Attitudes towards and rationale for antipsychotic polypharmacy among psychiatrists in Nigeria: Characteristics associated with high reported antipsychotic polypharmacy

James, Bawo Onesirosan; Omoaregba, Joyce Ohiole; Raji, Saheed O; Imishue, O.E.; Okonoda, Kingsley Mayowa; Nyamali, Y.I.; Famuyiwa, P.A.; Correll, Christoph U.

doi:10.1016/j.psychres.2016.12.032

Cited by 10 publications

(11 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous surveys on psychiatrists' attitudes were conducted in America, Japan, and Nigeria and have shown similarities in the PAP among both high and low polypharmacy prescribers. [15][16][17] Contrary to these previous results, our results indicated a significant association between attitude toward polypharmacy and treatment decision-making toward polypharmacy using case vignettes. This discrepancy between our results and previous findings could be attributed to differences in evaluating the following two aspects: 1) attitudes toward polypharmacy and 2) treatment decision-making toward polypharmacy.…”

Section: Discussioncontrasting

confidence: 99%

“…PAP have been assessed in several reports, although these are much fewer than studies on polypharmacy rates. Previous surveys on psychiatrists’ attitudes were conducted in America, Japan, and Nigeria and have shown similarities in the PAP among both high and low polypharmacy prescribers [ 15 - 17 ]. Contrary to these previous results, our results indicated a significant association between attitude toward polypharmacy and treatment decision-making toward polypharmacy using case vignettes.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A Call for a Rational Polypharmacy Policy: International Insights From Psychiatrists

Nakagami

Hayakawa

Horinouchi

et al. 2021

Psychiatry Investig

View full text Add to dashboard Cite

Objective Recently, rational polypharmacy approaches have been proposed, regardless of the lower risk and cost of monotherapy. Considering monotherapy as first-line treatment and polypharmacy as rational treatment, a balanced attitude toward polypharmacy is recommended. However, the high prevalence of polypharmacy led the Japanese government to establish a polypharmacy reduction policy. Based on this, the association between the policy and psychiatrists’ attitude toward polypharmacy has been under debate.Methods We developed an original questionnaire about Psychiatrists’ attitudes toward polypharmacy (PAP). We compared the PAP scores with the treatment decision-making in clinical case vignettes. Multiple regression analyses were performed to quantify associations of explanatory variables including policy factors and PAP scores. The anonymous questionnaires were administered to psychiatrists worldwide.Results The study included 347 psychiatrists from 34 countries. Decision-making toward polypharmacy was associated with high PAP scores. Multiple regression analysis revealed that low PAP scores were associated with the policy factor (β=-0.20, p=0.004). The culture in Korea was associated with high PAP scores (β=0.34, p<0.001), whereas the culture in India and Nepal were associated with low scores (β=-0.15, p=0.01, and β=-0.17, p=0.006, respectively).Conclusion Policy on polypharmacy may influence psychiatrists’ decision-making. Thus, policies considering rational polypharmacy should be established.

show abstract

Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Call for a Rational Polypharmacy Policy: International Insights From Psychiatrists

Nakagami

Hayakawa

Horinouchi

et al. 2021

Psychiatry Investig

View full text Add to dashboard Cite

show abstract

“…Secondly, antipsychotics are often prescribed for other disorders than their licensed indication, leading to off-label use rates of sometimes up to 93% (Carton et al, 2015). Thirdly, a significant portion of patients of all ages is treated with antipsychotic polypharmacy (Z 2 concurrent antipsychotic substances), which can lead to increased rates of adverse effects (Campos Mendes et al, 2016;Fontanella et al, 2014;James et al, 2017;Norgaard et al, 2017;Westaway et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

International trends in antipsychotic use: A study in 16 countries, 2005–2014

Hálfdánarson

Zoëga

Aagaard³

et al. 2017

European Neuropsychopharmacology

210

185

View full text Add to dashboard Cite

The objective of this study was to assess international trends in antipsychotic use, using a standardised methodology. A repeated cross-sectional design was applied to data extracts from the years 2005 to 2014 from 16 countries worldwide. During the study period, the overall prevalence of antipsychotic use increased in 10 of the 16 studied countries. In 2014, the overall prevalence of antipsychotic use was highest in Taiwan (78.2/1000 persons), and lowest in Colombia (3.2/1000). In children and adolescents (0-19 years), antipsychotic use ranged from 0.5/1000 (Lithuania) to 30.8/1000 (Taiwan). In adults (20-64 years), the range was 2.8/1000 (Colombia) to 78.9/1000 (publicly insured US population), and in older adults (65+ years), antipsychotic use ranged from 19.0/1000 (Colombia) to 149.0/1000 (Taiwan). Atypical antipsychotic use increased in all populations (range of atypical/typical ratio: 0.7 (Taiwan) to 6.1 (New Zealand, Australia)). Quetiapine, risperidone, and olanzapine were most frequently prescribed. Prevalence and patterns of antipsychotic use varied markedly between countries. In the majority of populations, antipsychotic utilisation and especially the use of atypical antipsychotics increased over time. The high rates of antipsychotic prescriptions in older adults and in youths in some countries merit further investigation and systematic pharmacoepidemiologic monitoring.

show abstract

“…These data clearly suggest that most clinicians use APP under similar purpose for enhancement of treatment outcomes and with careful considerations for minimization of AEs regardless they prefer APP or not. Interestingly another survey has found that clinicians preferring APP shares similar concerns such as unexpected potential AEs of APP regardless they are heavy or light APP users (< 30% of patients) [ 62 ]. Indeed, the AEs of AP use have not been intensively and widely studied in routine practice, however, a recent systematic review [ 63 ] including 53 researches has shown critical points regarding AEs in the use of APPs, stating that APP with longer duration may be significantly associated with increased frequency and greater severity of AEs, although it should be more replicated in subsequent long-term comparative studies, especially with high-dose APM.…”

Section: Discussionmentioning

confidence: 99%

Exploring Hidden Issues in the Use of Antipsychotic Polypharmacy in the Treatment of Schizophrenia

Kim

Pae

Han

et al. 2021

Clin Psychopharmacol Neurosci

View full text Add to dashboard Cite

The mainstay of schizophrenia treatment is pharmacological therapy using various antipsychotics including first-and second-generation antipsychotics which have different pharmacokinetic and pharmacodynamic property leading to differential presentation of adverse events (AEs) and treatment effects such as negative symptoms, cognitive symptoms and cormorbid symptoms. Major treatment guidelines suggest the use of antipsychotic monotherapy (APM) as a gold standard in the treatment of schizophrenia. However, the effects of APM is inadequate and less potent to achieve symptom remission as well as functional recovery in real practice which has been consistently reported in numerous controlled clinical trials, large practical trials, independent small studies and systematic reviews till today. Therefore antipsychotic polypharmacy (APP) regardless of the class of antipsychotics has been also commonly utilized for many reasons in real world practice. However, APP has also crucial pitfalls including increase of total psychotics including antipsychotics, high-doses of antipsychotics used, poor compliance, drug-drug interaction and risks for developing AEs, all of which are paradoxically related to poor clinical outcomes, whereas APP has also substantial advantages in reduction of re-hospitalization, severe psychopathology and targeted control of concurrent symptoms. Given currently limited therapeutic options, it is also important to properly utilize APP in order to maximize its clinical utility and minimize its risk for better treatment outcomes for patients with schizophrenia, based on risk/benefit with full understanding of pharmacological and clinical issues on APP. The present paper intends to address intriguing and important issues in the use of APP in real world practice.

show abstract

Attitudes towards and rationale for antipsychotic polypharmacy among psychiatrists in Nigeria: Characteristics associated with high reported antipsychotic polypharmacy

Cited by 10 publications

References 20 publications

A Call for a Rational Polypharmacy Policy: International Insights From Psychiatrists

A Call for a Rational Polypharmacy Policy: International Insights From Psychiatrists

International trends in antipsychotic use: A study in 16 countries, 2005–2014

Exploring Hidden Issues in the Use of Antipsychotic Polypharmacy in the Treatment of Schizophrenia

Contact Info

Product

Resources

About