and CNS side effects 149(49.6%); and extrapyramidal side effects 114(38.0%). There is a significant association between occurrence of side effects of FGAs and duration of illness (P = 0.04). CONCLUSIONS The prevalence of first generation antipsychotics induced side effects was high. However, management practice of the side effects was minimal.
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Affiliation(s)
- Yirgalem Shewakena Wubeshet
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Oumer Sada Mohammed
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tigestu Alemu Desse
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Stomski NJ, Morrison P, Whitely M, Brennan P. Mental Health Consumers' Motives for Seeking Advocacy Support: A Qualitative Exploration. Community Ment Health J 2018; 54:607-615. [PMID: 29094230 DOI: 10.1007/s10597-017-0177-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 10/28/2017] [Indexed: 10/18/2022]
Abstract
Advocacy plays a vital role in ensuring that mental health consumers' rights are maintained. However, the primary issues for which consumers seek advocacy support remain unknown. Understanding these issues provides a sound basis from which advocacy organisations may develop a clear service delivery focus. This study addresses the literature gap through presenting a qualitative analysis of 60 records from an advocacy service. Four major themes emerged, across which two key issues were dominant: the sense of fearfulness and disempowerment. These issues accentuate the importance of advocates in enhancing the agency of mental health consumers.
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Affiliation(s)
- N J Stomski
- School of Health Professions, Murdoch University, 90 South St, Murdoch, WA, 6150, Australia.
| | - P Morrison
- School of Health Professions, Murdoch University, 90 South St, Murdoch, WA, 6150, Australia
| | - M Whitely
- Health Policy and Research, Health Consumers Council (WA), 40 Lord St, East Perth, 6004, Western Australia, Australia
| | - P Brennan
- Health Consumers Council (WA), 40 Lord St, East Perth, 6004, Western Australia, Australia
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Stomski NJ, Morrison P. Participation in mental healthcare: a qualitative meta-synthesis. Int J Ment Health Syst 2017; 11:67. [PMID: 29151851 PMCID: PMC5678577 DOI: 10.1186/s13033-017-0174-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 10/27/2017] [Indexed: 01/14/2023] Open
Abstract
Background Facilitation of service user participation in the co-production of mental healthcare planning and service delivery is an integral component of contemporary mental health policy and clinical guidelines. However, many service users continue to experience exclusion from the planning of their care. This review synthesizes qualitative research about participation in mental healthcare and articulates essential processes that enable service user participation in mental health care. Methods Electronic databases were systematically searched. Studies were included if they were peer reviewed qualitative studies, published between 2000 and 2015, examining participation in mental health care. The Critical Appraisal Skills Program checklist was used to assess the quality of each included study. Constant comparison was used to identify similar constructs across several studies, which were then abstracted into thematic constructs. Results The synthesis resulted in the identification of six principal themes, which articulate key processes that facilitate service user participation in mental healthcare. These themes included: exercising influence; tokenism; sharing knowledge; lacking capacity; respect; and empathy. Conclusions This meta-synthesis demonstrates that service user participation in mental healthcare remains a policy aspiration, which generally has not been translated into clinical practice. The continued lack of impact on policy on the delivery of mental healthcare suggests that change may have to be community driven. Systemic service user advocacy groups could contribute critically to promoting authentic service user participation in the co-production of mental health services.
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Affiliation(s)
- Norman J Stomski
- School of Health Professions, Murdoch University, ECL 2049 90 South St, Murdoch, WA 6150 Australia
| | - Paul Morrison
- School of Health Professions, Murdoch University, ECL 2049 90 South St, Murdoch, WA 6150 Australia
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Stomski NJ, Morrison P. Carers' involvement in decision making about antipsychotic medication: A qualitative study. Health Expect 2017; 21:308-315. [PMID: 28841260 PMCID: PMC5750765 DOI: 10.1111/hex.12616] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2017] [Indexed: 11/27/2022] Open
Abstract
Background Current Australian mental health policy recommends that carers should be involved in the provision of mental health services. Carers often provide intensive support to mental health consumers and gain detailed insight into their lives. As such, carers could make valuable contributions to well‐informed decisions about mental health consumers' use of antipsychotic medication. Objectives The aim of this study was to explore carers' participation in antipsychotic medication decision making. Methods Snowball sampling was used to enrol 29 carers in this study. Of these carers, 19 participated in semi‐structured interviews, and ten participated in a focus group. Data were analysed thematically. Results Four main themes emerged from the analysis. The findings highlighted that carers typically received little or no information about antipsychotic medication. Carers commonly addressed the shortfall in information by obtaining additional information through online sources or distributing among carer networks material that they had developed themselves. Almost all carers emphasized that they should be involved in decisions about antipsychotic medication, but noted that they were typically excluded. The lack of involvement in medication decisions was a source of frustration, as carers could contribute saliently through sharing detailed knowledge about mental health consumers' lives, address communication gaps that resulted from disjointed care and improve communication between health professionals and mental health consumers. Conclusion Health professionals could consider improving the extent to which they collaborate with carers in medication decisions.
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Affiliation(s)
- Norman J Stomski
- School of Health Professions, Murdoch University, Murdoch, WA, Australia
| | - Paul Morrison
- School of Health Professions, Murdoch University, Murdoch, WA, Australia
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Morrison P, Stomski NJ, Meehan T. Australian mental health nurses’ perspectives about the identification and management of antipsychotic medication side effects: a cross-sectional survey. J Ment Health 2016; 27:23-29. [DOI: 10.1080/09638237.2016.1222060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Paul Morrison
- School of Health Professions, Murdoch University, Murdoch, Australia and
| | - Norman J. Stomski
- School of Health Professions, Murdoch University, Murdoch, Australia and
| | - Tom Meehan
- School of Medicine, University of Queensland, Brisbane, Australia
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Stomski NJ, Morrison P, Meyer A. Antipsychotic medication side effect assessment tools: A systematic review. Aust N Z J Psychiatry 2016; 50:399-409. [PMID: 26480934 DOI: 10.1177/0004867415608244] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this systematic review was to critically appraise the psychometric properties of antipsychotic medication side effect assessment tools. METHODS Systematic searches were undertaken in PubMed, CINAHL and CENTRAL from inception to October 2014. Studies were included if they detailed the evaluation of psychometric properties of antipsychotic medication side effect assessment tools in mental health populations. Studies were excluded if they examined the use of antipsychotic medication side effect assessment tools in non-mental health populations, including people suffering from dementia, Parkinsonism and Alzheimer's. Narrative reviews and studies published in any language other than English were also excluded. RESULTS Content validity was appropriately established for only one of the tools, reliability was inappropriately evaluated for all but one tool, and the assessment of responsiveness was not acceptable for any tool. CONCLUSION Further psychometric studies are warranted to consolidate the psychometric properties of the included antipsychotic medication side effect assessment tools before any of these tools can be confidently recommended for either research or clinical purposes.
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Affiliation(s)
- Norman Jay Stomski
- School of Health Professions, Murdoch University, Murdoch, WA, Australia
| | - Paul Morrison
- School of Health Professions, Murdoch University, Murdoch, WA, Australia
| | - Amanda Meyer
- School of Health Professions, Murdoch University, Murdoch, WA, Australia
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