Antipsychotic Polypharmacy and High Doses in a Rural Portuguese Community Mental Health Service

Abstract

Introduction: Antipsychotic polypharmacy (APP) and high dose (APHD) remain a common practice in the treatment of severe mental illness, even though they are not supported by current international guidelines.
 Methods: We aimed to establish the prescribing patterns of antipsychotics in a community mental health service in a rural setting, to determine the prevalence of APP and APHD treatment and to identify associated factors.
 Results: We identified 284 patients. APP was present in 46.5% patients and was associated to younger age, single status, more previous psychiatric admissions, and anticholinergic prescription. Prescription of APHD was observed in 14.4% patients and was associated with previous inpatient admissions, being prescribed with a first generation long‑acting injectable antipsychotic and anticholinergics. We also found that APP and APHD were mutually associated.
 Conclusion: Despite current guidelines, we found prevalences of APP and APHD of 46.5% and 14.4%, respectively. Further studies are necessary to better evaluate the antipsychotic prescription patterns in Portugal.

Psychotropic drugs in Portugal from 2016 to 2019: a nationwide pharmacoepidemiological profile

“…The North region records the highest prescription rates of antidepressants and benzodiazepines, but the lowest for antipsychotics. Our results are against recent evidence suggesting heavy use of antipsychotics in rural areas in the north of Portugal (Ramos et al 2021). The Algarve region, on the contrary, always assumes low rates in comparison to other regions.…”