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Ansari Z, Rashmi A, Pawar S. A Naturalistic, Non-interventional Investigation of the Clinical and Sociodemographic Characteristics and Prescription Patterns in Patients With Psychotic Disorders at a Tertiary Care Facility in South Asia. Cureus 2024; 16:e53541. [PMID: 38445139 PMCID: PMC10912971 DOI: 10.7759/cureus.53541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2024] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVES This study aimed to evaluate the trends in the sociodemographic, clinical, and prescription characteristics of patients with psychotic illnesses seen in the outpatient psychiatry department of a tertiary care facility. METHODS Between March 2021 and April 2022, a cross-sectional, prospective, observational, naturalistic, non-interventional study was conducted. A total of two hundred prescriptions were analyzed. To assess the rationality of prescriptions, World Health Organization (WHO) indicators were also computed. RESULTS With a range of 18 to 75 years, the cohort's mean age was 40.26 years, and its average disease duration was 10.75 years. Sixty-seven patients (68.5%) were diagnosed with schizophrenia. Of the 200 prescriptions that were analyzed, 13 antipsychotic prescriptions were written 343 times. Olanzapine was prescribed as an antipsychotic the most frequently (132, 66%), followed by clozapine (75, 37.5%). Haloperidol (41, 20.5%), trifluoperazine (3, 1.5%), loxapine (1, 0.5%), and flupenthixol depot (1, 0.5%) were the most commonly prescribed typical antipsychotics. 91% (181/200) of patients received prescriptions for other drugs in addition to antipsychotics. Trihexyphenidyl (45%), escitalopram (30%), clonazepam (26.5%), sodium valproate (10%), propranolol (10.5%), and modafinil (9.5%) were the most frequently prescribed concurrent medicines. Forty-eight percent (95/200) of prescriptions demonstrated polypharmacy. Among patients, the frequency of antipsychotic prescriptions was 1 in 44% (88/200), 2 in 36.50% (73/200), 3 in 17% (34/200), 4 in 0.5% (1/200), and 5 again in 0.5% (1/200). Conclusions: On average, the cohort of the current study was young. The commonest diagnosis was mainly schizophrenia. Atypical antipsychotics accounted for the majority of antipsychotic prescriptions in the current study. In this study, a high prevalence of polypharmacy was noted.
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Affiliation(s)
- Zarrin Ansari
- Pharmacology and Therapeutics, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, IND
| | - Abhilasha Rashmi
- Pharmacology and Therapeutics, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, IND
| | - Sudhir Pawar
- Pharmacology and Therapeutics, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, IND
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Abstract
Background: Concurrent prescription of more than one type of antipsychotic for the same patient - antipsychotic polypharmacy (APP) - is associated with increased incidence of side effects, uncertain therapeutic benefit and general guidelines advise against it. Nevertheless, APP is common and there is little evidence about possible interventions to improve practice.Aims: To investigate the prevalence and documentation quality of APP in specialized psychiatric care and assess the feasibility and effect of a simple intervention to improve clinical practice.Methods: We examined the prevalence and the quality of documentation of APP in medical records from a large inpatient treatment department before and 6 months after an intervention, which consisted of giving feedback to doctors on their prescription practices as well as teaching about current guidelines. Prescription and documentation before and after intervention were compared between intervention and control wards.Results: One hundred and twenty-one medical records were examined at baseline. 43% of these had APP, of these 27% was satisfactory documented. After the intervention, the proportion with APP was reduced from 42% to 29% in the intervention group. There was a statistically significant interaction effect of the intervention group and the after-intervention condition on this reduction. The percentage with satisfactory documentation of APP was increased after the intervention in both groups, but we found no corresponding interaction effect.Conclusion: APP is prevalent in inpatient treatment of patients with mainly psychotic disorders but documentation of this is insufficient. Simple education and feedback on prescription and records documentation practices may increase adherence to guidelines.
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Affiliation(s)
- Hanne Høilund
- Department for Inpatient Treatment, Adult Mental Health, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - David P Galea
- Department for Inpatient Treatment, Adult Mental Health, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Petter Andreas Ringen
- Department for Inpatient Treatment, Adult Mental Health, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Okkels N, Mogensen RB, Crean LC, Vestergaard CH, Skadhede S, Rasmussen C, Shanmuganathan JWD, Hansen KB, Munk-Jørgensen P. Treatment profiles in a Danish psychiatric university hospital department. Nord J Psychiatry 2017; 71:289-295. [PMID: 28112009 DOI: 10.1080/08039488.2017.1279212] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Despite concerns about rising treatment of psychiatric patients with psychotropic medications and declining treatment with psychotherapy, actual treatment profiles of psychiatric patients are largely unknown. AIMS To describe patterns in the treatment of patients in a large psychiatric university hospital department. METHODS A descriptive mapping of treatment of in- and outpatients in a psychiatric department at Aarhus University Hospital Risskov, Denmark. Information was collected by healthcare staff using a 25-item survey form. The p-value was calculated with a chi-squared test and p < 0.05 was considered significant. The study was preceded by a pilot study on 41 patients. RESULTS Over a 1 month period, a total of 343 consecutive patients were assessed and hereof 200 were included in the age range 18-90 years (mean 53.76); 86 men and 114 women. One-hundred and eighty-eight patients (94%) used psychotropic medication, 37 (19%) as monotherapy, and 148 (74%) in combination with non-pharmacological therapy. Ninety-seven (49%) had psychotherapy and 104 (52%) social support. Among inpatients, 21 (64%) had physical therapy, and 10 (30%) electroconvulsive therapy. In total, 163 (82%) had non-pharmacological therapy. Fifty-two (26%) patients had monotherapy, and 148 (74%) polytherapy. Mean number of treatment modalities used per patient was 2.07 for all patients and 3.23 for inpatients. CONCLUSIONS In this department, polytherapy including non-pharmacological modalities is applied widely across all settings and patient categories. However, psychotropic medication clearly dominates as the most frequently applied treatment.
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Affiliation(s)
- Niels Okkels
- a Department of Affective Disorders , Aarhus University Hospital Risskov , Risskov , Denmark.,b Psychiatric Research Academy , Aarhus University Hospital Risskov , Risskov , Denmark.,c Clinic for OCD and Anxiety , Aarhus University Hospital Risskov , Risskov , Denmark
| | - Rasmus Beyer Mogensen
- d Department of Organic Psychiatric Disorders and Emergency Ward , Aarhus University Hospital Risskov , Risskov , Denmark
| | - Lea Catherine Crean
- b Psychiatric Research Academy , Aarhus University Hospital Risskov , Risskov , Denmark.,e Department of Mathematics , Aarhus University , Aarhus , Denmark
| | - Claus Høstrup Vestergaard
- d Department of Organic Psychiatric Disorders and Emergency Ward , Aarhus University Hospital Risskov , Risskov , Denmark
| | - Søren Skadhede
- d Department of Organic Psychiatric Disorders and Emergency Ward , Aarhus University Hospital Risskov , Risskov , Denmark
| | - Camilla Rasmussen
- d Department of Organic Psychiatric Disorders and Emergency Ward , Aarhus University Hospital Risskov , Risskov , Denmark
| | | | - Kenneth Brandt Hansen
- d Department of Organic Psychiatric Disorders and Emergency Ward , Aarhus University Hospital Risskov , Risskov , Denmark
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Bolstad A, Andreassen OA, Røssberg JI, Agartz I, Melle I, Tanum L. Previous hospital admissions and disease severity predict the use of antipsychotic combination treatment in patients with schizophrenia. BMC Psychiatry 2011; 11:126. [PMID: 21812996 PMCID: PMC3160878 DOI: 10.1186/1471-244x-11-126] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Accepted: 08/03/2011] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Although not recommended in treatment guidelines, previous studies have shown a frequent use of more than one antipsychotic agent among patients with schizophrenia. The main aims of the present study were to explore the antipsychotic treatment regimen among patients with schizophrenia in a catchment area-based sample and to investigate clinical characteristics associated with antipsychotic combination treatment. METHODS The study included 329 patients diagnosed with schizophrenia using antipsychotic medication. Patients were recruited from all psychiatric hospitals in Oslo. Diagnoses were obtained by use of the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). Additionally, Global Assessment of Functioning (GAF), Positive and Negative Syndrome Scale (PANSS) and number of hospitalisations and pharmacological treatment were assessed. RESULTS Multiple hospital admissions, low GAF scores and high PANSS scores, were significantly associated with the prescription of combination treatment with two or more antipsychotics. The use of combination treatment increased significantly from the second hospital admission. Combination therapy was not significantly associated with age or gender. Regression models confirmed that an increasing number of hospital admission was the strongest predictor of the use of two or more antipsychotics. CONCLUSIONS Previous hospital admissions and disease severity measured by high PANSS scores and low GAF scores, predict the use of antipsychotic combination treatment in patients with schizophrenia. Future studies should further explore the use of antipsychotic drug treatment in clinical practice and partly based on such data establish more robust treatment guidelines for patients with persistently high symptom load.
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Affiliation(s)
- Albert Bolstad
- Department of Psychiatry Research, Diakonhjemmet Hospital, P.O. Box 85 Vinderen, Oslo 0319, Norway.
| | - Ole A Andreassen
- Section of Psychosis Research, Clinic of Mental Health and Addiction, Oslo University Hospital, Ullevål Hospital, P.O. Box 4956 Nydalen, Oslo 0424, Norway,Institute of Clinical Medicine, University of Oslo, P.O. Box 1171 Blindern, Oslo 0318, Norway
| | - Jan I Røssberg
- Section of Psychosis Research, Clinic of Mental Health and Addiction, Oslo University Hospital, Ullevål Hospital, P.O. Box 4956 Nydalen, Oslo 0424, Norway,Institute of Clinical Medicine, University of Oslo, P.O. Box 1171 Blindern, Oslo 0318, Norway
| | - Ingrid Agartz
- Department of Psychiatry Research, Diakonhjemmet Hospital, P.O. Box 85 Vinderen, Oslo 0319, Norway,Section of Psychosis Research, Clinic of Mental Health and Addiction, Oslo University Hospital, Ullevål Hospital, P.O. Box 4956 Nydalen, Oslo 0424, Norway
| | - Ingrid Melle
- Section of Psychosis Research, Clinic of Mental Health and Addiction, Oslo University Hospital, Ullevål Hospital, P.O. Box 4956 Nydalen, Oslo 0424, Norway,Institute of Clinical Medicine, University of Oslo, P.O. Box 1171 Blindern, Oslo 0318, Norway
| | - Lars Tanum
- Institute of Clinical Medicine, University of Oslo, P.O. Box 1171 Blindern, Oslo 0318, Norway,Department of Psychiatric Research and Development, Akershus University Hospital and University of Oslo, Lørenskog 1478, Norway
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Abstract
OBJECTIVE To evaluate the prescribing practices in psychiatric residential facilities, with particular focus both on the antipsychotic dose and polypharmacy as well as the variation of antipsychotic patterns during a patient's stay within the facilities. METHODS Fifteen residential facilities of Liguria region in Italy were included. Data were collected through a chart review during a one-day census. Frequency of psychotropic patterns was estimated. Different non-parametric tests were used to analyse the changes in prescription patterns as well as the relationship among antipsychotic dose, the number of antipsychotics and anticholinergic use. RESULTS The study sample includes 362 patients, 61.9% males. On the census day 77.5% of patients received psychotropic polypharmacy and 57.2% antipsychotic polypharmacy. Antipsychotic polypharmacy was related to the total antipsychotic daily dose and to anticholinergic use. A trend towards an increase of antipsychotic and psychotropic polypharmacy and higher doses of antipsychotics over the period of stay within the facilities was noted. This tendency was related to the length of stay in the facility. CONCLUSIONS Compared to earlier studies in the same clinical environment a significant increase in the use of psychotropic and antipsychotic polypharmacy was observed. The risk of prescribed polypharmacy seems to be related to time spent in the facility.
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Millier A, Sarlon E, Azorin JM, Boyer L, Aballea S, Auquier P, Toumi M. Relapse according to antipsychotic treatment in schizophrenic patients: a propensity-adjusted analysis. BMC Psychiatry 2011; 11:24. [PMID: 21314943 PMCID: PMC3045883 DOI: 10.1186/1471-244x-11-24] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Accepted: 02/11/2011] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To compare the rate of relapse as a function of antipsychotic treatment (monotherapy vs. polypharmacy) in schizophrenic patients over a 2-year period. METHODS Using data from a multicenter cohort study conducted in France, we performed a propensity-adjusted analysis to examine the association between the rate of relapse over a 2-year period and antipsychotic treatment (monotherapy vs. polypharmacy). RESULTS Our sample consisted in 183 patients; 50 patients (27.3%) had at least one period of relapse and 133 had no relapse (72.7%). Thirty-eight (37.7) percent of the patients received polypharmacy. The most severely ill patients were given polypharmacy: the age at onset of illness was lower in the polypharmacy group (p = 0.03). Patients that received polypharmacy also presented a higher general psychopathology PANSS subscore (p = 0.04) but no statistically significant difference was found in the PANSS total score or the PANSS positive or negative subscales. These patients were more likely to be given prescriptions for sedative drugs (p < 0.01) and antidepressant medications (p = 0.03). Relapse was found in 23.7% of patients given monotherapy and 33.3% given polypharmacy (p = 0.16). After stratification according to quintiles of the propensity score, which eliminated all significant differences for baseline characteristics, antipsychotic polypharmacy was not statistically associated with an increase of relapse: HR = 1.686 (0.812; 2.505). CONCLUSION After propensity score adjustment, antipsychotic polypharmacy is not statistically associated to an increase of relapse. Future randomised studies are needed to assess the impact of antipsychotic polypharmacy in schizophrenia.
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Affiliation(s)
- Aurelie Millier
- Creativ-Ceutical France, rue du Faubourg Saint-Honoré, 75008 Paris, France
| | - Emmanuelle Sarlon
- National Institute of Health and Medical Research, INSERM, U669, Maison de Solenn, Boulevard de Port Royal, 75679 Paris, France,University of Paris-Sud and University of Paris Descartes, UMR-S0669, 75014 Paris, France,Department of Public Health, Hospital Center, Creil/Senlis, 60309 Senlis, France
| | - Jean-Michel Azorin
- Department of Psychiatry, University Hospital Ste-Marguerite, Boulevard Sainte-Marguerite, 13009 Marseille, France
| | - Laurent Boyer
- Department of Public Health, EA 3279 Research Unit, University Hospital, Boulevard Jean Moulin 13385 Marseille, France
| | - Samuel Aballea
- Creativ-Ceutical France, rue du Faubourg Saint-Honoré, 75008 Paris, France
| | - Pascal Auquier
- Department of Public Health, EA 3279 Research Unit, University Hospital, Boulevard Jean Moulin 13385 Marseille, France
| | - Mondher Toumi
- UCBL 1 - Chair of Market Access University Claude Bernard Lyon I, Decision Sciences & Health Policy, Boulevard du 11 Novembre 1918, 69622 Villeurbanne, France
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Kroken RA, Johnsen E, Ruud T, Wentzel-Larsen T, Jørgensen HA. Treatment of schizophrenia with antipsychotics in Norwegian emergency wards, a cross-sectional national study. BMC Psychiatry 2009; 9:24. [PMID: 19445700 PMCID: PMC2693495 DOI: 10.1186/1471-244x-9-24] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Accepted: 05/16/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Surveys on prescription patterns for antipsychotics in the Scandinavian public health system are scarce despite the prevalent use of these drugs. The clinical differences between antipsychotic drugs are mainly in the areas of safety and tolerability, and international guidelines for the treatment of schizophrenia offer rational strategies to minimize the burden of side effects related to antipsychotic treatment. The implementation of treatment guidelines in clinical practice have proven difficult to achieve, as reflected by major variations in the prescription patterns of antipsychotics between different comparable regions and countries. The objective of this study was to evaluate the practice of treatment of schizophrenic patients with antipsychotics at discharge from acute inpatient settings at a national level. METHODS Data from 486 discharges of patients from emergency inpatient treatment of schizophrenia were collected during a three-month period in 2005; the data were collected in a large national study that covered 75% of Norwegian hospitals receiving inpatients for acute treatment. Antipsychotic treatment, demographic variables, scores from the Global Assessment of Functioning and Health of the Nation Outcome Scales and information about comorbid conditions and prior treatment were analyzed to seek predictors for nonadherence to guidelines. RESULTS In 7.6% of the discharges no antipsychotic treatment was given; of the remaining discharges, 35.6% were prescribed antipsychotic polypharmacy and 41.9% were prescribed at least one first-generation antipsychotic (FGA). The mean chlorpromazine equivalent dose was 450 (SD 347, range 25-2800). In the multivariate regression analyses, younger age, previous inpatient treatment in the previous 12 months before index hospitalization, and a comorbid diagnosis of personality disorder or mental retardation predicted antipsychotic polypharmacy, while previous inpatient treatment in the previous 12 months also predicted prescription of at least one FGA. CONCLUSION Our national survey of antipsychotic treatment at discharge from emergency inpatient treatment revealed antipsychotic drug regimens that are to some degree at odds with current guidelines, with increased risk of side effects. Patients with high relapse rates, comorbid conditions, and previous inpatient treatment are especially prone to be prescribed antipsychotic drug regimens not supported by international guidelines.
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Affiliation(s)
- Rune A Kroken
- Division of Psychiatry, Haukeland University Hospital, PO Box 23, N-5812, Bergen, Norway.
| | - Erik Johnsen
- Division of Psychiatry, Haukeland University Hospital, PO Box 23, N-5812, Bergen, Norway
| | - Torleif Ruud
- Division of Mental Health Services, Department of Research and Development, Akershus University Hospital, 1478 Lørenskog, Norway,SINTEF Health Research, 0314 Oslo, Norway
| | - Tore Wentzel-Larsen
- Centre for Clinical Research, Haukeland University Hospital, N-5021 Bergen, Norway
| | - Hugo A Jørgensen
- Division of Psychiatry, Haukeland University Hospital, PO Box 23, N-5812, Bergen, Norway,Department of Clinical Medicine, Section Psychiatry, University of Bergen, N-5020 Bergen, Norway
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Abstract
OBJECTIVE To investigate the prevalence of hyperprolactinemia and common hyperprolactinemia-related symptoms and explore the association between them in patients using a modern antipsychotic drug regimen and, in addition, investigate the prevalence of the inert fraction of prolactin called macroprolactin, which, to our knowledge, has not been investigated systematically in this population before. Macroprolactin may cause misdiagnosis of hyperprolactinemia. METHOD A cross-sectional design was applied, and 106 patients who were using antipsychotics for symptoms of psychosis were included. RESULTS Hyperprolactinemia was found in 39% of the patients. Women were overrepresented in the group with the highest prolactin levels. Macroprolactin was not detected in any cases. Several of the second-generation antipsychotics were associated with hyperprolactinemia. Pearson correlation between prolactin level and symptoms revealed no association, and some patients did not report any symptoms despite grossly elevated levels of biologically active prolactin. CONCLUSIONS The results suggest that hyperprolactinemia is still an important and prevalent side effect. In patients using antipsychotics with prolactin-elevating potential, prolactin levels should be routinely measured to prevent potential long-term complications of "silent" hyperprolactinemia, although we are still in the early stages of knowing what to do with the information.
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Atik L, Erdogan A, Karaahmet E, Saracli O, Atasoy N, Kurcer MA, Balcioglu I. Antipsychotic prescriptions in a university hospital outpatient population in Turkey: a retrospective database analysis, 2005-2006. Prog Neuropsychopharmacol Biol Psychiatry 2008; 32:968-74. [PMID: 18243462 DOI: 10.1016/j.pnpbp.2007.12.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2007] [Revised: 12/27/2007] [Accepted: 12/27/2007] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study is to document the sociodemographic and the clinical profile of patients who are on antipsychotic (AP) medication prescribed in outpatient mental health clinic of a university hospital. METHODS A retrospective chart review was conducted for all outpatient files between 2005 and 2006 at the Zonguldak Karaelmas University, Medical Faculty Hospital, Department of Psychiatry in Turkey. All patients prescribed AP with regular follow up were recruited for the study. The type of AP and the route of administration were recorded. The diagnosis, age and gender of the patients were also evaluated. RESULTS We reviewed 1606 patients' files. APs were prescribed in 27.6% of the patients. Atypical antipsychotics (AAPs) represented 75.1% and typical antipsychotics (TAPs) represented 24.9% of all antipsychotic prescriptions in our study. The main psychiatric diagnoses associated with a TAP prescription were: psychotic disorders (6.5%), major affective disorders (49.5%), anxiety disorders (36.4%), and other psychiatric diseases (7.4%). The main psychiatric diagnoses associated with an AAP prescription were: psychotic disorders (35.1%), major affective disorders (31.1%), anxiety disorders (27.8%), somatoform disorders (2.4%) and other psychiatric diseases (6.4%). Twenty-eight of these patients (6.3%) were prescribed more than one AP, 45 patients were prescribed mood stabilizer (10.2%) and 272 patients were prescribed antidepressant agents (61.2%) in addition to AP. CONCLUSIONS The results reflect the particular use of AAPs in present study population. In line with the published data, the results of this study show that AAPs and TAPs are widely used in those with major affective disorders and psychotic disorders. These findings also underline the widespread off-label use of APs in the treatment of other psychiatric disorders.
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Affiliation(s)
- Levent Atik
- Department of Psychiatry, Zonguldak Karaelmas University, Faculty of Medicine, Zonguldak, Turkey.
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Johnsen E, Jørgensen HA. Effectiveness of second generation antipsychotics: a systematic review of randomized trials. BMC Psychiatry 2008; 8:31. [PMID: 18439263 PMCID: PMC2386457 DOI: 10.1186/1471-244x-8-31] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2008] [Accepted: 04/25/2008] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Systematic reviews based on efficacy trials are inconclusive about which second generation antipsychotic drug (SGA) should be preferred in normal clinical practice, and studies with longer duration and more pragmatic designs are called for. Effectiveness studies, also known as naturalistic, pragmatic, practical or real life studies, adhere to these principles as they aim to mimic daily clinical practice and have longer follow-up. OBJECTIVE To review the head-to-head effectiveness of SGAs in the domains of global outcomes, symptoms of disease, and tolerability. METHODS Searches were made in Embase, PubMED, and the Cochrane central register of controlled trials for effectiveness studies published from 1980 to 2008, week 1. Different combinations of the keywords antipsychotic*, neuroleptic* AND open, pragmatic, practical, naturalistic, real life, effectiveness, side effect*, unwanted effect*, tolera* AND compar* AND random* were used. RESULTS Sixteen different reports of randomized head-to-head comparisons of SGA effectiveness were located. There were differences regarding sample sizes, inclusion criteria and follow-up periods, as well as sources of financial sponsorship. In acute-phase and first-episode patients no differences between the SGAs were disclosed regarding alleviating symptoms of disease. Olanzapine was associated with more weight gain and adverse effects on serum lipids. In the chronic phase patients olanzapine groups had longer time to discontinuation of treatment and better treatment adherence compared to other SGAs. The majority of studies found no differences between the SGAs in alleviating symptoms of psychosis in chronically ill patients. Olanzapine was associated with more metabolic adverse effects compared to the others SGAs. There were surprisingly few between-drug differences regarding side effects. First generation antipsychotics were associated with lower total mental health care costs in 2 of 3 studies on chronically ill patients, but were also associated with more extrapyramidal side effects compared to the SGAs in several studies. CONCLUSION In chronically ill patients olanzapine may have an advantage over other SGAs regarding longer time to treatment discontinuation and better drug adherence, but the drug is also associated with more metabolic side effects. More effectiveness studies on first-episode psychosis are needed.
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Affiliation(s)
- Erik Johnsen
- Haukeland University Hospital, Division of Psychiatry, Sandviken, P.O.Box 23, N-5812, Bergen, Norway
| | - Hugo A Jørgensen
- Haukeland University Hospital, Division of Psychiatry, Sandviken, P.O.Box 23, N-5812, Bergen, Norway
- Department of Clinical Medicine, Section Psychiatry, University of Bergen, N-5020 Bergen, Norway
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Deurell M, Weischer M, Pagsberg AK, Labianca J. The use of antipsychotic medication in child and adolescent psychiatric treatment in Denmark. A cross-sectional survey. Nord J Psychiatry 2008; 62:472-80. [PMID: 18841508 DOI: 10.1080/08039480801985096] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The number of children and adolescents with psychiatric disorders being treated with antipsychotic medication is increasing significantly; however, only a limited evidence-base is available on this topic, especially when children are concerned. This study reports and discusses the use of antipsychotic medication in children and adolescents below 19 years of age in Denmark. A national cross-sectional survey registered the use of antipsychotic drugs on a given date. A questionnaire was sent to all child and adolescent psychiatric departments and all consultants in child and adolescent psychiatry throughout the country. All children and adolescents, aged 0-18 years, registered in treatment with antipsychotic medication, were included. Sixty-seven per cent of clinics and 63% of consultants participated. The total number of subjects registered in examination or treatment in the participating units was 3854. Antipsychotic medication was used in n=244 (6.4%) of these cases. Eighty-eight patients received additional medication, of which 24% received antidepressants, 8% sedative medication and 4% psychostimulants. The age of the patients was 4-18 years, and 63% was male. The most frequent diagnoses for patients in antipsychotic treatment were: schizophrenia, schizotypal disorder, autism spectrum disorders and personality disorders. Monotherapy was used in 87% of cases. Sixty-four per cent of patients treated with antipsychotics, received a second-generation antipsychotic as the main treatment. All 244 patients received one or more additional treatment modalities other than medication. Antipsychotic medication has a definite role in the treatment of children and adolescents with psychiatric disorders. Second-generation antipsychotics used as monotherapy prevail.
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Affiliation(s)
- Maria Deurell
- Bispebjerg Hospital, Child and Adolescent Psychiatric Department, Copenhagen University Hospital, Copenhagen, Denmark.
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Mortimer AM, Shepherd CJ, Rymer M, Burrows A. Primary care use of antipsychotic drugs: an audit and intervention study. Ann Gen Psychiatry 2005; 4:18. [PMID: 16316473 PMCID: PMC1318453 DOI: 10.1186/1744-859x-4-18] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2005] [Accepted: 11/29/2005] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Concerns regarding the use of antipsychotic medication in secondary care suggested an examination of primary care prescribing. AIM To audit and intervene in the suboptimal prescribing of antipsychotic drugs to primary care patients. DESIGN OF STUDY Cross-sectional prevalence: subsequent open treatment intervention. SETTING Seven of the 29 practices in the Eastern Hull Primary Care Trust. METHODS Criteria for best practice were developed, against which prescribing standards were tested via audit. Patients identified as suboptimally prescribed for were invited to attend an expert review for intervention. RESULTS 1 in 100 of 53,000 patients was prescribed antipsychotic treatment. Diagnoses indicating this were impossible to ascertain reliably. Half the regimes failed one or more audit criteria, leaving diagnosis aside. Few practices agreed to patients being approached: of 179 invitations sent, only 40 patients attended. Of 32 still taking an antipsychotic drug, 26 required changes. Mean audit criteria failed were 3.4, lack of psychotic disorder diagnosis and problematic side effects being most frequent. Changes were fully implemented in only 16 patients: reasons for complete or partial failure to implement recommendations included the wishes or inaction of patients and professionals, and worsening of symptoms including two cases of antipsychotic withdrawal syndrome. CONCLUSION Primary care prescribing of antipsychotic drugs is infrequent, but most is unsatisfactory. Intervention is hampered by pluralistic reluctance: even with expert guidance, rationalisation is not without risk. Use of antipsychotic drugs in primary care patients whose diagnosis does not warrant this should be avoided. HOW THIS FITS IN: This study adds to concerns regarding high levels of off-licence use of potentially harmful medication. It adds evidence of major difficulties in rationalizing suboptimal regimes despite expert input. Relevance to the clinician is that it is better to avoid such regimes in the first place especially if there is no clear 'exit strategy': if in doubt, seek a specialist opinion.
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Affiliation(s)
- Ann M Mortimer
- Foundation Chair in Psychiatry/Head of Department, The Department of Psychiatry, The University of Hull, Cottingham Road, Hull, HU6 7RX, UK
| | - Charles J Shepherd
- Research Nurse, The Department of Psychiatry, The University of Hull, Cottingham Road, Hull, HU6 7RX, UK
| | - Michael Rymer
- Pharmaceutical Advisor, Eastern Hull Primary Care Team, Central Office, Netherhall, Wawne Road, Sutton, UK, Hull, HU7 4YG, UK
| | - Alison Burrows
- Consultant Psychiatrist, Harrogate District Hospital, Lancaster Park Road, Harrogate, North Yorkshire, HG2 7SX, UK
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