Adverse drug reactions in geriatric psychiatry—retrospective cohort study of a 6-year period

Abstract

Objective To investigate the frequency and characteristics of adverse drug reactions (ADRs) that occurred on the gerontopsychiatric ward of Hannover Medical School over a 6-year period. Design Retrospective monocentric cohort study. Results Six hundred thirty-four patient cases (mean age 76.6 ± 7.1 years; 67.2% female) were analysed. In total, 92 ADRs in 56 patient cases were registered in the study population. The overall ADR prevalence, the ADR prevalence upon hospital admission, and the ADR prevalence during hospitalisation were 8.8%, 6.3%, and 4.9%, respectively. The most frequent ADRs were extrapyramidal symptoms, alterations in blood pressure or heart rate, and electrolyte disturbances. Of note, two cases of asystole and one case of obstructive airway symptoms related to general anaesthesia in the context of electroconvulsive therapy (ECT) were detected. The presence of coronary heart disease was associated with an increased risk of ADR occurrence (odds ratio (OR) 2.92, 95% confidence interval (CI) 1.37–6.22), while the presence of dementia was associated with a decreased risk of ADR development (OR 0.45, 95% CI 0.23–0.89). Conclusions Type and prevalence of ADRs in the present study were largely in accordance with previous reports. By contrast, we did not observe a relationship between advanced age or female sex and ADR occurrence. We detected a risk signal for cardiopulmonary ADRs related to general anaesthesia in the context of ECT that warrants further investigation. Elderly psychiatric patients should be carefully screened for cardiopulmonary comorbidities before initiation of ECT.

Managing medical and psychiatric multimorbidity in older patients

“…197 Another example of the increased risk from polypharmacy for medical and psychiatric conditions in the finding that SSRIs and SNRIs can promote electrolyte disturbances such as hyponatremia when used alongside thiazide diuretics. 197 Conversely, efforts to review and decrease prescriptions can reduce hospitalization and death in nursing home patients 208,209 and reduced mortality in ambulatory settings. 210 Previous studies have indicated the importance of working with an interdisciplinary team including pharmacists, nurses, and other professionals.…”

“…197 In linking these agents with the most frequent adverse drug reactions, the authors noted that antipsychotic medications are a known contributor to extrapyramidal side effects and join tricyclic antidepressants as the two main psychotropic agents known to influence blood pressure and heart rate -with an increased risk of the latter effect when they are taken in combination with cardiovascular agents such as antihypertensives and various diuretics. 197 Another example of the increased risk from polypharmacy for medical and psychiatric conditions in the finding that SSRIs and SNRIs can promote electrolyte disturbances such as hyponatremia when used alongside thiazide diuretics. 197 Conversely, efforts to review and decrease prescriptions can reduce hospitalization and death in nursing home patients 208,209 and reduced mortality in ambulatory settings.…”

“…A retrospective cohort study of adverse drug reactions in the geriatric psychiatry unit of a university hospital in Germany found that 62% of the agents involved in adverse drug reactions were psychotropic agents, and 38% were non-psychiatric medications. 197 Second-generation antipsychotics were the most involved agents, followed by antihypertensives, antidepressants, first-generation antipsychotics, and anticonvulsants.…”

“… 206 , 207 A study of adverse drug reactions among psychiatric inpatients with multimorbidity found that extrapyramidal events were the most common adverse drug effect, followed by alterations in heart rate or blood pressure, and thirdly electrolyte disturbances including SIADH, hyponatremia or hypokalemia. 197 In linking these agents with the most frequent adverse drug reactions, the authors noted that antipsychotic medications are a known contributor to extrapyramidal side effects and join tricyclic antidepressants as the two main psychotropic agents known to influence blood pressure and heart rate – with an increased risk of the latter effect when they are taken in combination with cardiovascular agents such as antihypertensives and various diuretics. 197 Another example of the increased risk from polypharmacy for medical and psychiatric conditions in the finding that SSRIs and SNRIs can promote electrolyte disturbances such as hyponatremia when used alongside thiazide diuretics.…”

“… 197 Another example of the increased risk from polypharmacy for medical and psychiatric conditions in the finding that SSRIs and SNRIs can promote electrolyte disturbances such as hyponatremia when used alongside thiazide diuretics. 197 …”