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Soliman G, LaCaze A. Psychotropic medicines are frequently dosed outside recommended ranges: a clinical audit in an Australian mental health hospital. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2022. [DOI: 10.1002/jppr.1840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ghadir Soliman
- Department of Pharmacy St John of God Richmond Hospital North Richmond Australia
| | - Adam LaCaze
- School of Pharmacy and Pharmacology The University of Queensland Brisbane Australia
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Ayenew W, Asmamaw G, Bitew T. Antipsychotic Polypharmacy Among Patients With Schizophrenia in Africa: A Systematic Review and Meta-Analysis. Int J Neuropsychopharmacol 2021; 24:956-964. [PMID: 34245271 PMCID: PMC8653871 DOI: 10.1093/ijnp/pyab046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 06/22/2021] [Accepted: 07/09/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES In Africa, antipsychotic polypharmacy (APP) is increasing due to a high antipsychotic dose prescribing, repeated psychiatric hospitalization, uncontrolled psychotic symptoms, and greater side effect burden. Therefore, the aim of this review and meta-analysis is to assess the prevalence and correlates of APP among patients with schizophrenia in Africa. METHODS A systematic search was performed from August 1 to 31, 2020, on PubMed, MEDLINE, Google Scholar, and Science Direct databases to select articles based on the inclusion criteria. Meta-Analysis of Observational studies in Epidemiology guidelines were employed. Cross-sectional observational studies that reported APP and/or its correlates in schizophrenia patients in English language published in peer-reviewed journals without time limits were included in the review. The quality of included articles was assessed using Newcastle-Ottawa quality assessment tool. Prevalence and correlates of APP were the outcome measures of this review and meta-analysis. Open Meta Analyst and RevMan version 5.3 software were used for meta-analysis. A random effect model was used to synthesize data based on the heterogeneity test. RESULTS Six studies that involved 2154 schizophrenia patients met the inclusion criteria in this review and meta-analysis. The quality of included studies ranges from 6.5 to 10 based on the Newcastle-Ottawa quality assessment tool. The pooled prevalence of APP among patients with schizophrenia was 40.6% with 95% confidence interval: 27.6% to 53.7%. Depot first-generation antipsychotics and oral first-generation antipsychotics were the most commonly prescribed APP combinations. Socio-demographic, clinical, and antipsychotic treatment characteristics were significantly associated with APP. There was a wide variation in the correlates of APP assessed by studies and the way that association/correlations was determined and reported. CONCLUSIONS APP is common and highly prevalent. Advanced age, male gender, longer duration of schizophrenia, hospital admission, and longer antipsychotic treatment were correlates of APP in Africa.
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Affiliation(s)
- Wondim Ayenew
- Department of Pharmaceutics, College of Medicine and Health Science, School of Pharmacy, University of Gondar, Gondar, Ethiopia,Correspondence: Wondim Ayenew, BSc, Department of Pharmaceutics, College of Medicine and Health Science, School of Pharmacy, University of Gondar, P.O. BOX: 196, Gondar, Ethiopia ()
| | - Getahun Asmamaw
- Department of Pharmacy, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia
| | - Teshome Bitew
- Department of Pharmacy, Pawe Health Science College, Pawe, Ethiopia
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Correll C, Cañas F, Larmo I, Levy P, Montes JM, Fagiolini A, Papageorgiou G, Rossi A, Sturlason R, Zink M. Individualizing antipsychotic treatment selection in schizophrenia: characteristics of empirically derived patient subgroups. Eur Psychiatry 2020; 26:3-16. [DOI: 10.1016/s0924-9338(11)71709-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AbstractTreatment of schizophrenia with antipsychotic drugs is frequently sub-optimal. One reason for this may be heterogeneity between patients with schizophrenia. The objectives of this study were to identify patient, disease and treatment attributes that are important for physicians in choosing an antipsychotic drug, and to identify empirically subgroups of patients who may respond differentially to antipsychotic drugs. The survey was conducted by structured interview of 744 randomly-selected psychiatrists in four European countries who recruited 3996 patients with schizophrenia. Information on 39 variables was collected. Multiple component analysis was used to identify dimensions that explained the variance between patients. Three axes, accounting for 99% of the variance, were associated with disease severity (64%), socioeconomic status (27%) and patient autonomy (8%). These dimensions discriminated between six discrete patient subgroups, identified using ascending hierarchical classification analysis. The six subgroups differed regarding educational level, illness severity, autonomy, symptom presentation, addictive behaviors, comorbidities and cardiometabolic risk factors. Subgroup 1 patients had moderately severe physician-rated disease and addictive behaviours (23.2%); Subgroup 2 patients were well-integrated and autonomous with mild to moderate disease (6.7%); Subgroup 3 patients were less well-integrated with mild to moderate disease, living alone (11.2%); Subgroup 4 patients were women with low education levels (5.4%), Subgroup 5 patients were young men with severe disease (36.8%); and Subgroup 6 patients were poorly-integrated with moderately severe disease, needing caregiver support (16.7%). The presence of these subgroups, which require confirmation and extension regarding potentially identifiable biological markers, may help individualizing treatment in patients with schizophrenia.
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Leavy B, Michaëlsson K, Åberg AC, Melhus H, Byberg L. The Impact of Disease and Drugs on Hip Fracture Risk. Calcif Tissue Int 2017; 100:1-12. [PMID: 27671989 PMCID: PMC5214955 DOI: 10.1007/s00223-016-0194-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 09/13/2016] [Indexed: 11/13/2022]
Abstract
We report the risks of a comprehensive range of disease and drug categories on hip fracture occurrence using a strict population-based cohort design. Participants included the source population of a Swedish county, aged ≥50 years (n = 117,494) including all incident hip fractures during 1 year (n = 477). The outcome was hospitalization for hip fracture (ICD-10 codes S72.0-S72.2) during 1 year (2009-2010). Exposures included: prevalence of (1) inpatient diseases [International Classification of Diseases (ICD) codes A00-T98 in the National Patient Register 1987-2010] and (2) prescribed drugs dispensed in 2010 or the year prior to fracture. We present age- and sex-standardized risk ratios (RRs), risk differences (RDs) and population attributable risks (PARs) of disease and drug categories in relation to hip fracture risk. All disease categories were associated with increased risk of hip fracture. Largest risk ratios and differences were for mental and behavioral disorders, diseases of the blood and previous fracture (RRs between 2.44 and 3.00; RDs (per 1000 person-years) between 5.0 and 6.9). For specific drugs, strongest associations were seen for antiparkinson (RR 2.32 [95 % CI 1.48-1.65]; RD 5.2 [1.1-9.4]) and antidepressive drugs (RR 1.90 [1.55-2.32]; RD 3.1 [2.0-4.3]). Being prescribed ≥10 drugs during 1 year incurred an increased risk of hip fracture, whereas prescription of cardiovascular drugs or ≤5 drugs did not appear to increase risk. Diseases inferring the greatest PARs included: cardiovascular diseases PAR 22 % (95 % CI 14-29) and previous injuries (PAR 21 % [95 % CI 16-25]; for specific drugs, antidepressants posed the greatest risk (PAR 16 % [95 % CI 12.0-19.3]).
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Affiliation(s)
- Breiffni Leavy
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Sweden.
- Stockholms Sjukhem Foundation, Stockholm, Sweden.
| | - Karl Michaëlsson
- Department of Surgical Sciences, Orthopedics, Uppsala University, Uppsala, Sweden
| | - Anna Cristina Åberg
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Uppsala, Sweden
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Håkan Melhus
- Department of Medical Sciences, Osteoporosis and Clinical Pharmacogenetics, Uppsala University, Uppsala, Sweden
| | - Liisa Byberg
- Department of Surgical Sciences, Orthopedics, Uppsala University, Uppsala, Sweden
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Igbinomwanhia NG, Olotu SO, James BO. Prevalence and correlates of antipsychotic polypharmacy among outpatients with schizophrenia attending a tertiary psychiatric facility in Nigeria. Ther Adv Psychopharmacol 2017; 7:3-10. [PMID: 28101318 PMCID: PMC5228713 DOI: 10.1177/2045125316672134] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The study aimed to determine the prevalence, pattern and correlates of antipsychotic polypharmacy (APP) among outpatients with schizophrenia attending a tertiary psychiatric facility in Nigeria. METHOD A cross-sectional study of 250 patients with schizophrenia attending the outpatient clinic of a regional tertiary psychiatric facility in Nigeria was undertaken. They were administered a sociodemographic questionnaire, the Positive and Negative Syndrome Scale (PANSS), the Global Assessment of Functioning (GAF) scale and the Liverpool University Side Effects Rating Scale (LUNSERS). RESULTS Of the 250 subjects interviewed, 176 (70.4%) were on APP. APP was significantly associated with higher prescribed chlorpromazine equivalent doses of antipsychotics (p < 0.001), increased frequency of dosing (p < 0.001), negative symptoms (p < 0.01), poorer functioning (p = 0.04) and greater side-effect burden (p = 0.04). CONCLUSION The APP rate reported from this study is high. Clinicians should be mindful of its impact on dosage and side-effect profiles as APP use is associated with negative symptoms and poor psychosocial functioning.
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Affiliation(s)
- Nosa Godwin Igbinomwanhia
- Department of Clinical Services, Federal Neuro-Psychiatric Hospital, P.M.B 1108, Benin City, Nigeria
| | - Sunday Osasu Olotu
- Department of Clinical Services, Federal Neuro-Psychiatric Hospital, Benin City, Nigeria
| | - Bawo Onesirosan James
- Department of Clinical Services, Federal Neuro-Psychiatric Hospital, Benin City, Nigeria
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Karadag H, Orsel S, Akkoyunlu S, Kahilogulları AK, Guriz O, Turkcapar H, Hatiloglu U. Comparison of Polypharmacy in Schizophrenia and Other Psychotic Disorders in Outpatient and Inpatient Treatment Periods: A Naturalistic One Year Follow-up Study. ACTA ACUST UNITED AC 2016. [DOI: 10.5455/bcp.20120419124219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Hasan Karadag
- Psychiatry Service of Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara - Turkey
| | - Sibel Orsel
- Psychiatry Service of Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara - Turkey
| | | | | | - Olga Guriz
- Psychiatry Service of Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara - Turkey
| | - Hakan Turkcapar
- Psychiatry Service of Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara - Turkey
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Berrouiguet S, Barrigón ML, Brandt SA, Ovejero-García S, Álvarez-García R, Carballo JJ, Lenca P, Courtet P, Baca-García E. Development of a Web-Based Clinical Decision Support System for Drug Prescription: Non-Interventional Naturalistic Description of the Antipsychotic Prescription Patterns in 4345 Outpatients and Future Applications. PLoS One 2016; 11:e0163796. [PMID: 27764107 PMCID: PMC5072715 DOI: 10.1371/journal.pone.0163796] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 09/14/2016] [Indexed: 12/03/2022] Open
Abstract
PURPOSE The emergence of electronic prescribing devices with clinical decision support systems (CDSS) is able to significantly improve management pharmacological treatments. We developed a web application available on smartphones in order to help clinicians monitor prescription and further propose CDSS. METHOD A web application (www.MEmind.net) was developed to assess patients and collect data regarding gender, age, diagnosis and treatment. We analyzed antipsychotic prescriptions in 4345 patients attended in five Psychiatric Community Mental Health Centers from June 2014 to October 2014. The web-application reported average daily dose prescribed for antipsychotics, prescribed daily dose (PDD), and the PDD to defined daily dose (DDD) ratio. RESULTS The MEmind web-application reported that antipsychotics were used in 1116 patients out of the total sample, mostly in 486 (44%) patients with schizophrenia related disorders but also in other diagnoses. Second generation antipsychotics (quetiapine, aripiprazole and long-acting paliperidone) were preferably employed. Low doses were more frequently used than high doses. Long acting paliperidone and ziprasidone however, were the only two antipsychotics used at excessive dosing. Antipsychotic polypharmacy was used in 287 (26%) patients with classic depot drugs, clotiapine, amisulpride and clozapine. CONCLUSIONS In this study we describe the first step of the development of a web application that is able to make polypharmacy, high dose usage and off label usage of antipsychotics visible to clinicians. Current development of the MEmind web application may help to improve prescription security via momentary feedback of prescription and clinical decision support system.
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Affiliation(s)
- Sofian Berrouiguet
- Department of Psychiatry and Emergency, Brest Medical University Hospital, Brest, France
- Logics in Uses, Social Science and Information Science department, Telecom Bretagne, Plouzané, France
| | | | - Sara A. Brandt
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, United States of America
| | | | - Raquel Álvarez-García
- Department of Psychiatry, University Hospital Rey Juan Carlos, Móstoles, Madrid, Spain
| | - Juan Jose Carballo
- Department of Psychiatry at Fundación Jimenez Diaz Hospital, Madrid, Spain
| | - Philippe Lenca
- Logics in Uses, Social Science and Information Science department, Telecom Bretagne, Plouzané, France
| | - Philippe Courtet
- INSERM U888, Department of Psychiatry, Montpellier University Hospital, Montpellier, France
| | | | - Enrique Baca-García
- Department of Psychiatry, IIS-Jimenez Diaz Foundation, Madrid, Spain
- Department of Psychiatry, University Hospital Infanta Elena, Valdemoro, Spain
- Department of Psychiatry, University Hospital Rey Juan Carlos, Móstoles, Spain
- Department of Psychiatry, General Hospital of Villalba, Autonoma University, Madrid, Spain
- CIBERSAM, Madrid, Spain
- Columbia University, New York, NY, United States of America
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Lochmann van Bennekom MWH, Gijsman HJ, Zitman FG. Antipsychotic polypharmacy in psychotic disorders: a critical review of neurobiology, efficacy, tolerability and cost effectiveness. J Psychopharmacol 2013; 27:327-36. [PMID: 23413275 DOI: 10.1177/0269881113477709] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The purpose of this study was to review the scientific evidence for neurobiological rationale, efficacy, tolerability and cost effectiveness of antipsychotic polypharmacy (APP). DATA SOURCES A systematic literature search of Medline, Embase, Ovid and the Cochrane Database of Systematic Reviews until April 2012 was carried out. RESULTS Theories behind APP have only modest pre-clinical and clinical evidence. We found limited statistical evidence supporting modest efficacy of APP in patients with psychotic symptoms refractory to clozapine. APP is associated with increased mortality, metabolic syndrome, decreased cognitive functioning, high dose prescription and non-adherence. It brings up extra costs, lacking evidence for cost-effectiveness. CONCLUSIONS Pre-clinical studies underpinning neurobiological hypotheses in APP are lacking. Evidence supporting efficacy of APP is limited with modest beneficial clinical relevance. APP is associated with several serious adverse effects and increased health costs. In the absence of more convincing pre-clinical support and clinical evidence we advise adherence to existing guidelines and limiting combinations of antipsychotics (in consideration with other pharmacotherapeutic, somatic and psychotherapeutic options) to patients with clozapine-refractory psychosis in well-evaluated individual trials that might need 10 weeks or more.
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Correll CU, Gallego JA. Antipsychotic polypharmacy: a comprehensive evaluation of relevant correlates of a long-standing clinical practice. Psychiatr Clin North Am 2012; 35:661-81. [PMID: 22929872 PMCID: PMC3717367 DOI: 10.1016/j.psc.2012.06.007] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Antipsychotic polypharmacy (APP) is common in the treatment of schizophrenia spectrum disorders. The literature indicates that APP is related to patient, illness, and treatment variables that are proxy measures for greater illness acuity, severity, complexity, and chronicity. The largely unknown relative risks and benefits of APP need to be weighed against the known risks and benefits of clozapine for treatment-resistant patients. To inform evidence-based clinical practice, controlled, high-quality antipsychotic combination and discontinuation trials are necessary to determine the effectiveness, safety, and role of APP in the management of severely ill patients with insufficient response to antipsychotic monotherapy.
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Affiliation(s)
- Christoph U. Correll
- The Zucker Hillside Hospital, Division of Psychiatry Research, North Shore-LIJ Health System, 75-59, 263rd Street, Glen Oaks, NY 11004, USA,Hofstra North Shore-LIJ School of Medicine, Hempstead, NY 11549, USA,Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA,The Feinstein Institute for Medical Research, 350 Community Drive, Manhasset, NY 11030, USA,Corresponding author.
| | - Juan A. Gallego
- The Zucker Hillside Hospital, Division of Psychiatry Research, North Shore-LIJ Health System, 75-59, 263rd Street, Glen Oaks, NY 11004, USA,The Feinstein Institute for Medical Research, 350 Community Drive, Manhasset, NY 11030, USA
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Hallinen T, Soini EJ, Granström O, Ovaskainen Y, Leinonen E, Koponen HJ, Hänninen K. Differential use of extended and immediate release quetiapine: a retrospective registry study of Finnish inpatients with schizophrenia spectrum and bipolar disorders. BMJ Open 2012; 2:e000915. [PMID: 22761282 PMCID: PMC3391370 DOI: 10.1136/bmjopen-2012-000915] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 05/29/2012] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Extended release (XR) and immediate release (IR) quetiapine have differing dosing, titration and plasma concentration profiles. The authors assessed whether the use of quetiapine XR and IR in schizophrenia spectrum disorders (SCZ) and bipolar disorder (BD) differ. DESIGN Retrospective non-interventional registry study. SETTING Secondary healthcare. PARTICIPANTS All SCZ and BD (ICD-10 codes F20-F29, F30-F31) patients discharged between June 2008 and June 2010 from a Finnish psychiatric hospital with any use of quetiapine during their inpatient stay. PRIMARY AND SECONDARY OUTCOME MEASURES Differences in patient characteristics between quetiapine XR and IR users were tested. To assess the profile of XR versus IR patients, logistic regressions were performed. RESULTS 43 patients used quetiapine XR, 58 used quetiapine IR and 55 used both formulations (n=156). 102 patients were diagnosed with SCZ and 54 with BD, with no significant differences between the quetiapine formulations. The mean daily dose of quetiapine XR was significantly higher than that of quetiapine IR (542 mg vs 328 mg; p<0.001). This was also true for the SCZ subgroup (XR: 593 mg vs IR: 338 mg; p<0.001) and the BD subgroup (XR: 466 mg vs IR: 308 mg; p=0.009). 48% of all quetiapine IR patients used a mean dose of ≤200 mg compared with 2% of XR patients. Injectable antipsychotics were combined with quetiapine IR but not with quetiapine XR (12% vs 0%; p=0.019). At discharge, quetiapine XR was used as monotherapy to a greater extent than IR (79% vs 44%; p=0.003). The odds for quetiapine XR use in hospital were lower with advancing age, substance abuse diagnosis and prior IR use. CONCLUSIONS Among SCZ and BD inpatients, quetiapine XR was more often used as monotherapy and in significantly higher doses than quetiapine IR. Differential use of the quetiapine formulations appears to depend, at least in part, on patient characteristics.
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Affiliation(s)
| | | | | | | | - Esa Leinonen
- Department of Psychiatry, University of Tampere, Medical School and Tampere University Hospital, Tampere, Finland
| | - Hannu J Koponen
- Department of Psychiatry, Kuopio University Hospital, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Kari Hänninen
- South Karelia Central Hospital, Lappeenranta, Finland
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Bernardo M, Coma A, Ibáñez C, Zara C, Bari JM, Serrano-Blanco A. Antipsychotic polypharmacy in a regional health service: a population-based study. BMC Psychiatry 2012; 12:42. [PMID: 22587453 PMCID: PMC3511232 DOI: 10.1186/1471-244x-12-42] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Accepted: 02/17/2012] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND To analyse the extent and profile of outpatient regular dispensation of antipsychotics, both in combination and monotherapy, in the Barcelona Health Region (Spain), focusing on the use of clozapine and long-acting injections (LAI). METHODS Antipsychotic drugs dispensed for people older than 18 and processed by the Catalan Health Service during 2007 were retrospectively reviewed. First and second generation antipsychotic drugs (FGA and SGA) from the Anatomical Therapeutic Chemical classification (ATC) code N05A (except lithium) were included. A patient selection algorithm was designed to identify prescriptions regularly dispensed. Variables included were age, gender, antipsychotic type, route of administration and number of packages dispensed. RESULTS A total of 117,811 patients were given any antipsychotic, of whom 71,004 regularly received such drugs. Among the latter, 9,855 (13.9%) corresponded to an antipsychotic combination, 47,386 (66.7%) to monotherapy and 13,763 (19.4%) to unspecified combinations. Of the patients given antipsychotics in association, 58% were men. Olanzapine (37.1%) and oral risperidone (36.4%) were the most common dispensations. Analysis of the patients dispensed two antipsychotics (57.8%) revealed 198 different combinations, the most frequent being the association of FGA and SGA (62.0%). Clozapine was dispensed to 2.3% of patients. Of those who were receiving antipsychotics in combination, 6.6% were given clozapine, being clozapine plus amisulpride the most frequent association (22.8%). A total of 3.800 patients (5.4%) were given LAI antipsychotics, and 2.662 of these (70.1%) were in combination. Risperidone was the most widely used LAI. CONCLUSIONS The scant evidence available regarding the efficacy of combining different antipsychotics contrasts with the high number and variety of combinations prescribed to outpatients, as well as with the limited use of clozapine.
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Affiliation(s)
- Miguel Bernardo
- Schizophrenia Clinic Program, Department of Psychiatry, Neuroscience Institute, Hospital Clinic de Barcelona, Barcelona, Spain.
| | - Anna Coma
- Pharmacy Direction. Catalan Health Service, Barcelona, Spain
| | - Cristina Ibáñez
- Pharmacy Direction. Catalan Health Service, Barcelona, Spain
| | - Corinne Zara
- Pharmacy Direction. Catalan Health Service, Barcelona, Spain
| | - Josep Maria Bari
- Schizophrenia Clinic Program, Department of Psychiatry, Neuroscience Institute, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Antoni Serrano-Blanco
- Parc Sanitari Sant Joan de Déu, Servicios de Salud Mental y Fundación Sant Joan de Déu, Red de Investigación en Actividades Preventivas y Promoción de la Salud (RedIAPP), Barcelona, Spain
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Khaja KAJA, Al-Haddad MK, Sequeira RP, Al-Offi AR. Antipsychotic and Anticholinergic Drug Prescribing Pattern in Psychiatry: Extent of Evidence-Based Practice in Bahrain. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/pp.2012.34055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
OBJECTIVE To evaluate the prescribing practices in psychiatric residential facilities, with particular focus both on the antipsychotic dose and polypharmacy as well as the variation of antipsychotic patterns during a patient's stay within the facilities. METHODS Fifteen residential facilities of Liguria region in Italy were included. Data were collected through a chart review during a one-day census. Frequency of psychotropic patterns was estimated. Different non-parametric tests were used to analyse the changes in prescription patterns as well as the relationship among antipsychotic dose, the number of antipsychotics and anticholinergic use. RESULTS The study sample includes 362 patients, 61.9% males. On the census day 77.5% of patients received psychotropic polypharmacy and 57.2% antipsychotic polypharmacy. Antipsychotic polypharmacy was related to the total antipsychotic daily dose and to anticholinergic use. A trend towards an increase of antipsychotic and psychotropic polypharmacy and higher doses of antipsychotics over the period of stay within the facilities was noted. This tendency was related to the length of stay in the facility. CONCLUSIONS Compared to earlier studies in the same clinical environment a significant increase in the use of psychotropic and antipsychotic polypharmacy was observed. The risk of prescribed polypharmacy seems to be related to time spent in the facility.
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