Potentially inappropriate prescriptions in patients admitted to a psychiatric hospital

Abstract

Background Very little is known about the general appropriateness of prescribing for psychiatric patients. Aims To identify prevalence and types of potentially inappropriate prescribing (PIP) of psychotropic and somatic medications, to assess the severity of potential clinical consequences and to identify possible predictive factors of PIP in a sample of adult psychiatric in-patients. Methods A descriptive, cross-sectional design using medication reviews by clinical pharmacologists to identify PIP during a 3-month period. The setting was in-patient units in a psychiatric department of a Danish university hospital during a 3-month period (September 2013-November 2013). Patients medication lists (n = 207) were reviewed at the time of admission and all identified PIPs were assessed for potential consequences by clinical pharmacologists. Results There were 349 PIP identified in 1291 prescriptions. The proportion of patients found to have at least one PIP was 123/207 (59%) and the proportions of patients with at least one PIP assessed to be potentially serious or fatal was 69/207 (33%) and 24/207 (12%), respectively. Interactions between drugs 125/207 (36%) and too high doses of drugs 56/207 (16%) were the most frequent PIP. Predictive factors for PIP were polypharmacy (>5 prescriptions) and having one or more somatic diagnoses. Conclusion PIP is common in psychiatric patients and potentially fatal. Particularly polypharmacy (>5 prescriptions) and concomitant somatic illness were associated with the probability of PIP. Improving the quality of prescribing might benefit from an interprofessional approach and thus better training of physicians and nurses is needed in order to minimize PIP.

Improving Medication Safety in Psychiatry – A Controlled Intervention Study of Nurse Involvement in Avoidance of Potentially Inappropriate Prescriptions

“…The prevalence of patients having at least one PIP was found to be 66%, which is higher than the 59% previously reported . In comparison, researchers reported prevalences between 21% and 79% in an extensive systematic review of criteria used to identify PIPs in the elderly .…”

Potential Drug interactions with Drugs used for Bipolar Disorder: A Comparison of 6 Drug Interaction Database Programs

“…Multiple resources were used to select the 125 drug interaction pairs. These include studies of potential DDI detected in various healthcare settings [11,[39][40][41][42][43][44], reviews of potential DDI involving psychiatric drugs [23,27,28,[45][46][47], lists of serious drug interactions used in prior testing of drug interaction database programs [48][49][50], and lists of frequently prescribed drugs [51,52]. All 125 drug interaction pairs had at least 1 category rating of major from at least one of the 6 drug interaction database programs.…”

Association between prescribed antidepressants and other prescribed drugs differ by gender: a nationwide register-based study in Sweden

“…However, even though depression is still the main indication for antidepressant use, it is important to consider, when using antidepressants as a proxy for depression, that antidepressants are also prescribed for other indications than depression [7]. In general, people with depression are also prescribed drugs other than antidepressants more often than are those without depression [8][9][10]. The reason for this can partly be explained by comorbidity between depression and other conditions, mental as well as physical [11,12].…”