Antipsychotic Polypharmacy Among Patients Admitted to a Geriatric Psychiatry Unit

Dolder, Christian R.; McKinsey, Jonathan

doi:10.1097/01.pra.0000405368.20538.cd

Cited by 26 publications

(22 citation statements)

References 33 publications

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“…Similar results were found in a study from Finland in which 8% of community-dwelling older AP users with Alzheimer's disease received concurrent treatment (Taipale et al, 2014). In both the abovementioned studies, previous severe mental and psychiatric disorders were predictors of AP polypharmacy (Dolder and McKinsey, 2011;Taipale et al, 2014). We also found a high baseline prevalence of other mental disorders; however, it is difficult to determine whether AP polypharmacy in patients with dementia is related to pre-existing psychiatric morbidity or BPSD.…”

Section: Treatment Patterns Of Antipsychotic Usesupporting

confidence: 85%

Treatment patterns and characteristics of older antipsychotic users in Germany

Schmedt

Jobski

Kollhorst

et al. 2016

International Clinical Psychopharmacology

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The aim of this study was to investigate the characteristics and treatment patterns of older antipsychotic (AP) users in Germany. We carried out a cohort study in the German Pharmacoepidemiological Research Database and identified new AP users aged at least 65 years between 2005 and 2011. Possible indications, comedication, and information on persistence and adherence, concurrent multiple use, and switch of APs were assessed. Overall, 298,847 individuals were included in the cohort. Almost 70% entered the cohort with a typical antipsychotic (TAP). Melperone (23.4%) was used most frequently, followed by promethazine (18.3%), sulpiride (11.0%), and risperidone (10.3%). AP users had a low prevalence of schizophrenia and bipolar disorders in contrast to dementia. Initiators of atypical antipsychotics had more treatment episodes compared with TAPs (median 3 vs. 2), but lower median persistence (14 vs. 22 days). Persistence was also lower in patients with, rather than without, dementia. The overall percentage of concurrent multiple use and switch to other APs was low with 5.6%, but higher in patients with, rather than without, dementia. In conclusion, APs were used for a broad range of indications, mostly other than schizophrenia and bipolar disorders. Low persistence and a high number of treatment episodes suggest frequent 'as-needed' treatment, especially in dementia patients.

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Section: Treatment Patterns Of Antipsychotic Usesupporting

confidence: 85%

Treatment patterns and characteristics of older antipsychotic users in Germany

Schmedt

Jobski

Kollhorst

et al. 2016

International Clinical Psychopharmacology

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show abstract

“…Consistent with a number of studies in adults (Faries et al, 2005;López de Torre et al, 2012), quetiapine is also the most frequently co-prescribed drug in adolescent (Ganguly et al, 2004) and geriatric populations (Dolder and Mckinsey, 2011). Furthermore, in a survey of prescribers, quetiapine was the most common choice for combination therapy (Correll et al, 2011).…”

Section: Discussionmentioning

confidence: 77%

Antipsychotic polypharmacy and high-dose prescription in schizophrenia: a 5-year comparison

Roh

Chang

Kim

et al. 2013

Aust N Z J Psychiatry

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“…21,22 Some plausible reasons for these figures include patient or clinician dissatisfaction with treatment effects, bothersome side effects, or undetected poor adherence leading to persistent symptoms that are incorrectly attributed to ineffective pharmacotherapy. Nonetheless, prescribing multiple antipsychotics may result in adverse outcomes, such as emergency department visits from adverse drug reactions or psychiatric admissions, 23 while also increasing direct treatment costs for the system, metabolic disturbance, indirect societal burden and impaired quality of life for the patient. 24-26 …”

Section: Introductionmentioning

confidence: 99%

Polypharmacy with antipsychotic drugs in patients with schizophrenia: Trends in multiple health care systems

Sun¹,

Stock

Copeland

et al. 2014

American Journal of Health-System Pharmacy

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Purpose To investigate patterns in pharmacological treatment for patients with schizophrenia, we examined antipsychotic polypharmacy across multiple outpatient healthcare settings and their association with hospital admission. Methods This multi-system study utilized data on patients diagnosed with schizophrenia, including 119,662 Veterans in the Department of Veterans Affairs (VA) healthcare system, 553 and 4,887 patients in two private, integrated health systems (HMO), and outpatients (17,596,617 visits in 1-week look-back) from a nationally representative sample of U.S. residents seeking care outside federal systems (National Ambulatory Medical Care Survey, NAMCS). Antipsychotic polypharmacy was defined as the use of more than one antipsychotic agent during the covered period (week, year). The prevalence and trend of antipsychotic polypharmacy was assessed in each system (2002-2009 or 2005-2009) and their association with one-year hospital admission using multivariable logistic regression. Results Annual antipsychotic treatment in the VA ranged 74-78% each year, with the lowest rates observed in the HMO (49-67% site 1, 22-41% site 2) per pharmacy fill data; NAMCS ranged 69-84% per clinician-reported prescriptions. Polypharmacy rates depended on the defined covered period. The VA had lower polypharmacy rates when data were restricted to the one-week covered period used in non-federal systems (20-22% vs. 19-31% NAMCS). In each system, polypharmacy was associated with increased odds of admission (odds ratio ranging 1.4-2.4). Conclusions The unadjusted longitudinal trends suggest tremendous system variations in antipsychotic use among patients with schizophrenia. Cross-system comparisons are inherently subject to uncertainty due to variation in the amount and type of data collected. Given the current debate over healthcare access and costs, electronic systems to signal polypharmacy could assist in identifying patients requiring more complex clinical and pharmacy management, individuals at substantially higher risk for adverse events. Such enhanced sentinel detection and follow-up care could ultimately lead to improved clinical practice and fiscal well-being.

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Antipsychotic Polypharmacy Among Patients Admitted to a Geriatric Psychiatry Unit

Cited by 26 publications

References 33 publications

Treatment patterns and characteristics of older antipsychotic users in Germany

Treatment patterns and characteristics of older antipsychotic users in Germany

Antipsychotic polypharmacy and high-dose prescription in schizophrenia: a 5-year comparison

Polypharmacy with antipsychotic drugs in patients with schizophrenia: Trends in multiple health care systems

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