Antipsychotic polypharmacy in a regional health service: a population-based study

Bernardo, Miquel; Coma, Anna; Ibáñez, Cristina; Zara, Corinne; Bari, Josep Maria; Serrano‐Blanco, Antoni

doi:10.1186/1471-244x-12-42

Cited by 32 publications

(25 citation statements)

References 43 publications

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“…For example, hospitalized patients are particularly at risk of experiencing high polypharmacy levels compared with nonhospitalized patients; and also, they are at high risk of adverse events related to polypharmacy. Even among nonhospitalized individuals, whether the population studied is in a clinical or community setting, have a significant impact on the prevalence of reported polypharmacy . The few existing studies that focus on specific medication classes responsible for pediatric polypharmacy are mainly concerned with psychotropic medications.…”

Section: Introductionmentioning

confidence: 99%

“…Even among nonhospitalized individuals, whether the population studied is in a clinical or community setting, have a significant impact on the prevalence of reported polypharmacy. 12,13 The few existing studies that focus on specific medication classes responsible for pediatric polypharmacy are mainly concerned with psychotropic medications. Therefore, a gap exists when assessing the overall prevalence of polypharmacy in children or the prevalence in other pharmacological groups.…”

Section: Introductionmentioning

confidence: 99%

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Variation of the prevalence of pediatric polypharmacy: A scoping review

Baker

Feinstein

et al. 2019

Pharmacoepidemiology and Drug

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Purpose To examine the range of prevalence of pediatric polypharmacy in literature through a scoping review, focusing on factors that contribute to its heterogeneity in order to improve the design and reporting of quality improvement, pharmacovigilance, and research studies. Methods We searched Ovid Medline, PubMed, EMBASE, CINAHL, Ovid PsycINFO, Cochrane CENTRAL, and Web of Science Core Collection databases for studies with concepts of children and polypharmacy, along with a hand search of the bibliographies of six reviews and 30 included studies. We extracted information regarding study design, disease conditions, and prevalence of polypharmacy. Results Two hundred eighty‐four studies reported prevalence of polypharmacy. They were more likely to be conducted in North America (37.7%), published after 2010 (44.4%), cross‐sectional (67.3%), in outpatient settings (59.5%). Prevalence ranged from 0.9% to 98.4%, median 39.7% (interquartile range [IQR] 22.0%‐54.0%). Studies from Asia reported the highest median prevalence of 45.4% (IQR 27.3%‐61.0%) while studies from North America reported the lowest median prevalence of 30.4% (IQR 14.7%‐50.2%). Prevalence decreased over time: median 45.6% before 2001, 38.1% during 2001 to 2010, and 34% during 2011 to 2017. Studies involving children under 12 years had a higher median prevalence (46.9%) than adolescent studies (33.7%). Inpatient setting studies had a higher median prevalence (50.3%) than studies in outpatient settings (38.8%). Community level samples, higher number and duration of medications defining polypharmacy, and psychotropic medications were associated with lower prevalence. Conclusions The prevalence of pediatric polypharmacy is high and variable. Studies reporting pediatric polypharmacy should account for context, design, polypharmacy definition, and medications evaluated.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Variation of the prevalence of pediatric polypharmacy: A scoping review

Baker

Feinstein

et al. 2019

Pharmacoepidemiology and Drug

View full text Add to dashboard Cite

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“…2 Antipsychotic polypharmacy, which has virtually no support in the literature, is now used more frequently than clozapine. 3–5 …”

Section: Introductionmentioning

confidence: 99%

“…For unclear reasons, homozygotes as a group also have an average ANC that is roughly 1.5×10 3 cells/mm 3 less than groups of heterozygotes or non-carriers, without any evidence of immunocompromise. 3,14,15 By chance, a significant number of these individuals normally have circulating ANC values that fall into a “neutropenic” range as defined by norms created by study of European descent patients. In a large cross-sectional study of 25,222 participants, Hsieh et al 16 reported that 4.5% of African-American participants had an ANC of less than 1.5×10 3 cells/mm 3 versus only 0.79% of European Americans.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Safety of Clozapine Use in Patients With Benign Neutropenia

Richardson

Davis

Vyas

et al. 2016

J. Clin. Psychiatry

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Objective Determine if clozapine can be safely utilized in a population of psychiatric patients with current or a history of benign neutropenia. Method A single-center, retrospective chart review was conducted in an inpatient psychiatric hospital. Patients included had benign neutropenia prior to receiving clozapine and received clozapine using modified monitoring guidelines. All available laboratory values for absolute neutrophil count (ANC) before clozapine initiation and during treatment were evaluated. The primary endpoint was the difference in ANC after initiation of clozapine compared to before clozapine treatment. Results A total of 26 patients were reviewed. Mean age was 34 years at clozapine initiation. The majority were African-American (73%), with more males than females (73% vs. 27%). The mean lowest ANC value was not significantly different after clozapine initiation compared to before (1.5 and 1.4×103 cells/mm3, respectively; p=0.22). There were no cases of agranulocytosis (ANC <0.5 ×103 cells/mm3) and no patients were discontinued for falling below limits set by modified guidelines. There were fewer occurrences of mild neutropenia (ANC <2.0×103 cells/mm3) after clozapine initiation than before (16% and 31.4%, respectively; p<0.001). There were also fewer occurrences of moderate neutropenia (ANC <1.5×103 cells/mm3) with 2.1% after clozapine and 13.3% before (p<0.001). Occurrence of ANC <1.0×103 cells/mm3 did not differ (0.4% before, 0.3% after, p=0.79). Conclusion Twenty-six patients with benign neutropenia were safely treated with clozapine. Their pre-clozapine neutropenia did not predict increased risk for agranulocytosis with clozapine. Patients had significantly fewer episodes of mild and moderate neutropenia after receiving clozapine compared to before.

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“…PESSOAS Regarding risk factors relating to psychotic polypharmacy, we found that severe mental illness diagnoses were associated with psychotic polypharmacy for both men and women and almost 60% of the patients had severe mental illness diagnosis. The literature describes primary psychiatric diagnosis as one of the most important factors associated with psychotropic polypharmacy: patients with severe mental illnesses such as schizophrenia, depression with psychotic symptoms, and bipolar disorders are at greater risk of polypharmacy and increased use of psychotropic medicines 13,26,30,32,33 .…”

Section: Tablementioning

confidence: 99%