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Engel J, Haack B, Zolk O, Greiner T, Heinze M, Toto S, Seifert J, Bleich S, Glocker C, Grohmann R, Schneider M, Stübner S. Edema related to treatment with psychotropic drugs. J Neural Transm (Vienna) 2024; 131:253-266. [PMID: 38353811 PMCID: PMC10874320 DOI: 10.1007/s00702-024-02738-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/02/2024] [Indexed: 02/18/2024]
Abstract
Edema as an adverse drug reaction is a commonly underestimated yet potentially debilitating condition. This study analyzes the incidence of severe psychotropic drug-induced edema (e.g., edema affecting the face, legs, or multiple body parts and lasting for more than 1 week, or in any case necessitating subsequent diuretic use) among psychiatric inpatients. The cases under examination are derived from an observational pharmacovigilance program conducted in German-speaking countries ("Arzneimittelsicherheit in der Psychiatrie", AMSP) from 1993 to 2016. Among the 462,661 inpatients monitored, severe edema was reported in 231 cases, resulting in an incidence of 0.05%. Edema occurred more frequently in women (80% of all cases) and older patients (mean age 51.8 years). Pregabalin had the highest incidence of severe edema, affecting 1.46‰ of patients treated with pregabalin, followed by mirtazapine (0.8‰). The majority of edema cases showed a positive response to appropriate countermeasures, such as dose reduction and drug discontinuation, and resolved by the end of the observation period. While most instances of drug-induced edema are reversible, they can have a significant impact on patient well-being and potentially result in decreased treatment adherence. It is, therefore, crucial to remain vigilant regarding risk-increasing circumstances during treatment with psychotropic drugs.
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Affiliation(s)
- Johanna Engel
- Brandenburg Medical School, University Clinic for Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf bei Berlin, Germany.
| | - Beatrice Haack
- Brandenburg Medical School, University Clinic for Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf bei Berlin, Germany
| | - Oliver Zolk
- Institute of Clinical Pharmacology of the Brandenburg Medical School, Immanuel Klinik Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf bei Berlin, Germany
| | - Timo Greiner
- Brandenburg Medical School, University Clinic for Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf bei Berlin, Germany
| | - Martin Heinze
- Brandenburg Medical School, University Clinic for Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf bei Berlin, Germany
| | - Sermin Toto
- Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Johanna Seifert
- Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Catherine Glocker
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Nussbaumstr. 7, 80336, Munich, Germany
| | - Renate Grohmann
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Nussbaumstr. 7, 80336, Munich, Germany
| | - Michael Schneider
- Brandenburg Medical School, University Clinic for Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf bei Berlin, Germany
| | - Susanne Stübner
- Maßregelvollzugsleitung, Klinik für Forensische Psychiatrie, Bezirksklinikum Ansbach, Ludwig-Maximilians-Universität München, Feuchtwanger Straße 38, 91522, Ansbach, Germany
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Seifert J, Eckermann G, Heck J, Bleich S, Dabbert D, Grohmann R, Toto S. [Understanding and assessing the antidepressant drug-associated risk of bleeding]. Fortschr Neurol Psychiatr 2023. [PMID: 37327817 DOI: 10.1055/a-2089-3490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Antidepressants, in particular selective serotonin reuptake inhibitors (SSRIs), are the most commonly prescribed psychopharmacological drug group. Thus, a precise knowledge of the expected adverse drug reactions is indispensable. The increased risk of bleeding events is well documented, especially in patients treated with SSRIs. However, many other antidepressant drug groups have also been implicated in increasing the risk of bleeding. In the following review, the thrombocytic serotonin system and the respective targets of the different antidepressants are explained. Subsequently, the available literature on bleeding under the respective antidepressant classes or individual substances is presented, using data from meta-analyses whenever possible. In addition to the risk of bleeding in general, individual bleeding entities are also considered, such as gastrointestinal and cerebral hemorrhages. Finally, the effects of other drugs that increase the risk of bleeding (i. e., nonsteroidal anti-inflammatory drugs, platelet aggregation inhibitors and anticoagulants) in combination with antidepressant drugs are discussed. The information presented here is meant to guide practitioner's decision making regarding an appropriate antidepressant pharmacotherapy based on the patient's individual risk constellation.
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Affiliation(s)
- Johanna Seifert
- Klinik für Psychiatrie, Sozialpsychiatrie und Psychotherapie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Gabriel Eckermann
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie, Arbeitsgruppe Polypharmazie, München, Germany
| | - Johannes Heck
- Institut für Klinische Pharmakologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Stefan Bleich
- Klinik für Psychiatrie, Sozialpsychiatrie und Psychotherapie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Dominik Dabbert
- Klinik für Forensische Psychiatrie und Psychotherapie, Klinikum Bremen-Ost gGmbH, Bremen, Germany
| | - Renate Grohmann
- Psychiatrie und Psychotherapie, Klinik und Poliklinik der Ludwig-Maximilians-Universität München, München, Germany
| | - Sermin Toto
- Klinik für Psychiatrie, Sozialpsychiatrie und Psychotherapie, Medizinische Hochschule Hannover, Hannover, Germany
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de Bardeci M, Greil W, Stassen H, Willms J, Köberle U, Bridler R, Hasler G, Kasper S, Rüther E, Bleich S, Toto S, Grohmann R, Seifert J. Dear Doctor Letters regarding citalopram and escitalopram: guidelines vs real-world data. Eur Arch Psychiatry Clin Neurosci 2023; 273:65-74. [PMID: 35217913 PMCID: PMC9957836 DOI: 10.1007/s00406-022-01392-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 02/04/2022] [Indexed: 12/14/2022]
Abstract
Dear Doctor Letters (DDLs, Direct Healthcare Professional Communications) from 2011 provided guidance regarding QTc-prolonging effects with risk of torsade de pointes during treatment with citalopram and escitalopram. This study examines the DDLs' effects on prescription behavior. Data from 8842 inpatients treated with citalopram or escitalopram with a primary diagnosis of major depressive disorder (MDD) were derived from a European pharmacovigilance study (Arzneimittelsicherheit in der Psychiatrie, AMSP) from 2001 to 2017. It was examined to what extent new maximum doses were adhered to and newly contraindicated combinations with QTc-prolonging drugs were avoided. In addition, the prescriptions of psychotropic drugs before and after DDLs were compared in all 43,480 inpatients with MDD in the data set. The proportion of patients dosed above the new limit decreased from 8 to 1% in patients ≤ 65 years and from 46 to 23% in patients > 65 years old for citalopram versus 14-5% and 47-31% for escitalopram. Combinations of es-/citalopram with other QTc-prolonging psychotropic drugs reduced only insignificantly (from 35.9 to 30.9%). However, the proportion of patients with doses of quetiapine > 150 mg/day substantially decreased within the combinations of quetiapine and es-/citalopram (from 53 to 35%). After the DDLs, prescription of citalopram decreased and of sertraline increased. The DDLs' recommendations were not entirely adhered to, particularly in the elderly and concerning combination treatments. This might partly be due to therapeutic requirements of the included population. Official warnings should consider clinical needs.
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Affiliation(s)
- Mateo de Bardeci
- grid.5252.00000 0004 1936 973XDepartment of Psychiatry and Psychotherapy, Ludwig Maximilian University, Nussbaumstr. 7, 80331 Munich, Germany ,grid.492890.e0000 0004 0627 5312Psychiatric Private Hospital, Sanatorium Kilchberg, Kilchberg-Zurich, Switzerland
| | - Waldemar Greil
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Nussbaumstr. 7, 80331, Munich, Germany. .,Psychiatric Private Hospital, Sanatorium Kilchberg, Kilchberg-Zurich, Switzerland.
| | - Hans Stassen
- grid.492890.e0000 0004 0627 5312Psychiatric Private Hospital, Sanatorium Kilchberg, Kilchberg-Zurich, Switzerland ,grid.412004.30000 0004 0478 9977Institute for Response-Genetics, Psychiatric University Hospital (KPPP), Zurich, Switzerland
| | - Jamila Willms
- grid.492890.e0000 0004 0627 5312Psychiatric Private Hospital, Sanatorium Kilchberg, Kilchberg-Zurich, Switzerland
| | - Ursula Köberle
- Arzneimittelkommission der Deutschen Ärzteschaft, Berlin, Germany
| | - René Bridler
- grid.492890.e0000 0004 0627 5312Psychiatric Private Hospital, Sanatorium Kilchberg, Kilchberg-Zurich, Switzerland
| | - Gregor Hasler
- grid.8534.a0000 0004 0478 1713Psychiatry Research Unit, University of Fribourg, Fribourg, Switzerland
| | - Siegfried Kasper
- grid.22937.3d0000 0000 9259 8492Department of Molecular Neuroscience, Medical University of Vienna, Vienna, Austria
| | - Eckart Rüther
- grid.5252.00000 0004 1936 973XDepartment of Psychiatry and Psychotherapy, Ludwig Maximilian University, Nussbaumstr. 7, 80331 Munich, Germany
| | - Stefan Bleich
- grid.10423.340000 0000 9529 9877Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Sermin Toto
- grid.10423.340000 0000 9529 9877Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Renate Grohmann
- grid.5252.00000 0004 1936 973XDepartment of Psychiatry and Psychotherapy, Ludwig Maximilian University, Nussbaumstr. 7, 80331 Munich, Germany
| | - Johanna Seifert
- grid.10423.340000 0000 9529 9877Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
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Glocker C, Grohmann R, Burkhardt G, Seifert J, Bleich S, Held T, Toto S, Stübner S, Schüle C. Antipsychotic drug-induced neutropenia: results from the AMSP drug surveillance program between 1993 and 2016. J Neural Transm (Vienna) 2023; 130:153-163. [PMID: 36653686 PMCID: PMC9902410 DOI: 10.1007/s00702-023-02589-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/09/2023] [Indexed: 01/20/2023]
Abstract
Neutropenia and agranulocytosis (N&A) are relatively rare, but potentially fatal adverse drug reactions (ADR). This study presents cases of N&A related to one or more antipsychotic drugs (APDs) in psychiatric inpatients. Data on APD utilization and reports of N&A caused by APDs were analyzed by using data from an observational pharmacovigilance program in German-speaking countries-Arzneimittelsicherheit in der Psychiatrie (AMSP)-from 1993 to 2016. 333,175 psychiatric inpatients were treated with APDs for schizophrenia and other indications during the observation period. A total of 124 cases of APD-induced N&A were documented, 48 of which fulfilled the criteria for agranulocytosis, corresponding to a rate of 0.37, respectively, 0.14 in 1000 inpatients treated with APDs. Neutropenia was more often detected in women, whereas there was no difference regarding sex in cases of agranulocytosis. Clozapine had the highest relative risk for inducing N&A and was imputed alone as a probable cause of N&A in 60 cases (1.57‰ of all patients exposed). Perazine showed the second highest relative risk with 8 cases and an incidence 0.52‰, followed by quetiapine (15 cases resp. 0.23‰ of all patients exposed) and olanzapine (7 cases; 0.13‰ of all patients exposed). N&A most often occurred during the first 3 months of treatment. Overall N&A are severe and potentially fatal complications that can occur during treatment with APDs. The results from this study largely agree with the currently available literature, highlighting the positive effects of alertness and established appropriate monitoring.
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Affiliation(s)
- Catherine Glocker
- Department of Psychiatry und Psychotherapy, LMU Klinikum, Nußbaumstraße 7, 80336, Munich, Germany.
| | - R. Grohmann
- Department of Psychiatry und Psychotherapy, LMU Klinikum, Nußbaumstraße 7, 80336 Munich, Germany
| | - G. Burkhardt
- Department of Psychiatry und Psychotherapy, LMU Klinikum, Nußbaumstraße 7, 80336 Munich, Germany
| | - J. Seifert
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - S. Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - T. Held
- Department of Hematology and Cell Therapy, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125 Berlin, Germany
| | - S. Toto
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - S. Stübner
- Department of Forensic Psychiatry, Bezirksklinikum Ansbach, Feuchtwanger Str. 38, 91522 Ansbach, Germany
| | - C. Schüle
- Department of Psychiatry und Psychotherapy, LMU Klinikum, Nußbaumstraße 7, 80336 Munich, Germany
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Zolk O, Greiner T, Schneider M, Heinze M, Dahling V, Ramin T, Grohmann R, Bleich S, Zindler T, Toto S, Seifert J. Antipsychotic drug treatment of schizophrenia in later life: Results from the European cross-sectional AMSP study. World J Biol Psychiatry 2022; 23:374-386. [PMID: 34907857 DOI: 10.1080/15622975.2021.2011403] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To investigate the relationship between patient age and the selection and dosage of antipsychotic drugs (APDs) for treatment of schizophrenia. We describe age effects for multiple individual APDs, thus allowing comparisons between drugs. METHODS Prescription data of 32,062 inpatients with schizophrenia from 2000 to 2017 were obtained from the Drug Safety Program in Psychiatry (AMSP) database. APD selection and dosage were related to patient age with sex as an influencing variable. Moreover, a systematic search of current guideline recommendations on APD treatment in patients with schizophrenia aged ≥65 years was performed. RESULTS Eighty percentof elderly patients (≥65 years) received a second-generation APD, most commonly risperidone. The dosage of APDs increased with age until about age 40 years, then decreased slowly at first and more steeply beyond age 55 years. The influence of age as well as sex on dosage partly differed between the individual drugs. Only one of eight schizophrenia guidelines systematically addressed specific aspects of pharmacotherapy in older adults. CONCLUSIONS In clinical routine, age has a significant impact on selection and dosing of APDs. Information on optimising pharmacotherapy in older adults with schizophrenia from clinical trials is needed. Guidelines should be improved regarding APD therapy specifically for older adults.
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Affiliation(s)
- Oliver Zolk
- Institute of Clinical Pharmacology of the Brandenburg Medical School, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
| | - Timo Greiner
- Institute of Clinical Pharmacology of the Brandenburg Medical School, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
| | - Michael Schneider
- University Clinic for Psychiatry and Psychotherapy of the Brandenburg Medical School, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
| | - Martin Heinze
- University Clinic for Psychiatry and Psychotherapy of the Brandenburg Medical School, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
| | - Volker Dahling
- University Clinic for Psychiatry and Psychotherapy of the Brandenburg Medical School, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
| | - Tabea Ramin
- Institute of Clinical Pharmacology of the Brandenburg Medical School, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
| | - Renate Grohmann
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover, Germany
| | - Tristan Zindler
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover, Germany
| | - Sermin Toto
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover, Germany
| | - Johanna Seifert
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover, Germany
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Toto S, Grohmann R, Bleich S. Current data from the AMSP Project on the risk of treatment with
antidepressants and antipsychotics within the clinical setting. PHARMACOPSYCHIATRY 2022. [DOI: 10.1055/s-0042-1747664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- S. Toto
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover
Medical School, Germany
| | - R. Grohmann
- Department of Psychiatry and Psychotherapy,
Ludwig-Maximilian-University, Munich, Germany
| | - S. Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover
Medical School, Germany
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Friedrich ME, Grohmann R, Rabl U, Winkler D, Konstantinidis A, Engel R, Seifert J, Toto S, Stübner S, Frey R, Kasper S. Incidence of Drug-Induced Delirium During Treatment With Antidepressants or Antipsychotics: A Drug Surveillance Report of German-Speaking Countries Between 1993 and 2016. Int J Neuropsychopharmacol 2022; 25:556-566. [PMID: 35106566 PMCID: PMC9352180 DOI: 10.1093/ijnp/pyac005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 12/15/2021] [Accepted: 01/26/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Successful treatment of delirium depends on the detection of the reversible contributors. Drugs with delirogenic properties are the most prevalent reversible cause of delirium. METHODS This observational study is based on data from Arzneimittelsicherheit in der Psychiatrie, a multicenter drug surveillance program in German-speaking countries recording severe adverse drug reactions (ADRs) in psychiatric inpatients. The present study analyzes drug-induced delirium (DID) during treatment with antidepressants and antipsychotics. RESULTS A total of 436 565 psychiatric inpatients were treated with antidepressants and/or antipsychotics during the observation period from 1993 to 2016 in the participating 110 hospitals. Overall, 254 cases (0.06% of all patients treated with antidepressants and/or antipsychotics) of DID were detected. Implicated either in combination or alone (multiple drugs were implicated in 70.1% of DID), clomipramine (0.24%), amitriptyline (0.21%), and clozapine (0.18%) showed the highest incidence rates of DID. When implicated alone (98 cases overall), clozapine (0.11%) followed by amitriptyline (0.05%) were most likely causally associated with the occurrence of DID. Drugs with strong antimuscarinic properties generally exhibited higher risk of DID. CONCLUSIONS With an incidence rate of <0.1%, the use of antidepressants and antipsychotics was rarely associated with DID within the Arzneimittelsicherheit in der Psychiatrie program. Tricyclic antidepressants and clozapine were the most commonly implicated psychotropic drugs. These data support the specific role of antimuscarinic properties in DID.
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Affiliation(s)
- M E Friedrich
- Correspondence: Siegfried Kasper, MD, Professor Emeritus, Medical University of Vienna, Center for Brain Research, Department of Molecular Neuroscience, Spitalgasse 4, 1090 Vienna, Austria ()
| | - R Grohmann
- Department of Forensic Psychiatry, Ansbach, Germany,Ludwig-Maximilian-University, Munich, Germany
| | - U Rabl
- Department of Psychiatry and Psychotherapy, Division of General Psychiatry, Medical University of Vienna, Vienna, Austria
| | - D Winkler
- Department of Psychiatry and Psychotherapy, Division of General Psychiatry, Medical University of Vienna, Vienna, Austria
| | - A Konstantinidis
- Department of Psychiatry and Psychotherapy, Division of General Psychiatry, Medical University of Vienna, Vienna, Austria
| | - R Engel
- Department of Forensic Psychiatry, Ansbach, Germany,Ludwig-Maximilian-University, Munich, Germany
| | - J Seifert
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - S Toto
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - S Stübner
- Department of Forensic Psychiatry, Ansbach, Germany,Ludwig-Maximilian-University, Munich, Germany
| | - R Frey
- Department of Psychiatry and Psychotherapy, Division of General Psychiatry, Medical University of Vienna, Vienna, Austria
| | - S Kasper
- Department of Psychiatry and Psychotherapy, Division of General Psychiatry, Medical University of Vienna, Vienna, Austria,Center of Brain Research, Medical University of Vienna, Vienna, Austria
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Baumgärtner J, Grohmann R, Bleich S, Glocker C, Seifert J, Toto S, Rüther E, Engel RR, Stübner S. Atypical dyskinesias under treatment with antipsychotic drugs: Report from the AMSP multicenter drug safety project. World J Biol Psychiatry 2022; 23:151-164. [PMID: 34096837 DOI: 10.1080/15622975.2021.1938213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The aim of this study was to describe atypical dyskinesias (AtypDs) occurring during treatment with antipsychotic drugs (APDs). AtypDs are dyskinesias showing either an unusual temporal relationship between onset of treatment and start of the adverse drug reaction (ADR) or an unusual presentation of clinical symptoms. METHODS Data on the utilisation of APDs and reports of severe APD-induced AtypDs were collected using data from the observational pharmacovigilance programme - 'Arzneimittelsicherheit in der Psychiatrie (English: drug safety in psychiatry)' (AMSP) - from 1993 to 2016. RESULTS A total of 495,615 patients were monitored, of which 333,175 were treated with APDs. Sixty-seven cases (0.020%) of severe AtypDs under treatment with APDs were registered. The diagnoses of schizophrenic disorders as well as organic mental disorders were related to significantly higher rates of AtypDs. Second-generation antipsychotic drugs (SGAs) showed slightly higher rates of AtypDs (0.024%) than high-potency (0.011%) or low-potency first-generation antipsychotic drugs (FGAs; 0.006%). In 41 cases (61.2%), two or more drugs were found to cause AtypDs. CONCLUSIONS Our study indicates that AtypDs are rare ADRs. SGAs may have a higher risk for the occurrence of AtypDs than FGAs. Clinicians should be aware of this ADR and patients should be monitored and examined carefully.
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Affiliation(s)
- Jessica Baumgärtner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Renate Grohmann
- Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover, Germany
| | - Catherine Glocker
- Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany
| | - Johanna Seifert
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover, Germany
| | - Sermin Toto
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover, Germany
| | - Eckart Rüther
- Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany.,Prosomno, Clinic for Sleep Medicine, Munich, Germany
| | - Rolf R Engel
- Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany
| | - Susanne Stübner
- Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany.,Department of Forensic Psychiatry, Bezirksklinikum Ansbach, Ansbach, Germany
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9
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Greil W, de Bardeci M, Seifert J, Bernegger X, Cattapan K, Stassen H, Wagner AL, Sieberer M, Grohmann R, Toto S. Treatment of depression: Are psychotropic drugs appropriately dosed in women and in the elderly? Dosages of psychotropic drugs by sex and age in routine clinical practice. Hum Psychopharmacol 2022; 37:e2809. [PMID: 34464471 DOI: 10.1002/hup.2809] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 07/30/2021] [Accepted: 08/02/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Several researchers have shown higher concentration-dose ratios of psychotropic drugs in women and the elderly. Therefore, lower dosages of psychotropic drugs may be recommended in women and the elderly. This study describes sex- and age-related dosage of psychotropic drugs prescribed to patients with major depressive disorder (MDD) in routine clinical practice. METHOD Influence of sex and age on dosages are analysed for the 10 most commonly prescribed drugs in our dataset consisting of 32,082 inpatients with MDD. Data stems from the European drug safety program "Arzneimittelsicherheit in der Psychiatrie". The observed sex and age differences in prescriptions are compared to differences described in literature on age- and gender-related pharmacokinetics. RESULTS Among patients over 65 years, a statistically significant decrease in dosages with increasing age (between 0.65% and 2.83% for each increasing year of age) was observed, except for zopiclone. However, only slight or no influence of sex-related adjustment of dosage in prescriptions was found. CONCLUSION Age appears to influence adjustment of dosage in most psychotropic drugs, but to a lower extent than data on age-related pharmacokinetics suggests. Although literature also suggests that lower dosages of psychotropic drugs may be appropriate for females, this study found women are usually prescribed the same dosage as men.
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Affiliation(s)
- Waldemar Greil
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany.,Psychiatric Private Hospital, Sanatorium Kilchberg, Zurich, Switzerland
| | - Mateo de Bardeci
- Psychiatric Private Hospital, Sanatorium Kilchberg, Zurich, Switzerland
| | - Johanna Seifert
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Xueqiong Bernegger
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany.,Psychiatric Private Hospital, Sanatorium Kilchberg, Zurich, Switzerland
| | - Katja Cattapan
- Psychiatric Private Hospital, Sanatorium Kilchberg, Zurich, Switzerland.,University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Hans Stassen
- Psychiatric Private Hospital, Sanatorium Kilchberg, Zurich, Switzerland.,Institute for Response-Genetics, Psychiatric University Hospital (KPPP), Zurich, Switzerland
| | - Anita L Wagner
- Psychiatric Private Hospital, Sanatorium Kilchberg, Zurich, Switzerland
| | - Marcel Sieberer
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany.,Department of Psychiatry and Psychotherapy, St. Marien-Hospital, University Witten/Herdecke, Hamm, Germany
| | - Renate Grohmann
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Sermin Toto
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
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10
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Winkler D, Grohmann R, Friedrich ME, Toto S, Bleich S, Seifert J, Konstantinidis A, Shariat SF, Kasper S, Pjrek E. Urological adverse drug reactions of psychotropic medication in psychiatric inpatients - A drug surveillance report from German-speaking countries. J Psychiatr Res 2021; 144:412-420. [PMID: 34741839 DOI: 10.1016/j.jpsychires.2021.10.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 10/01/2021] [Accepted: 10/19/2021] [Indexed: 01/21/2023]
Abstract
Urological adverse drug reactions (UADR) are common during treatment with psychotropic medication. The aim of this study was to provide a systematic description of the differential profile of UADR of psychotropic drugs in a large naturalistic population. Data stems from psychiatric hospitals collected by AMSP (Arzneimittelsicherheit in der Psychiatrie), a continuous multi-center pharmacovigilance program in Austria, Germany, and Switzerland. 171 cases of severe UADR (0.037%) among a total population of 462 661 inpatients treated with psychotropic drugs in 99 psychiatric hospitals between 1993 and 2016 were examined. Urinary retention (129 cases, 0.028%) was the most common UADR followed by incontinence (23 cases, 0.005%) and nocturnal enuresis (16 cases, 0.003%). Risk of UADR was higher in patients with mania than in other diagnostic groups. Promethazine and haloperidol were the antipsychotics with the highest rate of UADR. Tricyclic antidepressants had a higher and selective serotonin reuptake inhibitors a lower risk for UADR than the respective other antidepressants. Amitriptyline and clomipramine were the most common causes of urinary retention and clozapine of urinary incontinence. This research improves our knowledge of the urological risk profiles of psychotropic drugs in inpatients and highlights compounds associated with higher or lower risk.
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Affiliation(s)
- Dietmar Winkler
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria.
| | - Renate Grohmann
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | | | - Sermin Toto
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Germany
| | - Johanna Seifert
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Germany
| | | | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York, USA; Institute for Urology and Reproductive Health, I. M. Sechenov First Moscow State Medical University, Moscow, Russia; Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - Siegfried Kasper
- Center for Brain Research, Medical University of Vienna, Austria
| | - Edda Pjrek
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
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11
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Seifert J, Heck J, Eckermann G, Singer M, Bleich S, Grohmann R, Toto S. [Vaccination Against COVID-19 in Patients Treated with Psychotropic Drugs]. Psychiatr Prax 2021; 48:399-403. [PMID: 34344044 PMCID: PMC8570910 DOI: 10.1055/a-1531-4460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Vaccines against SARS-CoV-2 have been available in the European Union since December 2020. Persons suffering from mental illness have an increased risk of a severe or fatal course following an infection with SARS-CoV-2. Thus, the question arises to what extent interactions between the newly approved vaccines and psychotropic drugs may be expected. Data on the tolerability and efficacy of vaccines against SARS-CoV-2 under treatment with psychotropic drugs are not available to date - however, potential interactions can be derived from previous investigations on vaccines against other pathogens, such as a reduced immune response with lower clinical efficacy and an increase in drug plasma levels due to the indirect vaccine-mediated inhibition of metabolizing enzymes. On the other hand, depressed patients treated with antidepressant medication show a better immune response.
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Affiliation(s)
- Johanna Seifert
- Klinik für Psychiatrie, Sozialpsychiatrie und Psychotherapie, Medizinische Hochschule Hannover, Hannover
| | - Johannes Heck
- Institut für Klinische Pharmakologie, Medizinische Hochschule Hannover, Hannover
| | - Gabriel Eckermann
- Klinik für Forensische Psychiatrie und Psychotherapie, Bezirkskrankenhaus Kaufbeuren, Kaufbeuren
| | - Monika Singer
- kbo-Lech-Mangfall-Klinik Agatharied, Fachklinik für Psychiatrie, Psychotherapie und Psychosomatik, Hausham
| | - Stefan Bleich
- Klinik für Psychiatrie, Sozialpsychiatrie und Psychotherapie, Medizinische Hochschule Hannover, Hannover
| | - Renate Grohmann
- Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität München, München
| | - Sermin Toto
- Klinik für Psychiatrie, Sozialpsychiatrie und Psychotherapie, Medizinische Hochschule Hannover, Hannover
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12
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Seifert J, Letmaier M, Greiner T, Schneider M, Deest M, Eberlein CK, Bleich S, Grohmann R, Toto S. Psychotropic drug-induced hyponatremia: results from a drug surveillance program-an update. J Neural Transm (Vienna) 2021; 128:1249-1264. [PMID: 34196782 PMCID: PMC8322004 DOI: 10.1007/s00702-021-02369-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 06/18/2021] [Indexed: 02/01/2023]
Abstract
Hyponatremia (HN) is the most common electrolyte imbalance (defined as a serum sodium concentration Na(S) of < 130 mmol/l) and often induced by drugs including psychotropic drugs. AMSP (Arzneimittelsicherheit in der Psychiatrie) is a multicenter drug surveillance program that assesses severe or unusual adverse drug reactions (ADRs) occurring during treatment with psychotropic drugs. This study presents data from 462,661 psychiatric inpatients treated in participating hospitals between 1993 and 2016 and serves as an update of a previous contribution by Letmaier et al. (JAMA 15(6):739–748, 2012). A total of 210 cases of HN were observed affecting 0.05% of patients. 57.1% of cases presented symptomatically; 19.0% presented with severe symptoms (e.g., seizures, vomiting). HN occurred after a median of 7 days following the first dose or dose increase. Incidence of HN was highest among the two antiepileptic drugs oxcarbazepine (1.661% of patients treated) and carbamazepine (0.169%), followed by selective serotonin-norepinephrine reuptake inhibitors (SSNRIs, 0.088%) and selective serotonin reuptake inhibitors (0.071%). Antipsychotic drugs, tricyclic antidepressants, and mirtazapine exhibited a significantly lower incidence of HN. The risk of HN was 16–42 times higher among patients concomitantly treated with other potentially HN-inducing drugs such as diuretic drugs, angiotensin-converting-enzyme inhibitors, angiotensin II receptor blockers, and proton pump inhibitors. Female SSNRI-users aged ≥ 65 years concomitantly using other HN-inducing drugs were the population subgroup with the highest risk of developing HN. The identification of high-risk drug combinations and vulnerable patient subgroups represents a significant step in the improvement of drug safety and facilitates the implementation of precautionary measures.
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Affiliation(s)
- Johanna Seifert
- Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - Martin Letmaier
- Department of Medical Psychology and Psychotherapy, Medical University of Graz, Auenbruggerplatz 2, 8036, Graz, Austria
| | - Timo Greiner
- Institute for Clinical Pharmacology of the Brandenburg Medical School, Immanuel Klinik Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf, Germany
| | - Michael Schneider
- Department of Psychiatry and Psychotherapy of the Brandenburg Medical School, Immanuel Klinik Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf, Germany
| | - Maximilian Deest
- Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Christian K Eberlein
- Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Renate Grohmann
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Nussbaumstr. 7, 80336, Munich, Germany
| | - Sermin Toto
- Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
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13
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Druschky K, Toto S, Bleich S, Baumgärtner J, Engel RR, Grohmann R, Maier HB, Neyazi A, Rudolph YJ, Rüther E, Schwörer H, Seifert J, Stübner S, Degner D. Severe drug-induced liver injury in patients under treatment with antipsychotic drugs: Data from the AMSP study. World J Biol Psychiatry 2021; 22:373-386. [PMID: 32892689 DOI: 10.1080/15622975.2020.1819565] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Drug-induced liver injury (DILI) has been associated with various antipsychotic drugs (APDs). Comparative studies between individual APDs are largely not available. METHODS Antipsychotic drug utilisation data and reports of severe antipsychotic DILI were assessed by using data from an observational pharmacovigilance programme-Arzneimittelsicherheit in der Psychiatrie (AMSP)-during the period 1993-2016. RESULTS Of the 333,175 patients treated with APDs, a total of 246 (0.07%) events of severe DILI were identified. Phenothiazines were associated with significantly higher rates of severe DILI (0.03%, 95% CI = 0.02-0.04) than thioxanthenes (0.01%, 95% CI = 0.00-0.02) or butyrophenones (0.01%, 95% CI = 0.00-0.01). Among individual drugs, olanzapine (0.12%, 95% CI = 0.10-0.16), perazine (0.09%, 95% CI = 0.05-0.15) and clozapine (0.09%, 95% CI = 0.10-0.12 ranked highest. In 78 cases (31.7%), combination therapies with antipsychotic and antidepressant drugs or with two or more APDs were considered responsible. Male sex and a diagnosis of mania were associated with significantly higher rates of severe DILI while older patients (≥65 years old) were significantly less often affected. CONCLUSIONS In the present analysis of a representative psychiatric inpatient cohort, olanzapine, perazine, and clozapine were the most common individual APDs associated with severe DILI.
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Affiliation(s)
- Katrin Druschky
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Sermin Toto
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Jessica Baumgärtner
- Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Augsburg, Germany
| | - Rolf R Engel
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Munich, Germany
| | - Renate Grohmann
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Munich, Germany
| | - Hannah B Maier
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Alexandra Neyazi
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Yannick J Rudolph
- Department of Psychiatry and Psychotherapy, Georg-August University of Goettingen, Goettingen, Germany
| | - Eckart Rüther
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Munich, Germany
| | - Harald Schwörer
- Department of Gastroenterology and Gastrointestinal Oncology, Liver Center Goettingen, University Medical Center Goettingen, Georg-August University of Goettingen, Göttingen, Germany
| | - Johanna Seifert
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Susanne Stübner
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Munich, Germany.,Department of Forensic Psychiatry, Kbo-IAK, Academic Teaching Hospital of the Ludwig-Maximilian University, Munich, Germany
| | - Detlef Degner
- Department of Psychiatry and Psychotherapy, Georg-August University of Goettingen, Goettingen, Germany
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14
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Moschny N, Hefner G, Grohmann R, Eckermann G, Maier HB, Seifert J, Heck J, Francis F, Bleich S, Toto S, Meissner C. Therapeutic Drug Monitoring of Second- and Third-Generation Antipsychotic Drugs-Influence of Smoking Behavior and Inflammation on Pharmacokinetics. Pharmaceuticals (Basel) 2021; 14:514. [PMID: 34071813 PMCID: PMC8230242 DOI: 10.3390/ph14060514&set/a 947965394+957477086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Both inflammation and smoking can influence a drug's pharmacokinetic properties, i.e., its liberation, absorption, distribution, metabolism, and elimination. Depending on, e.g., pharmacogenetics, these changes may alter treatment response or cause serious adverse drug reactions and are thus of clinical relevance. Antipsychotic drugs, used in the treatment of psychosis and schizophrenia, should be closely monitored due to multiple factors (e.g., the narrow therapeutic window of certain psychotropic drugs, the chronicity of most mental illnesses, and the common occurrence of polypharmacotherapy in psychiatry). Therapeutic drug monitoring (TDM) aids with drug titration by enabling the quantification of patients' drug levels. Recommendations on the use of TDM during treatment with psychotropic drugs are presented in the Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology; however, data on antipsychotic drug levels during inflammation or after changes in smoking behavior-both clinically relevant in psychiatry-that can aid clinical decision making are sparse. The following narrative review provides an overview of relevant literature regarding TDM in psychiatry, particularly in the context of second- and third-generation antipsychotic drugs, inflammation, and smoking behavior. It aims to spread awareness regarding TDM (most pronouncedly of clozapine and olanzapine) as a tool to optimize drug safety and provide patient-tailored treatment.
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Affiliation(s)
- Nicole Moschny
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (H.B.M.); (J.S.); (F.F.); (S.B.); (S.T.); (C.M.)
- Correspondence: ; Tel.: +49-511-532-3656
| | - Gudrun Hefner
- Department of Psychiatry and Psychotherapy, Vitos Clinic for Forensic Psychiatry, Kloster-Eberbach-Str. 4, 65346 Eltville, Germany;
| | - Renate Grohmann
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Nussbaum-Str. 7, 80336 Munich, Germany;
| | - Gabriel Eckermann
- Department of Forensic Psychiatry and Psychotherapy, Hospital Kaufbeuren, Kemnater-Str. 16, 87600 Kaufbeuren, Germany;
| | - Hannah B Maier
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (H.B.M.); (J.S.); (F.F.); (S.B.); (S.T.); (C.M.)
| | - Johanna Seifert
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (H.B.M.); (J.S.); (F.F.); (S.B.); (S.T.); (C.M.)
| | - Johannes Heck
- Institute for Clinical Pharmacology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany;
| | - Flverly Francis
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (H.B.M.); (J.S.); (F.F.); (S.B.); (S.T.); (C.M.)
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (H.B.M.); (J.S.); (F.F.); (S.B.); (S.T.); (C.M.)
| | - Sermin Toto
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (H.B.M.); (J.S.); (F.F.); (S.B.); (S.T.); (C.M.)
| | - Catharina Meissner
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (H.B.M.); (J.S.); (F.F.); (S.B.); (S.T.); (C.M.)
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15
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Seifert J, Führmann F, Reinhard MA, Engel RR, Bernegger X, Bleich S, Stübner S, Rüther E, Toto S, Grohmann R, Sieberer M, Greil W. Sex differences in pharmacological treatment of major depressive disorder: results from the AMSP pharmacovigilance program from 2001 to 2017. J Neural Transm (Vienna) 2021; 128:827-843. [PMID: 33977402 PMCID: PMC8205885 DOI: 10.1007/s00702-021-02349-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/02/2021] [Indexed: 12/25/2022]
Abstract
Data on drug prescription for outpatients with major depressive disorder (MDD) suggest women are more likely to be treated with psychotropic drugs, while data on sex differences regarding pharmacological treatment of psychiatric inpatients are currently not available. Drug utilization data from the program "Drug Safety in Psychiatry" (German: Arzneimittelsicherheit in der Psychiatrie, AMSP) of 44,418 psychiatric inpatients with MDD were analyzed for sex differences between 2001 and 2017. Sex differences were analyzed using relative risks (RR) and 95% confidence intervals (95% CI). Time trends were analyzed by comparing the first (2001-2003) with the last time period (2015-2017). In general, men and women were equally likely to use psychotropic drugs. Monotherapy was more common in men. Women were more likely to utilize ≥ 4 psychotropic drugs. Antidepressant drugs (ADDs) were the most prescribed drug class. Men had a higher utilization of noradrenergic and specific serotonergic antidepressants (RR 1.15; 95% CI 1.12-1.19), especially mirtazapine (RR 1.16; 95% CI 1.12-1.19), but also of other ADDs such as bupropion (RR 1.50; 95% CI 1.35-1.68). Males had a slightly higher utilization of second-generation antipsychotic drugs (RR 1.06; 95% CI 1.03-1.09) and were less often treated with low-potency first-generation antipsychotic drugs (RR 0.86; 95% CI 0.83-0.90). Tranquilizing (e.g., benzodiazepines; RR 0.89; 95% CI 0.86-0.92) and hypnotic drugs (e.g., Z-drugs; RR 0.85; 95% CI 0.81-0.89) were less utilized in the treatment of male patients. Not all sex differences were stable over time. More sex differences were detectable in 2015-2017 than in 2001-2003. Findings suggest that certain psychotropic drugs are preferred in the treatment of men vs. women, however, sex differences found in this study are not as large as in ambulatory settings. To make evidence-based sex-specific recommendations in the treatment of MDD, differences in drug response and tolerability need to be further researched.
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Affiliation(s)
- Johanna Seifert
- Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - Fabienne Führmann
- Department of Psychiatry and Psychotherapy, KRH Psychiatrie GmbH, Wunstorf, Germany
| | - Matthias A Reinhard
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany
| | - Rolf R Engel
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany
| | - Xueqiong Bernegger
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany.,Department of Psychiatry and Psychotherapy, University Witten/Herdecke, Witten, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Susanne Stübner
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany.,Department of Forensic Psychiatry, Bezirksklinikum Ansbach, Ansbach, Germany
| | - Eckart Rüther
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany.,Prosomno, Clinic for Sleep Medicine, Munich, Germany
| | - Sermin Toto
- Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Renate Grohmann
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany
| | - Marcel Sieberer
- Department of Psychiatry, Psychotherapy, and Psychosomatics, St. Marien-Hospital Hamm gGmbH, Hamm, Germany.,Department of Psychiatry and Psychotherapy, University Witten/Herdecke, Witten, Germany
| | - Waldemar Greil
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany.,Psychiatric Private Hospital, Sanatorium Kilchberg, Kilchberg, Switzerland
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16
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Heck J, Seifert J, Stichtenoth DO, Schroeder C, Groh A, Szycik GR, Degner D, Adamovic I, Schneider M, Glocker C, Rüther E, Bleich S, Grohmann R, Toto S. A case series of serious and unexpected adverse drug reactions under treatment with cariprazine. Clin Case Rep 2021; 9:e04084. [PMID: 34084502 PMCID: PMC8142394 DOI: 10.1002/ccr3.4084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/15/2021] [Accepted: 03/14/2021] [Indexed: 01/20/2023] Open
Abstract
Reporting of new or unexpected adverse drug reactions of medicines that are subject to additional monitoring ("black triangle" label), such as the antipsychotic drug cariprazine, is of paramount importance to improve pharmacotherapy safety.
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Affiliation(s)
- Johannes Heck
- Institute for Clinical PharmacologyHannover Medical SchoolHannoverGermany
| | - Johanna Seifert
- Department of PsychiatrySocial Psychiatry and PsychotherapyHannover Medical SchoolHannoverGermany
| | - Dirk O. Stichtenoth
- Institute for Clinical PharmacologyHannover Medical SchoolHannoverGermany
- Drug Commissioner of Hannover Medical SchoolHannoverGermany
| | - Christoph Schroeder
- Institute for Clinical PharmacologyHannover Medical SchoolHannoverGermany
- Head of Pharmacovigilance of Hannover Medical SchoolHannoverGermany
| | - Adrian Groh
- Department of PsychiatrySocial Psychiatry and PsychotherapyHannover Medical SchoolHannoverGermany
| | - Gregor R. Szycik
- Department of PsychiatrySocial Psychiatry and PsychotherapyHannover Medical SchoolHannoverGermany
| | - Detlef Degner
- Department of Psychiatry and PsychotherapyGeorg August University of GöttingenGöttingenGermany
| | - Ivana Adamovic
- Department of Psychiatry and PsychotherapyGeorg August University of GöttingenGöttingenGermany
| | - Michael Schneider
- University Clinic for Psychiatry and PsychotherapyBrandenburg Medical SchoolImmanuel KlinikRüdersdorfGermany
| | - Catherine Glocker
- Department of Psychiatry and PsychotherapyLudwig Maximilian University of MunichMunichGermany
| | - Eckart Rüther
- Department of Psychiatry and PsychotherapyLudwig Maximilian University of MunichMunichGermany
- Prosomno Klinik und Poliklinik für SchlafmedizinMunichGermany
| | - Stefan Bleich
- Department of PsychiatrySocial Psychiatry and PsychotherapyHannover Medical SchoolHannoverGermany
| | - Renate Grohmann
- Department of Psychiatry and PsychotherapyLudwig Maximilian University of MunichMunichGermany
| | - Sermin Toto
- Department of PsychiatrySocial Psychiatry and PsychotherapyHannover Medical SchoolHannoverGermany
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17
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Seifert J, Engel RR, Bernegger X, Führmann F, Bleich S, Stübner S, Sieberer M, Greil W, Toto S, Grohmann R. Time trends in pharmacological treatment of major depressive disorder: Results from the AMSP Pharmacovigilance Program from 2001-2017. J Affect Disord 2021; 281:547-556. [PMID: 33401143 DOI: 10.1016/j.jad.2020.12.073] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Currently available data on the prescription practice among patients with major depressive disorder (MDD) reflect the outpatient setting. This is the first study to provide information on time trends of psychotropic drug utilization in psychiatric inpatients. METHOD Data stems from German-speaking psychiatric hospitals collected by the program "Drug Safety in Psychiatry" (Arzneimittelsicherheit in der Psychiatrie, AMSP) between 2001 and 2017. 44,418 psychiatric inpatients with MDD were included. Time trends in drug utilization were analyzed by comparing the first (2001-2003) and last time point (2015-2017) using risk ratios (RR). RESULTS Antidepressant drugs (ADD) were the most used psychotropic drug class with utilization decreasing slightly from 2001-2003 (89.7%) to 2015-2017 (85.5%). Use of tricyclic ADDs showed the greatest decline (RR 0.35), while use of selective serotonin-noradrenaline reuptake inhibitors (RR 1.72) and "other ADDs" increased the most. Use of antipsychotic drugs (APD), especially second-generation antipsychotic drugs (RR 1.46), increased. Use of tranquilizing (RR 0.71) and hypnotic drugs (RR 0.43) both decreased. Most patients were treated with more than one psychotropic drug, most often ADD + APD, which was utilized more often in 2015-2017 (51.1%) than in 2001-2003 (45.1%; RR 1.13). Combination of two ADDs increased from 2001-2003 (24.5%) to 2015-2017 (33.0%; RR 1.35). LIMITATIONS The cross-sectional design does not allow conclusions to be drawn about causal relationship of findings. Further, only certain clinical and sociodemographic data was available. CONCLUSION Treatment of MDD has shown significant changes from 2001 to 2017.
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Affiliation(s)
- Johanna Seifert
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany.
| | - Rolf R Engel
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Xueqiong Bernegger
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany; Psychiatric Private Hospital, Sanatorium Kilchberg, Switzerland
| | - Fabienne Führmann
- Department of Psychiatry and Psychotherapy, KRH Psychiatrie GmbH, Wunstorf, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Susanne Stübner
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany; Department of Forensic Psychiatry, Bezirksklinikum Ansbach, Ansbach, Germany
| | - Marcel Sieberer
- Department of Psychiatry, Psychotherapy, and Psychosomatics, St. Marien-Hospital Hamm gGmbH, Hamm, Germany; Department of Psychiatry and Psychotherapy, University Witten/Herdecke, Witten, Germany
| | - Waldemar Greil
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany; Psychiatric Private Hospital, Sanatorium Kilchberg, Switzerland
| | - Sermin Toto
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Renate Grohmann
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
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18
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Reinhard MA, Seifert J, Greiner T, Toto S, Bleich S, Grohmann R. Pharmacotherapy of 1,044 inpatients with posttraumatic stress disorder: current status and trends in German-speaking countries. Eur Arch Psychiatry Clin Neurosci 2021; 271:1065-1076. [PMID: 33369692 PMCID: PMC8354906 DOI: 10.1007/s00406-020-01223-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/12/2020] [Indexed: 01/13/2023]
Abstract
Posttraumatic stress disorder (PTSD) is a debilitating psychiatric disorder with limited approved pharmacological treatment options and high symptom burden. Therefore, real-life prescription patterns may differ from guideline recommendations, especially in psychiatric inpatient settings. The European Drug Safety Program in Psychiatry ("Arzneimittelsicherheit in der Psychiatrie", AMSP) collects inpatients' prescription rates cross-sectionally twice a year in German-speaking psychiatric hospitals. For this study, the AMSP database was screened for psychiatric inpatients with a primary diagnosis of PTSD between 2001 and 2017. N = 1,044 patients with a primary diagnosis of PTSD were identified with 89.9% taking psychotropics. The average prescription rate was 2.4 (standard deviation: 1.5) psychotropics per patient with high rates of antidepressant drugs (72.0%), antipsychotics drugs (58.4%) and tranquilizing drugs (29.3%). The presence of psychiatric comorbidities was associated with higher rates of psychotropic drug use. The most often prescribed substances were quetiapine (24.1% of all patients), lorazepam (18.1%) and mirtazapine (15.0%). The use of drugs approved for PTSD was low (sertraline 11.1%; paroxetine 3.7%). Prescription rates of second-generation antipsychotic drugs increased, while the use of tranquilizing drugs declined over the years. High prescription rates and extensive use of sedative medication suggest a symptom-driven prescription (e.g., hyperarousal, insomnia) that can only be explained to a minor extent by existing comorbidities. The observed discrepancy with existing guidelines underlines the need for effective pharmacological and psychological treatment options in psychiatric inpatient settings.
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Affiliation(s)
- Matthias A Reinhard
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Nußbaumstr. 7, 80336, Munich, Bavaria, Germany.
| | - Johanna Seifert
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Timo Greiner
- Brandenburg Medical School, Immanuel Klinik Rüdersdorf, University Clinic for Psychiatry and Psychotherapy, Seebad 82/83, 15562, Rüdersdorf bei Berlin, Germany
| | - Sermin Toto
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Renate Grohmann
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Nußbaumstr. 7, 80336, Munich, Bavaria, Germany
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19
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Abstract
Im Rahmen der aktuellen coronavirus disease 2019(COVID-19)-Pandemie müssen sich viele Bereiche der Medizin umstrukturieren. Dies betrifft auch die Versorgung von Patienten mit psychischen Erkrankungen. Die Therapie psychischer Erkrankungen umfasst psychotherapeutische und psychopharmakologische Interventionen. Letztere können mit einer Vielzahl an unerwünschten Arzneimittelwirkungen (UAW) assoziiert sein, stellen aber in der aktuellen Situation mit Kontakt- und Ausgangsbeschränkungen die präferierte Therapieoption dar. Da der direkte Patientenkontakt zugunsten des Telefonats oder der Videokonferenz reduziert ist, müssen angepasste diagnostische und therapeutische Optionen gefunden werden, um eine ausreichende Patientensicherheit zu gewährleisten. Bedeutend sind hierbei die ausführliche Aufklärung der Patienten sowie eine aktive Abfrage von Symptomen zur rechtzeitigen Erkennung von UAW. Unter der Behandlung mit Psychopharmaka sind UAW zu befürchten, die besonders ungünstig sind, wenn sie im Rahmen einer akuten Infektion auftreten oder ein erhöhtes Infektionsrisiko begünstigen. Hierzu gehören Atemdepression, Agranulozytose, Intoxikation durch Hemmung des Arzneistoffmetabolismus und venöse Thromboembolien, die jeweils mit potenziell lebensbedrohlichen Folgen einhergehen. Gleichzeitig sollte auf eine ausreichende Wirksamkeit der Medikation geachtet werden, da die gegenwärtige Krise zu einer Exazerbation vorbestehender psychischer Erkrankungen führen bzw. deren Erstmanifestation begünstigen kann.
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Affiliation(s)
- J Seifert
- Klinik für Psychiatrie, Sozialpsychiatrie und Psychotherapie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland.
| | - J Heck
- Klinik für Psychiatrie, Sozialpsychiatrie und Psychotherapie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland
- Institut für Klinische Pharmakologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - G Eckermann
- Klinik für Forensische Psychiatrie und Psychotherapie, Bezirkskrankenhaus Kaufbeuren, Kaufbeuren, Deutschland
| | - M Singer
- Fachklinik für Psychiatrie, Psychotherapie und Psychosomatik, kbo-Lech-Mangfall-Klinik Agatharied, Hausham, Deutschland
| | - S Bleich
- Klinik für Psychiatrie, Sozialpsychiatrie und Psychotherapie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland
| | - R Grohmann
- Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität München, München, Deutschland
| | - S Toto
- Klinik für Psychiatrie, Sozialpsychiatrie und Psychotherapie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland
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20
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Toto S, Grohmann R, Bleich S. 26 Current data from the AMSP Project on the risk of treatment with antidepressants and antipsychotics within the clinical setting. PHARMACOPSYCHIATRY 2020. [DOI: 10.1055/s-0040-1710134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- S Toto
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School
| | - R Grohmann
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University
| | - S Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School
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21
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Mörkl S, Seltenreich D, Letmaier M, Bengesser S, Wurm W, Grohmann R, Bleich S, Toto S, Stübner S, Butler MI, Kasper S. Extrapyramidal reactions following treatment with antidepressants: Results of the AMSP multinational drug surveillance programme. World J Biol Psychiatry 2020; 21:308-316. [PMID: 31347932 DOI: 10.1080/15622975.2019.1648871] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objectives: Extrapyramidal symptoms (EPS) are a common adverse effect of antipsychotics. However, there are case reports describing EPS following treatment with antidepressants. It is not fully understood how antidepressants cause EPS, but a serotonergic input to dopaminergic pathways is a probable mechanism of action.Methods: Data from a multicenter drug-surveillance programme (AMSP, 'drug safety in psychiatry') which systemically documents severe drug reactions during psychiatric inpatient admissions, were reviewed to assess for EPS associated with antidepressant treatment. We identified 15 such cases, which were studied to detect similarities and to characterise risk factors.Results: We report on 15 patients with EPS following antidepressant-therapy between 1994 and 2016. EPS frequently occurred with selective serotonin reuptake inhibitor (SSRI) treatment alone (7/15 cases) or concomitant SSRI treatment (6/15 cases). EPS were most frequent with escitalopram-treatment (5 cases). The most common EPS was atypical dyskinesia (6/15 cases) followed by akathisia (4/15 cases). The mean age of onset for EPS was 54.93 years (SD 17.9). EPS occurred at any dosage and equally often in men and women.Conclusions: Our results highlight the possibility of EPS as an important, although uncommon, adverse effect of antidepressants. Clinicians should beware of this adverse effect and monitor early warning signs carefully.
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Affiliation(s)
- Sabrina Mörkl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Daniel Seltenreich
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Martin Letmaier
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Susanne Bengesser
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Walter Wurm
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Renate Grohmann
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Sermin Toto
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Susanne Stübner
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Mary I Butler
- Department of Psychiatry and Neurobehavioral Science, University College Cork, Cork, Ireland
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
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22
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Greiner T, Haack B, Toto S, Bleich S, Grohmann R, Faltraco F, Heinze M, Schneider M. Pharmacotherapy of psychiatric inpatients with adjustment disorder: current status and changes between 2000 and 2016. Eur Arch Psychiatry Clin Neurosci 2020; 270:107-117. [PMID: 31440829 DOI: 10.1007/s00406-019-01058-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 08/13/2019] [Indexed: 01/03/2023]
Abstract
Adjustment disorder is a temporary change in behaviour or emotion as a reaction to a stress factor. Therapy consists of psychotherapy, and pharmacotherapy can be advised. However, data on the real-life pharmacological treatment are sparse. Prescription data for 4.235 psychiatric inpatients diagnosed with adjustment disorder in the time period 2000-2016 were analysed. The data were obtained from the Drug Safety Programme in Psychiatry (AMSP). Data were collected on two reference days per year; prescription patterns and changes over time were analysed. Of all patients, 81.2% received some type of psychotropic drug. Mostly antidepressants (59.8%), antipsychotics (35.5%), and tranquilisers (22.6%) were prescribed. Prescription rates for antidepressants decreased slightly over the years, while rates for antipsychotics increased, especially for atypical antipsychotics. It is important to note that the diagnosis "adjustment disorder" is most likely a working diagnosis that is used for patients in immediate need of psychiatric aid. Overall, pharmacotherapy for inpatients with this diagnosis is mostly symptom-oriented and focuses on depressive moods, agitation and anxiety. Therapy regimes changed over time and show an increased use of atypical antipsychotics with sedative properties. However, for most of the medication, there are neither evidence-based studies nor guidelines, and drugs might be contraindicated in some cases.
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Affiliation(s)
- Timo Greiner
- Brandenburg Medical School, Immanuel Klinik Rüdersdorf, University Clinic for Psychiatry and Psychotherapy, 15562, Rüdersdorf, Germany.
| | - Beatrice Haack
- Brandenburg Medical School, Immanuel Klinik Rüdersdorf, University Clinic for Psychiatry and Psychotherapy, 15562, Rüdersdorf, Germany
| | - Sermin Toto
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, 30625, Hannover, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, 30625, Hannover, Germany
| | - Renate Grohmann
- Department of Psychiatry, Ludwig-Maximilians-University, 80336, Munich, Germany
| | - Frank Faltraco
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsmedizin Rostock, 18147, Rostock, Germany
| | - Martin Heinze
- Brandenburg Medical School, Immanuel Klinik Rüdersdorf, University Clinic for Psychiatry and Psychotherapy, 15562, Rüdersdorf, Germany
| | - Michael Schneider
- Brandenburg Medical School, Immanuel Klinik Rüdersdorf, University Clinic for Psychiatry and Psychotherapy, 15562, Rüdersdorf, Germany
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23
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Schneider M, Regente J, Greiner T, Lensky S, Bleich S, Toto S, Grohmann R, Stübner S, Heinze M. Neuroleptic malignant syndrome: evaluation of drug safety data from the AMSP program during 1993-2015. Eur Arch Psychiatry Clin Neurosci 2020; 270:23-33. [PMID: 30506147 DOI: 10.1007/s00406-018-0959-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 11/21/2018] [Indexed: 02/02/2023]
Abstract
Neuroleptic malignant syndrome (NMS) is a rare, but severe adverse drug reaction of drugs with anti-dopaminergic properties. The main symptoms are fever and rigor. In addition, other symptoms such as creatine kinase elevation, alteration of consciousness and various neurological symptoms may occur. A total of 52 NMS cases have been documented in the drug safety program 'Arzneimittelsicherheit in der Psychiatrie' from 1993 to 2015. We calculated incidences and analyzed imputed substances and additional risk factors to study the impact of changing therapy regimes. The overall incidence was 0.16‰. High-potency first-generation antipsychotics (FGAs) had the highest incidences, e.g. flupentixol with 0.61‰. Second-generation antipsychotics (SGAs) had lower incidences. Low-potency FGAs had very low incidences, comparable to SGAs, but in contrast to SGAs, had not been imputed alone in any case of NMS. Preexisting organic pathologies of the central nervous system, lithium treatment, infection/exsiccosis and the withdrawal of medication with anticholinergic properties or alcohol were found to be additional risk factors. With the increasing use of SGAs, one should always be aware of the risk of NMS. Better suited diagnostic criteria for 'atypical NMS' would lead to a better understanding and, therefore, to improved treatment possibilities.
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Affiliation(s)
- Michael Schneider
- University Clinic for Psychiatry and Psychotherapy, Brandenburg Medical School, Immanuel Klinik Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf bei Berlin, Germany.
| | - Johannes Regente
- University Clinic for Psychiatry and Psychotherapy, Brandenburg Medical School, Immanuel Klinik Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf bei Berlin, Germany.,Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Timo Greiner
- University Clinic for Psychiatry and Psychotherapy, Brandenburg Medical School, Immanuel Klinik Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf bei Berlin, Germany
| | - Stephanie Lensky
- University Clinic for Psychiatry and Psychotherapy, Brandenburg Medical School, Immanuel Klinik Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf bei Berlin, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Sermin Toto
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Renate Grohmann
- Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany
| | - Susanne Stübner
- Department of Psychiatry, Kbo-IAK, Academic Teaching Hospital of the Ludwig-Maximilians University, Haar, Munich, Germany
| | - Martin Heinze
- University Clinic for Psychiatry and Psychotherapy, Brandenburg Medical School, Immanuel Klinik Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf bei Berlin, Germany
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24
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Friedrich ME, Winkler D, Konstantinidis A, Huf W, Engel R, Toto S, Grohmann R, Kasper S. Cardiovascular Adverse Reactions During Antipsychotic Treatment: Results of AMSP, A Drug Surveillance Program Between 1993 and 2013. Int J Neuropsychopharmacol 2020; 23:67-75. [PMID: 31504560 PMCID: PMC7093998 DOI: 10.1093/ijnp/pyz046] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/12/2019] [Accepted: 08/28/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Cardiovascular diseases are still the leading cause of global mortality. Some antipsychotic agents can show severe cardiovascular side effects and are also associated with metabolic syndrome. METHODS This observational study was based on data of AMSP (Arzneimittelsicherheit in der Psychiatrie), a multicenter drug surveillance program in Austria, Germany and Switzerland, that recorded severe drug reactions in psychiatric inpatients. RESULTS A total of 404 009 inpatients were monitored between 1993 and 2013, whereas 291 510 were treated with antipsychotics either in combination or alone. There were 376 cases of severe cardiovascular adverse reactions reported in the given timespan, yielding a relative frequency of 0.13%. The study revealed that incidence rates of cardiovascular adverse reactions were highest during treatment with ziprasidone (0.35%), prothipendyl (0.32%), and clozapine (0.23%). The lowest rate of cardiovascular symptoms occurred during treatment with promethazine (0.03%) as well as with aripiprazole (0.06%). The most common clinical symptoms were orthostatic collapse and severe hypotonia, sinustachycardia, QTc prolongation, myocarditis, and different forms of arrhythmia. The dosage at the timepoint when severe cardiovascular events occurred was not higher in any of the given antipsychotics than in everyday clinical practice and was in average therapeutic ranges. In terms of subclasses of antipsychotics, no significant statistical difference was seen in the overall frequencies of adverse reactions cases, when first-generation high potency, first-generation low potency, and second-generation antipsychotics were compared. Thirty percent of adverse events among second-generation antipsychotics were induced by clozapine. CONCLUSIONS Our findings on cardiovascular adverse reactions contribute to a better understanding of cardiovascular risk profiles of antipsychotic agents in inpatients.
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Affiliation(s)
- Michaela-Elena Friedrich
- Department of Psychiatry and Psychotherapy, Division of General Psychiatry, Medical University of Vienna, Austria
| | - Dietmar Winkler
- Department of Psychiatry and Psychotherapy, Division of General Psychiatry, Medical University of Vienna, Austria
| | - Anastasios Konstantinidis
- Department of Psychiatry and Psychotherapy, Division of General Psychiatry, Medical University of Vienna, Austria
| | - Wolfgang Huf
- Karl Landsteiner Institute for Clinical Risk Management, Vienna, Austria
| | | | - Sermin Toto
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Germany
| | - Renate Grohmann
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Division of General Psychiatry, Medical University of Vienna, Austria
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25
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Druschky K, Bleich S, Grohmann R, Engel RR, Neyazi A, Stübner S, Toto S. Seizure rates under treatment with antipsychotic drugs: Data from the AMSP project. World J Biol Psychiatry 2019; 20:732-741. [PMID: 30058414 DOI: 10.1080/15622975.2018.1500030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objectives: The study aimed to assess seizure rates related to different antipsychotic drugs (APDs) in a clinical setting using data from the drug safety programme Arzneimittelsicherheit in der Psychiatrie (AMSP).Methods: Psychotropic drug use data and reports of APD-related seizures were collected in 89 psychiatric hospitals in Austria, Germany and Switzerland from 1993 to 2015.Results: Of 475,096 patients under surveillance, 320,383 patients were treated with APDs for the main indications of schizophrenic disorders, mood disorders and organic disorders. A total of 144 APD-related tonic clonic seizures were identified (0.04%). The butyrophenones ranked slightly lower (0.03%) compared to the phenothiazines, thioxanthenes and second-generation APDs (0.05% each). No significant differences were observed when comparing first- and second-generation APDs. Clozapine was related to the highest seizure rate (0.18%). In 107 cases (74.3%), more than one drug was considered responsible for seizure induction. With the exception of clozapine, seizures imputed to a single APD were in the clear minority. Seizure rates under the combinations of APDs with tricyclic antidepressants or lithium, as well as under triple combinations of APDs, were increased approximately two-fold. Young age (≤30 years), the male gender, and diagnosis of schizophrenic disorder were associated with significantly higher seizure rates (P < 0.05).Conclusions: Closely reflecting daily clinical practice, the present results provide supplementary information regarding APD therapy for patients not only at risk for seizures but also seizure-unaffected psychiatric inpatients.
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Affiliation(s)
- Katrin Druschky
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Renate Grohmann
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Munich, Germany
| | - Rolf R Engel
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Munich, Germany
| | - Alexandra Neyazi
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Susanne Stübner
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Munich, Germany
| | - Sermin Toto
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
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26
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Abstract
Objective: Priapism is a rare adverse effect of several psychotropics. Both, typical and atypical antipsychotics, as well as trazodone are known to cause priapism. The mechanism is still not fully understood, however, the most common assumption is that priapism occurs due to the α-adrenergic blocking effects of the drugs. Methods: Here we present from the AMSP database 19 cases of priapism being likely caused by a variety of psychotropics. We further reviewed case reports in order to find similarities and to identify risk factors. Results: Several patterns emerged: common was the introduction of a specific drug to a patient resulting into the immediate development of priapism, as well as a change in drug plasma concentration due to a change of drug dosage or due to comedication with certain SSRIs. Conclusion: However, priapism can occur at nearly any age and with any dose. Clinicians must be aware of the risk and reports of early signs, such as prolonged erections, should be taken seriously.
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Affiliation(s)
- Timo Greiner
- University Clinic for Psychiatry and Psychotherapy, Brandenburg Medical School , Rüdersdorf , Germany
| | - Michael Schneider
- University Clinic for Psychiatry and Psychotherapy, Brandenburg Medical School , Rüdersdorf , Germany
| | - Johannes Regente
- University Clinic for Psychiatry and Psychotherapy, Brandenburg Medical School , Rüdersdorf , Germany.,Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin , Berlin , Germany
| | - Sermin Toto
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School , Hannover , Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School , Hannover , Germany
| | - Renate Grohmann
- Department of Psychiatry, Ludwig-Maximilians University , Munich , Germany
| | - Martin Heinze
- University Clinic for Psychiatry and Psychotherapy, Brandenburg Medical School , Rüdersdorf , Germany
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27
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Toto S, Grohmann R, Bleich S, Frieling H, Maier HB, Greil W, Cordes J, Schmidt-Kraepelin C, Kasper S, Stübner S, Degner D, Druschky K, Zindler T, Neyazi A. Psychopharmacological Treatment of Schizophrenia Over Time in 30 908 Inpatients: Data From the AMSP Study. Int J Neuropsychopharmacol 2019; 22:560-573. [PMID: 31263888 PMCID: PMC6754736 DOI: 10.1093/ijnp/pyz037] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 05/28/2019] [Accepted: 06/30/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Psychotropic drugs are the cornerstone of schizophrenia treatment, often requiring lifelong treatment. Data on pharmacotherapy in inpatient settings are lacking. METHODS Prescription data of schizophrenic inpatients within the time period 2000-2015 were obtained from the database of the Drug Safety Program in Psychiatry (AMSP). Data were collected at 2 index dates per year; the prescription patterns and changes over time were analyzed. RESULTS Among 30 908 inpatients (mean age 41.6 years, 57.8% males), the drug classes administered most often were antipsychotics (94.8%), tranquilizers (32%), antidepressants (16.5%), antiparkinsonians (16%), anticonvulsants (14.1%), hypnotics (8.1%), and lithium (2.1%). The use of second-generation antipsychotics significantly increased from 62.8% in 2000 to 88.9% in 2015 (P < .001), whereas the prescription of first-generation antipsychotics decreased from 46.6% in 2000 to 24.7% in 2015 (P < .001). The administration of long-acting injectable antipsychotics decreased from 15.2% in 2000 to 11.7% in 2015 (P = .006). Clopazine was the most often used antipsychotic, having been used for 21.3% of all patients. Polypharmacy rates (≥5 drugs) increased from 19% in 2000 to 26.5% in 2015. Psychiatric polypharmacy (≥3 psychotropic drugs) was present in 44.7% of patients. CONCLUSIONS Combinations of antipsychotics and augmentation therapies with other drug classes are frequently prescribed for schizophrenic patients. Though treatment resistance and unsatisfactory functional outcomes reflect clinical necessity, further prospective studies are needed on real-world prescription patterns in schizophrenia to evaluate the efficacy and safety of this common practice.
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Affiliation(s)
- Sermin Toto
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany,Correspondence: Sermin Toto, MD, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str.1, 30625 Hannover, Germany ()
| | - Renate Grohmann
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Helge Frieling
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Hannah B Maier
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Waldemar Greil
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany,Psychiatric Private Hospital, Sanatorium Kilchberg, Switzerland
| | - Joachim Cordes
- Department of Psychiatry and Psychotherapy, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
| | - Christian Schmidt-Kraepelin
- Department of Psychiatry and Psychotherapy, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Division of Biological Psychiatry, Medical University of Vienna, Austria
| | - Susanne Stübner
- Department of Psychiatry, Kbo-IAK, Academic Teaching Hospital of the Ludwig-Maximilian University, Haar/ Munich, Germany
| | - Detlef Degner
- Department of Psychiatry and Psychotherapy, Georg-August University of Göttingen, Göttingen, Germany
| | - Katrin Druschky
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Tristan Zindler
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Alexandra Neyazi
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
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Greil W, Zhang X, Stassen H, Grohmann R, Bridler R, Hasler G, Toto S, Bleich S, Kasper S. Cutaneous adverse drug reactions to psychotropic drugs and their risk factors - a case-control study. Eur Neuropsychopharmacol 2019; 29:111-121. [PMID: 30424913 DOI: 10.1016/j.euroneuro.2018.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 09/11/2018] [Accepted: 10/23/2018] [Indexed: 01/01/2023]
Abstract
Cutaneous adverse drug reactions (CADRs) in patients with psychotropic drugs are common. Large studies on the relevant drugs and other risk factors are still scarce. 594 cases of severe CADRs ("cases") were compared with 8085 cases of other adverse drug reactions ("non-cases") documented in a pharmacovigilance program in psychiatry (AMSP) from 1993 to 2014. Logistic regression was carried out to determine risk factors and between-drug differences. CADRs were relatively more prevalent in patients treated with clomipramine, maprotiline, carbamazepine, lamotrigine, acamprosate, clomethiazole and disulfiram as well as with antidepressants and anticonvulsants as drug classes (p < 0.01). For these drugs, significantly more women were found in patients using maprotiline, lamotrigine (not carbamazepine) and in the groups of antidepressants, tricyclics and anticonvulsants (p < 0.01). Women were more vulnerable to CADRs (67% in cases and 56% in non-cases, p < 0.01). The significantly higher rate of CADRs in women was mainly observed under age of 50 years, i.e. during female reproductive years. In a multivariate logistic regression, female sex, the diagnostic group ICD F1 (substance abuse), maprotiline, carbamazepine, lamotrigine and clomethiazole were identified as risk factors of CADRs. The case/non-case approach allowed to identify risk factors based on empirical data rather than experts' evaluations. The new findings of substance abuse and clomethiazole as risk factors for CADRs have to be confirmed in further studies. Since CADRs can be life-threatening, it is important to be aware of risk factors, especially women during their reproductive period and with lamotrigine treatment.
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Affiliation(s)
- Waldemar Greil
- Department of Psychiatry, Ludwig-Maximilian University, Nussbaumstr. 7, Munich D-80331, Germany; Psychiatric Hospital, Kilchberg, Zurich, Switzerland.
| | - Xueqiong Zhang
- Department of Psychiatry, Ludwig-Maximilian University, Nussbaumstr. 7, Munich D-80331, Germany; Psychiatric Hospital, Kilchberg, Zurich, Switzerland
| | - Hans Stassen
- Psychiatric Hospital, Kilchberg, Zurich, Switzerland; Institute for Response-Genetics, Psychiatric University Hospital (KPPP), Zurich, Switzerland
| | - Renate Grohmann
- Department of Psychiatry, Ludwig-Maximilian University, Nussbaumstr. 7, Munich D-80331, Germany
| | - René Bridler
- Psychiatric Hospital, Kilchberg, Zurich, Switzerland
| | - Gregor Hasler
- Division of Molecular Psychiatry, University Psychiatry Department (UPD), University of Bern, Bern, Switzerland
| | - Sermin Toto
- Department of Psychiatry, Socialpsychiatry & Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Stefan Bleich
- Department of Psychiatry, Socialpsychiatry & Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
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Stübner S, Grohmann R, Greil W, Zhang X, Müller-Oerlinghausen B, Bleich S, Rüther E, Möller HJ, Engel R, Falkai P, Toto S, Kasper S, Neyazi A. Suicidal Ideation and Suicidal Behavior as Rare Adverse Events of Antidepressant Medication: Current Report from the AMSP Multicenter Drug Safety Surveillance Project. Int J Neuropsychopharmacol 2018; 21:814-821. [PMID: 29939264 PMCID: PMC6119288 DOI: 10.1093/ijnp/pyy048] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 06/15/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Suicidal ideations, suicide attempts, and fatal suicides are rare adverse drug reactions to antidepressant drugs, but they essentially are clinically relevant. Drawing on a larger dataset of the European drug surveillance program, the present naturalistic study updates a previous contribution (Stübner et al., 2010). METHODS First an analysis of the comprehensive data collected in 81 psychiatric hospitals from 1993 to 2014 by the European drug surveillance program Arzneimittelsicherheit in der Psychiatrie was made. All documented single cases of suicidal ideations or behavior judged as adverse drug reactions to antidepressant drugs were carefully assessed as to their clinical features and drug prescriptions. RESULTS Among 219,635 adult hospitalized patients taking antidepressant drugs under surveillance, 83 cases of suicidal adverse drug reactions occurred (0.04%): 44 cases of suicidal ideation, 34 attempted suicides, and 5 committed suicides were documented. Restlessness was present in 42 patients, ego-dystonic intrusive suicidal thoughts or urges in 39 patients, impulsiveness in 22 patients, and psychosis in 7 patients. Almost all adverse drug reactions occurred shortly after beginning antidepressant drug medication or increasing the dosage. Selective serotonin reuptake inhibitors caused a higher incidence of suicidal ideation and suicidal behavior as adverse drug reactions than noradrenergic and specific serotonergic antidepressants or tricyclic antidepressants, as did monotherapy consisting of one antidepressant drug, compared to combination treatments. CONCLUSIONS The study supports the view that antidepressant drug-triggered suicidal ideation and suicidal behavior (primarily with selective serotonin reuptake inhibitors) are rare. Special clinical features (restlessness, ego-dystonic thoughts or urges, impulsiveness) may be considered as possible warning signs. A combination therapy might be preferable to antidepressant drug monotherapy when beginning treatment.
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Affiliation(s)
- Susanne Stübner
- Department of Psychiatry, Kbo-IAK, Academic Teaching Hospital of the Ludwig-Maximilian University, Haar/ Munich, Germany,Department of Psychiatry, Ludwig-Maximilian University, Munich, Germany,Correspondence: Susanne Stübner, PD Dr, Department of Psychiatry, Kbo-IAK, Academic teaching hospital of the Ludwig-Maximilian, University, School of Medicine, Vockestraße 72, 85540 Haar/ Munich ()
| | - Renate Grohmann
- Department of Psychiatry, Ludwig-Maximilian University, Munich, Germany
| | - Waldemar Greil
- Department of Psychiatry, Ludwig-Maximilian University, Munich, Germany,Psychiatric Hospital Kilchberg /Zurich, Switzerland
| | - Xueqiong Zhang
- Department of Psychiatry, Ludwig-Maximilian University, Munich, Germany,Psychiatric Hospital Kilchberg /Zurich, Switzerland
| | | | - Stefan Bleich
- Department of Psychiatry, Hannover Medical School, Hannover, Germany
| | - Eckart Rüther
- Department of Psychiatry, Ludwig-Maximilian University, Munich, Germany,Department of Psychiatry, Georg August University, Göttingen, Germany
| | | | - Rolf Engel
- Department of Psychiatry, Ludwig-Maximilian University, Munich, Germany
| | - Peter Falkai
- Department of Psychiatry, Ludwig-Maximilian University, Munich, Germany
| | - Sermin Toto
- Department of Psychiatry, Hannover Medical School, Hannover, Germany
| | | | - Alexandra Neyazi
- Department of Psychiatry, Hannover Medical School, Hannover, Germany
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Letmaier M, Grohmann R, Kren C, Toto S, Bleich S, Engel R, Gary T, Papageorgiou K, Konstantinidis A, Holl AK, Painold A, Kasper S. Venous thromboembolism during treatment with antipsychotics: Results of a drug surveillance programme. World J Biol Psychiatry 2018; 19:175-186. [PMID: 28112047 DOI: 10.1080/15622975.2017.1285048] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Venous thromboembolism (VTE) can be a life-threatening medical condition that may lead to leg swelling, respiratory distress and death. METHODS The AMSP (Arzneimittelsicherheit in der Psychiatrie) is a continuous multicentre drug surveillance programme that assesses severe adverse drug reactions during treatment of psychiatric inpatients. We report on a total of 264,422 inpatients who were treated with antipsychotics (APs) and monitored from 1993 to 2011 in 99 psychiatric hospitals. RESULTS During this period VTE events were reported for 89 inpatients, corresponding to an occurrence rate of 34 cases per 100,000 inpatient admissions treated with APs or 43 cases per 10,000 person-years. The occurrence of VTE was greatest in patients over the age of 65 years of age with mood disorders. The chemical class of butyrophenones (48/100,000) followed by atypical APs (36/100,000) showed the highest occurrence rate for VTE compared to thioxanthenes (23/100,000), which were less associated with VTE. If imputed alone, pipamperone (61/100,000) and risperidone (55/100,000) were most frequently associated with VTE. In general, there was no difference in occurrence rate of VTE between high- and low-potency APs. CONCLUSIONS These results suggest that clinicians should consider AP drug exposure as a potential risk factor for VTE for patients older than 65 years. Additionally, the diagnosis of an affective disorder seems to increase the risk for VTE.
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Affiliation(s)
- Martin Letmaier
- a Department of Psychiatry , Medical University of Graz , Graz , Austria
| | - Renate Grohmann
- b Department of Psychiatry , Ludwig-Maximilians-University , Munich , Germany
| | | | - Sermin Toto
- d Department of Psychiatry, Social Psychiatry and Psychotherapy , Hannover Medical School , Hannover , Germany
| | - Stefan Bleich
- d Department of Psychiatry, Social Psychiatry and Psychotherapy , Hannover Medical School , Hannover , Germany
| | - Rolf Engel
- b Department of Psychiatry , Ludwig-Maximilians-University , Munich , Germany
| | - Thomas Gary
- e Department of Angiology , Medical University of Graz , Graz , Austria
| | - Konstantinos Papageorgiou
- f Department of Psychiatry and Psychotherapy, Division of Biological Psychiatry , Medical University of Vienna , Vienna , Austria
| | - Anastasios Konstantinidis
- f Department of Psychiatry and Psychotherapy, Division of Biological Psychiatry , Medical University of Vienna , Vienna , Austria
| | | | - Annamaria Painold
- a Department of Psychiatry , Medical University of Graz , Graz , Austria
| | - Siegfried Kasper
- f Department of Psychiatry and Psychotherapy, Division of Biological Psychiatry , Medical University of Vienna , Vienna , Austria
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Sanader B, Grohmann R, Grötsch P, Schumann T, Toto S, Fernando P, Stübner S. Clozapine-Induced DRESS Syndrome: A Case Series From the AMSP Multicenter Drug Safety Surveillance Project. Pharmacopsychiatry 2018; 52:156-159. [DOI: 10.1055/a-0586-8983] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
AbstractDrug reaction with eosinophilia and systemic symptoms (DRESS) is an infrequent, but severe, adverse drug-induced reaction which occurs due to massive T-cell stimulation resulting in cytotoxicity and eosinophil activation and recruitment. The incidence is 0.4 cases per 100, 0000 in the general population; the mortality rate is up to 10%. Therefore, we believe that recognizing this syndrome is of particular importance. The problem we notice is that DRESS is often seen and described in patients receiving rheumatologic or anticonvulsant drugs, but very rarely in psychiatric hospitals, where Clozapine is frequently used, and that is the importance of this paper. DRESS Syndrome must be recognized promptly, and causative drugs withdrawn. Indeed, it has been reported that the earlier the drug withdrawal, the better the prognosis. In this paper, we present three cases of Clozapine-induced DRESS. All cases were recorded in the Multicenter Drug Safety Surveillance Project (AMSP).
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Affiliation(s)
- Bruna Sanader
- Department of Psychiatry, Ludwig Maximilian University, Munich, Germany
| | - Renate Grohmann
- Department of Psychiatry, Ludwig Maximilian University, Munich, Germany
| | - Philipp Grötsch
- Department of Psychiatry, University Clinic Basel, Basel, Switzerland
| | - Thomas Schumann
- Psychiater Luzern Dr. Sabine Abele AG, Luzern/Lucerne, Switzerland
| | - Sermin Toto
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover, Germany
| | - Piyumi Fernando
- Department of Psychiatry, Ludwig Maximilian University, Munich, Germany
| | - Susanne Stübner
- Deparment of Psychiatry, Kbo-IAK, Academic Teaching Hospital of the Ludwig Maximilian University, Haar/Munich, Germany
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Druschky K, Bleich S, Grohmann R, Engel RR, Kleimann A, Stübner S, Greil W, Toto S. Use and safety of antiepileptic drugs in psychiatric inpatients-data from the AMSP study. Eur Arch Psychiatry Clin Neurosci 2018; 268:191-208. [PMID: 28766129 DOI: 10.1007/s00406-017-0827-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 07/24/2017] [Indexed: 12/19/2022]
Abstract
The psychiatric utilization patterns and risks of antiepileptic drugs (AEDs) were assessed by using data from the drug safety programme Arzneimittelsicherheit in der Psychiatrie over the time period 1993-2013. In a total of 432,215 patients, the main indications for AED use were acute mania, schizoaffective disorder, and schizophrenic and organic psychoses. Valproic acid (VPA) was the most common substance across all of those groups, reaching administration rates of up to 50% since 2005, at which time carbamazepine (CBZ) administration consistently dropped below a rate of 10%. Lamotrigine (LTG) and pregabalin (PGB) increased in relevance after 2005 and 2010, respectively (with administration rates of up to 9%), whereas oxcarbazepine (OXC) was least prevalent (<3%). The mean rates of severe adverse drug reactions (ADRs) ranged from 6 cases per 1000 patients treated (VPA) to 19/1000 (OXC) and were significantly lower with treatment with VPA compared to OXC and CBZ. Hyponatremia was the leading ADR during treatment with OXC; severe allergic skin reactions were most often observed during treatment with CBZ and LTG, and severe oedema was most common during treatment with PGB. Severe hyponatremia induced by OXC was observed significantly more often in female patients than in male patients.
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Affiliation(s)
- Katrin Druschky
- Department of Neurology, University of Erlangen-Nuernberg, Schwabachanlage 6, 91054, Erlangen, Germany.
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Renate Grohmann
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Nussbaumstraße 7, 80336, Munich, Germany
| | - Rolf R Engel
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Nussbaumstraße 7, 80336, Munich, Germany
| | - Alexandra Kleimann
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Susanne Stübner
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Nussbaumstraße 7, 80336, Munich, Germany
| | - Waldemar Greil
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Nussbaumstraße 7, 80336, Munich, Germany.,Psychiatric Hospital Kilchberg, Kilchberg-Zurich, Switzerland
| | - Sermin Toto
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
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33
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Ladwig J, Andreae D, Grohmann R, Toto S, Kropp S, Bleich S. New Onset of Suicidal Impulses Following Abrupt Cessation of Valproate. Pharmacopsychiatry 2017; 50:270. [PMID: 28482360 DOI: 10.1055/s-0043-109240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Johannes Ladwig
- Klinik für Psychiatrie, Medizinische Hochschule Hannover, Sozialpsychiatrie und Psychotherapie, Hannover, Germany
| | - Dorothea Andreae
- Department of Psychiatry, Psychotherapy and Psychosomatics, Asklepios Fachklinikum Teupitz, Teupitz, Germany
| | - Renate Grohmann
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universitat Munchen, Munchen, Bayern, Germany
| | - Sermin Toto
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Medizinische Hochschule Hannover, Hannover, Germany
| | - Stefan Kropp
- Department of Psychiatry, Psychotherapy and Psychosomatics, Asklepios Fachklinikum Teupitz, Teupitz, Germany
| | - Stefan Bleich
- Klinik für Psychiatrie, Medizinische Hochschule Hannover, Sozialpsychiatrie und Psychotherapie, Hannover, Germany
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Poppe C, Müller ST, Greil W, Walder A, Grohmann R, Stübner S. Pharmacotherapy for obsessive compulsive disorder in clinical practice - Data of 842 inpatients from the International AMSP Project between 1994 and 2012. J Affect Disord 2016; 200:89-96. [PMID: 27130958 DOI: 10.1016/j.jad.2016.04.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 04/16/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Specific treatment of obsessive compulsive disorder (OCD) is based on cognitive-behavioral therapy, serotonin reuptake inhibitors (SRIs) or their combination. Treatment strategies do not always follow evidence-based guidelines in outpatient settings. Data on pharmacotherapy in inpatient settings are lacking. METHODS Prescription data for inpatients suffering from OCD in the time period 1994-2012 were obtained from the database of the Drug Safety Program in Psychiatry (AMSP). Data were collected on two index dates per year; the prescription patterns and changes over time were analysed. RESULTS Of 842 patients 89.9% received at least one psychotropic drug and 67.6% a combination of at least two psychotropic drugs. The drug groups prescribed most often were antidepressants (78.0%), antipsychotics (46.7%), and tranquilizers (19.7%). In 58.0% of all cases selective serotonin reuptake inhibitors (SSRIs) were used as antidepressants, followed by tricyclic antidepressants (TCAs, 17.8%), mainly clomipramine (10.9%). Second-generation antipsychotics (SGAs) were administered in 37.8% of all cases, first-generation antipsychotics (FGAs) in 13.7%. While the use over time significantly increased for psychotropic drugs, antidepressants, antipsychotics, tranquilizers, SSRIs and SGAs, it remained stable for FGAs and decreased for TCAs. LIMITATIONS Observational cross-sectional study without follow-up or additional information. CONCLUSIONS In clinical practice, most OCD patients received pharmacological treatment. The high prescription rate of SSRIs and their preference over clomipramine as well as the augmentation of this therapy with SGAs comply with the guidelines. Administration of tranquilizers as well as sedative FGAs and the choice of single SGAs are not in line with expert recommendations.
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Affiliation(s)
- Christine Poppe
- Psychiatric Hospital Kilchberg, Kilchberg, Zürich, Switzerland.
| | | | - Waldemar Greil
- Psychiatric Hospital Kilchberg, Kilchberg, Zürich, Switzerland; Department of Psychiatry, Ludwig Maximilian University, Munich, Germany
| | - Alice Walder
- Psychiatric Hospital Kilchberg, Kilchberg, Zürich, Switzerland
| | - Renate Grohmann
- Department of Psychiatry, Ludwig Maximilian University, Munich, Germany
| | - Susanne Stübner
- Department of Psychiatry, Ludwig Maximilian University, Munich, Germany
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35
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Adamovic I, Grohmann R, Rüther E, Degner D. Acute urinary retention after treatment with doxepin and duloxetine. Pharmacopsychiatry 2016. [DOI: 10.1055/s-0036-1582052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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36
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Kleimann A, Schrader V, Stübner S, Greil W, Kahl KG, Bleich S, Grohmann R, Frieling H, Toto S. Psychopharmacological treatment of 1650 in-patients with acute mania-data from the AMSP study. J Affect Disord 2016; 191:164-71. [PMID: 26655125 DOI: 10.1016/j.jad.2015.11.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 11/16/2015] [Accepted: 11/18/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Several studies have analyzed prescription patterns for bipolar disorder, but few have for acute mania. Treatment strategies in this complex domain change over time and do not always follow evidence-based guidelines. METHODS Prescription data of in-patients suffering from acute mania in the time period from 2005 to 2012 were obtained from the database of the Drug Safety Program in Psychiatry (Institut für Arzneimittelsicherheit in der Psychiatrie; AMSP). Data were collected on two index dates per year. Changes over time were analyzed comparing the time periods 2005/06 and 2011/12. RESULTS Among 1650 patients (mean ±SD; age: 48.9±14.91 years; 53.1% females) 54.1% received anticonvulsants, 74.5% second-generation antipsychotics (SGAs), 17.8% first-generation antipsychotics (FGAs), 29.1% lithium, 44.1% benzodiazepines and 14.5% antidepressants. Prescription of SGAs increased from 70% to 79% (p=0.005), while prescription of FGAs and anticonvulsants decreased from 19% to 13% (p<0.05) and 59% to 46% (p<0.001), respectively. Only 30% of patients received monotherapy with one mood stabilizer. We observed an impact of gender, age and psychotic symptoms on treatment strategy. 36.8% of the women≤40 years received valproate. LIMITATIONS Follow-up data are missing and no differentiation between acute and maintenance treatments could be made due to the cross-sectional design. Additionally, our findings do not necessarily translate to outpatients or to other countries. CONCLUSIONS Combination therapies represent standard clinical practice. Though many results reflect clinical necessity, the high number of antidepressant prescriptions or valproate use in women of child-bearing age should be judged critically. Further prospective studies should focus on real-world prescription practice in acute mania to evaluate efficacy and safety of common practice. This paper is dedicated to Prof. Dr. Hanns Hippius on the occasion of his 90th birthday.
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Affiliation(s)
- Alexandra Kleimann
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany.
| | - Viktoria Schrader
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Susanne Stübner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Bezirkskrankenhaus Augsburg, Augsburg, Germany
| | - Waldemar Greil
- Department of Psychiatry, Ludwig Maximilian University, Munich, Germany; Psychiatric Hospital Kilchberg, Kilchberg-Zurich, Switzerland
| | - Kai G Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Renate Grohmann
- Department of Psychiatry, Ludwig Maximilian University, Munich, Germany
| | - Helge Frieling
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Sermin Toto
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
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37
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Friedrich ME, Akimova E, Huf W, Konstantinidis A, Papageorgiou K, Winkler D, Toto S, Greil W, Grohmann R, Kasper S. Drug-Induced Liver Injury during Antidepressant Treatment: Results of AMSP, a Drug Surveillance Program. Int J Neuropsychopharmacol 2015; 19:pyv126. [PMID: 26721950 PMCID: PMC4851269 DOI: 10.1093/ijnp/pyv126] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 11/16/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Drug-induced liver injury is a common cause of liver damage and the most frequent reason for withdrawal of a drug in the United States. The symptoms of drug-induced liver damage are extremely diverse, with some patients remaining asymptomatic. METHODS This observational study is based on data of Arzneimittelsicherheit in der Psychiatrie, a multicenter drug surveillance program in German-speaking countries (Austria, Germany, and Switzerland) recording severe drug reactions in psychiatric inpatients. Of 184234 psychiatric inpatients treated with antidepressants between 1993 and 2011 in 80 psychiatric hospitals, 149 cases of drug-induced liver injury (0.08%) were reported. RESULTS The study revealed that incidence rates of drug-induced liver injury were highest during treatment with mianserine (0.36%), agomelatine (0.33%), and clomipramine (0.23%). The lowest probability of drug-induced liver injury occurred during treatment with selective serotonin reuptake inhibitors ([0.03%), especially escitalopram [0.01%], citalopram [0.02%], and fluoxetine [0.02%]). The most common clinical symptoms were nausea, fatigue, loss of appetite, and abdominal pain. In contrast to previous findings, the dosage at the timepoint when DILI occurred was higher in 7 of 9 substances than the median overall dosage. Regarding liver enzymes, duloxetine and clomipramine were associated with increased glutamat-pyruvat-transaminase and glutamat-oxalat-transaminase values, while mirtazapine hardly increased enzyme values. By contrast, duloxetine performed best in terms of gamma-glutamyl-transferase values, and trimipramine, clomipramine, and venlafaxine performed worst. CONCLUSIONS Our findings suggest that selective serotonin reuptake inhibitors are less likely than the other antidepressants, examined in this study, to precipitate drug-induced liver injury, especially in patients with preknown liver dysfunction.
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Affiliation(s)
- Michaela-Elena Friedrich
- Department of Psychiatry and Psychotherapy, Division of Biological Psychiatry, Medical University of Vienna, Austria (Drs Friedrich, Akimova, Konstantinidis, Papageorgiou, Winkler, and Kasper); Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany (Dr Toto); Psychiatric Private Hospital, Sanatorium Kilchberg, Switzerland (Dr Greil); Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany (Drs Greil and Grohmann); Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria (Dr Huf)
| | - Elena Akimova
- Department of Psychiatry and Psychotherapy, Division of Biological Psychiatry, Medical University of Vienna, Austria (Drs Friedrich, Akimova, Konstantinidis, Papageorgiou, Winkler, and Kasper); Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany (Dr Toto); Psychiatric Private Hospital, Sanatorium Kilchberg, Switzerland (Dr Greil); Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany (Drs Greil and Grohmann); Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria (Dr Huf)
| | - Wolfgang Huf
- Department of Psychiatry and Psychotherapy, Division of Biological Psychiatry, Medical University of Vienna, Austria (Drs Friedrich, Akimova, Konstantinidis, Papageorgiou, Winkler, and Kasper); Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany (Dr Toto); Psychiatric Private Hospital, Sanatorium Kilchberg, Switzerland (Dr Greil); Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany (Drs Greil and Grohmann); Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria (Dr Huf)
| | - Anastasios Konstantinidis
- Department of Psychiatry and Psychotherapy, Division of Biological Psychiatry, Medical University of Vienna, Austria (Drs Friedrich, Akimova, Konstantinidis, Papageorgiou, Winkler, and Kasper); Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany (Dr Toto); Psychiatric Private Hospital, Sanatorium Kilchberg, Switzerland (Dr Greil); Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany (Drs Greil and Grohmann); Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria (Dr Huf)
| | - Konstantinos Papageorgiou
- Department of Psychiatry and Psychotherapy, Division of Biological Psychiatry, Medical University of Vienna, Austria (Drs Friedrich, Akimova, Konstantinidis, Papageorgiou, Winkler, and Kasper); Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany (Dr Toto); Psychiatric Private Hospital, Sanatorium Kilchberg, Switzerland (Dr Greil); Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany (Drs Greil and Grohmann); Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria (Dr Huf)
| | - Dietmar Winkler
- Department of Psychiatry and Psychotherapy, Division of Biological Psychiatry, Medical University of Vienna, Austria (Drs Friedrich, Akimova, Konstantinidis, Papageorgiou, Winkler, and Kasper); Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany (Dr Toto); Psychiatric Private Hospital, Sanatorium Kilchberg, Switzerland (Dr Greil); Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany (Drs Greil and Grohmann); Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria (Dr Huf)
| | - Sermin Toto
- Department of Psychiatry and Psychotherapy, Division of Biological Psychiatry, Medical University of Vienna, Austria (Drs Friedrich, Akimova, Konstantinidis, Papageorgiou, Winkler, and Kasper); Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany (Dr Toto); Psychiatric Private Hospital, Sanatorium Kilchberg, Switzerland (Dr Greil); Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany (Drs Greil and Grohmann); Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria (Dr Huf)
| | - Waldemar Greil
- Department of Psychiatry and Psychotherapy, Division of Biological Psychiatry, Medical University of Vienna, Austria (Drs Friedrich, Akimova, Konstantinidis, Papageorgiou, Winkler, and Kasper); Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany (Dr Toto); Psychiatric Private Hospital, Sanatorium Kilchberg, Switzerland (Dr Greil); Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany (Drs Greil and Grohmann); Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria (Dr Huf)
| | - Renate Grohmann
- Department of Psychiatry and Psychotherapy, Division of Biological Psychiatry, Medical University of Vienna, Austria (Drs Friedrich, Akimova, Konstantinidis, Papageorgiou, Winkler, and Kasper); Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany (Dr Toto); Psychiatric Private Hospital, Sanatorium Kilchberg, Switzerland (Dr Greil); Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany (Drs Greil and Grohmann); Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria (Dr Huf)
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Division of Biological Psychiatry, Medical University of Vienna, Austria (Drs Friedrich, Akimova, Konstantinidis, Papageorgiou, Winkler, and Kasper); Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany (Dr Toto); Psychiatric Private Hospital, Sanatorium Kilchberg, Switzerland (Dr Greil); Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany (Drs Greil and Grohmann); Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria (Dr Huf)
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Adamovic I, Sagebiel A, Grohmann R, Toto S, Degner D. Adverse drug reactions: vascular parkinsonism and sedation – a pharmacokinetic and pharmacodynamic evaluation from the German Pharmacovigilance project AMSP. Pharmacopsychiatry 2015. [DOI: 10.1055/s-0035-1557939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Laoutidis ZG, Konstantinidis A, Grohmann R, Luckhaus C, Mobascher J, Cordes J. Reversible Amisulpride-induced Elevation of Creatine Kinase (CK): A Case Series from the German AMSP Pharmacovigilance Project. Pharmacopsychiatry 2015; 48:178-81. [PMID: 25984709 DOI: 10.1055/s-0035-1549997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The elevation of creatine kinase (CK) levels without neuroleptic malignant syndrome has been reported for several antipsychotics. We present here 4 cases with CK elevation induced by amisulpride, which have been registered for the German pharmacovigilance project, Arzneimittelsicherheit in der Psychiatrie (AMSP). The magnitude of the CK elevation ranged between 1, 498 IU/L and 21,018 IU/L. All 4 patients reported myalgia. In each case CK returned to normal after amisulpride discontinuation. In the fourth case, fluids were administered intravenously in order to prevent acute renal failure. None of the cases showed deterioration of renal function. Finally, we present recommendations for clinical practice.
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Affiliation(s)
- Z G Laoutidis
- Department of Psychiatry and Psychotherapy, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
| | - A Konstantinidis
- Department of Psychiatry and Psychotherapy, Division of Biological Psychiatry, Medical University Vienna, Austria
| | - R Grohmann
- Department of Psychiatry, Ludwig Maximilian University of Munich, Germany
| | - C Luckhaus
- Department of Psychiatry and Psychotherapy, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
| | - J Mobascher
- Department of Psychiatry and Psychotherapy, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
| | - J Cordes
- Department of Psychiatry and Psychotherapy, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
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Bridler R, Häberle A, Müller ST, Cattapan K, Grohmann R, Toto S, Kasper S, Greil W. Psychopharmacological treatment of 2195 in-patients with borderline personality disorder: A comparison with other psychiatric disorders. Eur Neuropsychopharmacol 2015; 25:763-72. [PMID: 25907249 DOI: 10.1016/j.euroneuro.2015.03.017] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 02/16/2015] [Accepted: 03/31/2015] [Indexed: 10/23/2022]
Abstract
Patients with borderline personality disorder (BPD) are usually prescribed a variety of psychotropic drugs; however, none is recommended in the guidelines nor has any been approved for this indication. As data on drug prescriptions for BPD are sparse, cross-sectional data from the European Drug Safety Project AMSP were used to analyse drug prescriptions of 2195 in-patients with BPD between 2001 and 2011, and the mean values, confidence intervals and regression analyses were calculated. 70% of all BPD patients were medicated with antipsychotics and/or antidepressants, 33% with anticonvulsants, 30% with benzodiazepines, and 4% with lithium; 90% received at least one, 80%≥2, and 54%≥3 psychotropic drugs concomitantly (mean: 2.8). Prescription rates for quetiapine, the single drug most often used in BPD (22%), increased significantly over time. In view of the high percentage of young females with BPD, 18-40 year-old female patients with BPD were compared with patients of the same age but with depression (unipolar and bipolar) and schizophrenia. Typical sedative antipsychotics and anticonvulsants were prescribed more often in BPD than in the other diagnostic groups, with the exception of bipolar depression; this was true for the single substances quetiapine, levomepromazine, chlorprothixene, carbamazepine, and valproate. A limitation of the study was the use of clinical data without verifying the diagnoses by structured interviews. Contrary to the guidelines, about 90% of in-patients with BPD received psychotropic drugs. Polypharmacy was common, and antipsychotics with sedative profiles such as quetiapine and mood-stabilizing anticonvulsants such as valproate appear to be preferred.
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Affiliation(s)
- René Bridler
- Sanatorium Kilchberg/Zurich, Private Psychiatric Hospital, Alte Landstr. 70, CH-8802 Kilchberg ZH, Switzerland
| | - Anne Häberle
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Nussbaumstr. 7, D-80336 Munich, Germany
| | - Sabrina T Müller
- Sanatorium Kilchberg/Zurich, Private Psychiatric Hospital, Alte Landstr. 70, CH-8802 Kilchberg ZH, Switzerland
| | - Katja Cattapan
- Sanatorium Kilchberg/Zurich, Private Psychiatric Hospital, Alte Landstr. 70, CH-8802 Kilchberg ZH, Switzerland; University Hospital of Psychiatry, Bolligenstr. 111, CH-3060 Bern, Switzerland
| | - Renate Grohmann
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Nussbaumstr. 7, D-80336 Munich, Germany
| | - Sermin Toto
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, D-30625 Hannover, Germany
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Waldemar Greil
- Sanatorium Kilchberg/Zurich, Private Psychiatric Hospital, Alte Landstr. 70, CH-8802 Kilchberg ZH, Switzerland; Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Nussbaumstr. 7, D-80336 Munich, Germany.
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Holl AK, Grohmann R, Letmaier M, Painold A, Mörkl S, Toto S, Kasper S. Pharmacotherapy of anxiety disorders in German-speaking countries: current status and changes between 1994 and 2011. Eur Arch Psychiatry Clin Neurosci 2015; 265:199-208. [PMID: 25138236 DOI: 10.1007/s00406-014-0523-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 08/09/2014] [Indexed: 11/26/2022]
Abstract
Over the past years, international treatment guidelines have been established for the treatment of anxiety disorders. Nevertheless, little is known as to whether the actual inpatient treatment follows these guidelines. The main goal of this study was to answer the question whether patients with anxiety disorder are treated according to treatment guidelines. A total of 2,573 psychiatric inpatients with the diagnosis of anxiety disorder (920 men, 1,653 women) were identified on the basis of the data of the international drug safety programme in psychiatry AMSP. Of these patients, 25.3% presented with phobia, 26.6% with panic disorder, 18.7% with generalized anxiety disorder (GAD), and 29.4% with other diagnoses of anxiety. In all of the patients, 12.7% did not receive any psychotropic medication and 22.9% were not treated with antidepressants. Only 59.3% of patients with GAD, 73.9% of patients with panic disorder, and 52.1% of patients with phobia were treated according to diagnostic guidelines. The majority (60.3%) of all patients received one or two psychotropic drugs, and only 3.7% received five or more psychotropic drugs. In two groups of patients (one group with phobia and one with panic disorder), the annual prescription rate of antidepressants significantly increased over time. The prescription rate for anticonvulsants in patients with GAD increased from 0% in 1997 to 41.7% in 2011, and for antipsychotics, from 40.7% in 1997 to 47.2% in 2011. In particular, patients with GAD were commonly treated with antipsychotics.
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Affiliation(s)
- Anna K Holl
- Department of Psychiatry, Graz Medical University, Auenbruggerplatz 31, 8036, Graz, Austria
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Spindelegger CJ, Papageorgiou K, Grohmann R, Engel R, Greil W, Konstantinidis A, Agelink MW, Bleich S, Ruether E, Toto S, Kasper S. Cardiovascular adverse reactions during antidepressant treatment: a drug surveillance report of German-speaking countries between 1993 and 2010. Int J Neuropsychopharmacol 2015; 18:pyu080. [PMID: 25522416 PMCID: PMC4360213 DOI: 10.1093/ijnp/pyu080] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Antidepressants (ADs) are known to have the potential to cause various cardiovascular adverse drug reactions (ADRs). The tricyclic antidepressants (TCAs) were first revealed to be a possible source of cardiovascular ADRs. In recent years, newer classes of ADs were also suggested to have a higher risk of cardiovascular adverse effects. In particular, the selective serotonin reuptake inhibitors (SSRIs) were suspected to have the potential to induce QTc interval prolongation, and therefore increase the risk of ventricular arrhythmia. This descriptive study is based on the continuous pharmacovigilance program of German-speaking countries (Austria, Germany, and Switzerland), the Arzneimittelsicherheit in der Psychiatrie (AMSP), which assesses severe ADRs occurring in clinical routine situations. METHODS Of 169,278 psychiatric inpatients treated with ADs between 1993 and 2010, 198 cases of cardiovascular ADRs (0.12%) were analyzed. RESULTS Our study showed that the incidence rates of cardiovascular ADRs were highest during treatment with monoamine oxidase inhibitors (0.27%), TCAs (0.15%), and serotonin noradrenaline reuptake inhibitors (0.14%); the risk of occurring during treatment with SSRIs (0.08%) was significantly lower. The noradrenergic and specific serotonergic AD mirtazapine (0.07%) had a significantly lower risk of cardiovascular ADRs than all other ADs. Severe hypotension was the most frequent ADR, followed by hypertension, arrhythmia, and in some rare cases heart failure. CONCLUSIONS Despite certain limitations due to the AMSP study design, our observations on cardiovascular ADRs can contribute to a better knowledge of the cardiovascular risk profiles of antidepressants in the clinical routine setting. However, prospective studies are needed to verify our findings.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria (Drs Spindelegger, Papageorgiou, Konstantinidis, and Kasper); Department of Psychiatry, Psychotherapy and Preventive Medicine, Ruhr-University of Bochum, Germany (Dr Agelink); Psychiatric Private Hospital, Sanatorium Kilchberg, Switzerland (Dr Greil); Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Germany (Drs Bleich and Toto); Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Germany (Drs Grohmann, Engel, Greil, and Ruether)
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Grohmann R, Engel RR, Möller HJ, Rüther E, van der Velden JW, Stübner S. Flupentixol use and adverse reactions in comparison with other common first- and second-generation antipsychotics: data from the AMSP study. Eur Arch Psychiatry Clin Neurosci 2014; 264:131-41. [PMID: 23835526 DOI: 10.1007/s00406-013-0419-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2012] [Accepted: 06/25/2013] [Indexed: 02/06/2023]
Abstract
This study compares the first-generation antipsychotic (FGA) flupentixol to haloperidol and common second-generation antipsychotics (SGAs) as to drug utilization and severe adverse drug reactions (ADRs) in clinical treatment of schizophrenia inpatients using data from the drug safety program Arzneimittelsicherheit in der Psychiatrie (AMSP). AMSP drug utilization and reported ADR data were analyzed. Type and frequency of severe ADRs attributed to flupentixol were compared with haloperidol, clozapine, olanzapine, quetiapine, risperidone and amisulpride in a total of 56,861 schizophrenia inpatients exposed to these drugs. In spite of increasing prescription of SGAs, flupentixol was consistently used in schizophrenic inpatients (about 5 %) over time. Reporting rates of severe ADR ranged from 0.38 to 1.20 % for the individual antipsychotics (drugs imputed alone); flupentixol ranked lowest. The type of ADR differed considerably; as to severe EPMS, flupentixol (0.27 %), such as risperidone (0.28 %), held an intermediate position between haloperidol/amisulpride (0.55/0.52 %) and olanzapine/quetiapine (<0.1 %). The study is a heuristic approach, not a confirmatory test. Flupentixol has a stable place in the treatment of schizophrenia in spite of the introduction of different SGAs. Comparative ADR profiles suggest an intermediate position between FGAs and SGAs for flupentixol in clinical practice.
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Affiliation(s)
- R Grohmann
- Department of Psychiatry, School of Medicine, Ludwig-Maximilians University, Nussbaumstraße 7, 80336, Munich, Germany,
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Stübner S, Grohmann R, Schmauß M. [Drug safety in clinical practice--part 2: psychopharmacological treatment]. Fortschr Neurol Psychiatr 2013; 81:715-729. [PMID: 24307090 DOI: 10.1055/s-0033-1355883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- S Stübner
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Akademisches Krankenhaus der LMU München, Augsburg
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Köster M, Grohmann R, Engel RR, Nitsche MA, Rüther E, Degner D. Seizures during antidepressant treatment in psychiatric inpatients--results from the transnational pharmacovigilance project "Arzneimittelsicherheit in der Psychiatrie" (AMSP) 1993-2008. Psychopharmacology (Berl) 2013; 230:191-201. [PMID: 24068157 DOI: 10.1007/s00213-013-3281-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 09/02/2013] [Indexed: 12/12/2022]
Abstract
RATIONALE There is little clinical data available about seizure rates in psychiatric inpatients, and there are no studies with reference data to the frequencies of antidepressant (AD) use for this important clinical population. OBJECTIVE This study investigates seizure rates during AD treatment in psychiatric inpatient settings, drawn from the transnational pharmacovigilance programme Arzneimittelsicherheit in der Psychiatrie (AMSP) in relation to the known frequencies of ADs used in the participating clinics. Comparisons are made to former publications and their limitations. RESULTS Seventy-seven cases were identified with grand mal seizures (GMS) during AD treatment between 1993 and 2008, with a total number of 142,090 inpatients under surveillance treated with ADs in the participating hospitals. The calculated overall rate of reported seizures of patients during AD treatment in this collective is 0.05 % for ADs imputed alone or in combination with other psychotropic drug groups and 0.02 % when only ADs were given and held responsible for GMS. The patients receiving tri- or tetracyclic ADs (TCAs) had a 2-fold risk to develop a seizure as compared to the overall average rate in this sample. In 11 cases, there was only one AD imputed--the majority of these cases (9/11) were TCA. Monotherapy with selective serotonin reuptake inhibitors (SSRI) or dual serotonin and noradrenaline reuptake inhibitors (SNRI) were never imputed alone in this sample. CONCLUSIONS The results of the study favour the assumption that SSRIs, noradrenergic and specific serotonergic antidepressants (NaSSA) and dual SNRI might be more appropriate than TCAs for the treatment of psychiatric patients with an enhanced seizure risk.
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Affiliation(s)
- M Köster
- , Rothstrasse 54, 8057, Zürich, Switzerland,
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Greil W, Häberle A, Schuhmann T, Grohmann R, Baumann P. Age and adverse drug reactions from psychopharmacological treatment: data from the AMSP drug surveillance programme in Switzerland. Swiss Med Wkly 2013; 143:w13772. [PMID: 23821346 DOI: 10.4414/smw.2013.13772] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
QUESTION UNDER STUDY The frequency of severe adverse drug reactions (ADRs) from psychotropic drugs was investigated in hospitalised psychiatric patients in relation to their age. Specifically, the incidence of ADRs in patients up to 60 years was compared to that of patients older than 60 years. METHODS Prescription rates of psychotropic drugs and reports of severe ADRs were collected in psychiatric hospitals in Switzerland between 2001 and 2010. The data stem from the drug surveillance programme AMSP. RESULTS A total of 699 patients exhibited severe ADRs: 517 out of 28,282 patients up to 60 years (1.8%); 182 out of 11,446 elderly patients (1.6%, ns). Logistic regression analyses showed a significantly negative relationship between the incidence of ADRs and patients' age in general and in particular for weight gain, extrapyramidal motor system (EPMS) symptoms, increased liver enzymes and galactorrhoea. A significantly negative relationship was observed for age and the dosages of olanzapine, quetiapine, risperidone, valproic acid and lamotrigine. When comparing age groups, frequency of ADRs was lower in general for antipsychotic drugs and anticonvulsants, in particular for valproic acid in the elderly. Weight gain was found to be lower in the elderly for antipsychotic drugs, in particular for olanzapine. For the group of mood-stabilising anticonvulsants (carbamazepine, lamotrigine and valproic acid) the elderly exhibited a lower incidence of reported allergic skin reactions. CONCLUSION The results suggest that for psychiatric inpatients the incidence of common severe ADRs (e.g., weight gain or EPMS symptoms) arising from psychotropic medication decreases with the age of patients.
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Affiliation(s)
- Waldemar Greil
- Department of Psychiatry, Ludwig Maximilian University of Munich, Munich, Germany.
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Greil W, Haeberle A, Schuhmann T, Grohmann R, Baumann P. 682 – Age and adverse effects of psychopharmacological treatment. data from the drug surveillance program amsp in switzerland. Eur Psychiatry 2013. [DOI: 10.1016/s0924-9338(13)75915-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Haeberle A, Greil W, Russmann S, Grohmann R. Mono- and combination drug therapies in hospitalized patients with bipolar depression. Data from the European drug surveillance program AMSP. BMC Psychiatry 2012; 12:153. [PMID: 22998655 PMCID: PMC3514299 DOI: 10.1186/1471-244x-12-153] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 09/17/2012] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND For the pharmacological treatment of bipolar depression several guidelines exist. It is largely unknown, to what extent the prescriptions in daily clinical routine correspond to these evidence based recommendations and which combinations of psychotropic drugs are frequently used. METHODS The prescriptions of psychotropic drugs were investigated of all in-patients with bipolar depression (n = 2246; time period 1994-2009) from hospitals participating in the drug surveillance program AMSP. For the drug use in 2010, 221 cases were analysed additionally. RESULTS From 1994 to 2009, 85% of all patients received more than one class of psychotropic substances: 74% received antidepressants in combination therapy, 55% antipsychotics, 48% anticonvulsants and 33% lithium. When given in combination, lithium is the most often prescribed substance for bipolar depression (33%), followed by valproic acid (23%), mirtazapine and venlafaxine (16% each), quetiapine (15%), lamotrigine (14%) and olanzapine (13%). Both, lithium and valproic acid are often combined with selective serotonin reuptake inhibitors (SSRI), but also with mirtazapine und venlafaxine. Combinations of more than one antidepressant occur quite often, whereby combinations with bupropion, paroxetine, fluoxetine or fluvoxamine are very rare. In 2010, quetiapine (alone and combined) was the most frequently prescribed drug (39%); aripiprazole was administered in 10%. CONCLUSION Combinations of antidepressants (SSRI, mirtazapine, venlafaxine) with mood stabilizers (lithium, valproic acid, lamotrigine) and / or atypical antipsychotics (quetiapine, olanzapine) are common. Of most of those combinations the efficacy has not been studied. The use of aripiprazole and the concomitant use of two or three antidepressants contrast the guidelines.
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Affiliation(s)
- Anne Haeberle
- Department of Psychiatry, Ludwig Maximilian University, Munich, Germany, Nussbaumstr. 7, Munich, 80336, Germany
| | - Waldemar Greil
- Department of Psychiatry, Ludwig Maximilian University, Munich, Germany, Nussbaumstr. 7, Munich, 80336, Germany
- Sanatorium Kilchberg, Alte Landstrasse 70, Kilchberg-Zurich, 8802, Switzerland
| | - Stefan Russmann
- Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Renate Grohmann
- Department of Psychiatry, Ludwig Maximilian University, Munich, Germany, Nussbaumstr. 7, Munich, 80336, Germany
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Zorina OL, Haueis P, Greil W, Grohmann R, Kullak-Ublick GA, Russmann S. Comparative performance of two drug interaction screening programs analyzing a cross-sectional prescription dataset of 84,625 psychiatric inpatients. Pharmacopsychiatry 2012. [DOI: 10.1055/s-0032-1326771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Stübner S, Grohmann R, Schmauß M. [Drug safety in clinical practice--part 1: psychopharmacological treatment]. Fortschr Neurol Psychiatr 2012; 80:468-481. [PMID: 22895841 DOI: 10.1055/s-0032-1313085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- S Stübner
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirkskrankenhaus Augsburg, Dr.-Mack-Strasse 1, Augsburg.
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