Prevalence and nature of antipsychotic polypharmacy among inpatients with schizophrenia spectrum disorders at an Australian mental health service

John, Alexander; Gee, Trevor; Alexander, Sweeka; Ramankutty, P.; Dragović, Milan

doi:10.1177/1039856214546672

Cited by 17 publications

(17 citation statements)

References 18 publications

(43 reference statements)

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“…Furthermore, such use was not correlated with any of the other variables including gender, ethnicity, and duration of illness or the number of past psychiatric hospitalizations. This finding is consistent with the results of similar audits from New Zealand [11] and Australia [7].…”

Section: Gafsupporting

confidence: 92%

“…The extent of this practice varies widely depending on geographical, regional, clinical, demographic and prescriber characteristics [2]. It also varies considerably between different regions in the same country [7]. Literature shows that use of two or more antipsychotic medications occurs in 4% to 35% of outpatients and 30% to 50% of inpatients [8].…”

Section: Gafmentioning

confidence: 99%

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Antipsychotic Use in Community Mental Health Service

El‐Badri¹,

Essali²

2020

OJPsych

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Background: The use of antipsychotic medication remains an essential treatment modality for schizophrenia and related psychosis. However, there is a globally recognised variation in prescribing which is attributed to multiple factors. Guidelines set the expected standard and criteria for evidence based prescribing practice of antipsychotic medication. The aim of this clinical audit was to review antipsychotic prescribing patterns in adult patients with a history of schizophrenia or related psychosis attending community outpatients' clinics and to verify the uniformity of this prescribing with clinical guideline recommendations. Methods: Information about the use of antipsychotic medication was collected in a sample of a 100 patients with a history of psychosis in Waikato region to investigate the consistency of antipsychotic medication prescribing practice using standard guidelines. Identifying inconsistent patterns of prescribing will offer opportunities for intervention and advancement of best and safe practice. Results: Most patients (86%) were maintained on a single antipsychotic medication within the recommended dose range. 27% of the patients were prescribed clozapine alone or in combination with other antipsychotic medication making clozapine the most frequently prescribed antipsychotic medication in our sample. Nearly half of the patients (48%) were on depot antipsychotic injections of which 20% were first-generation antipsychotic injections. Conclusions: Prescribing patterns of antipsychotics amongst our group of patients seem to be consistent with current evidence-based guidelines particularly with regards to class, frequency and dose range. Further research is required to assist in the formulation of Clozapine augmentation evidence-based guidelines.

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Section: Gafsupporting

confidence: 92%

Section: Gafmentioning

confidence: 99%

Antipsychotic Use in Community Mental Health Service

El‐Badri¹,

Essali²

2020

OJPsych

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“…The association with polytherapy alone is supported by a US based audit of outpatients visiting office-based psychiatrists [11]; other inpatient studies did not explore such associations [45], or focused solely on patients with a diagnosis of schizophrenia or related disorder [22, 24, 25]. Antipsychotics are often not first-line treatment for other mental illnesses, such as bipolar disorder.…”

Section: Discussionmentioning

confidence: 99%

Antipsychotic prescribing for vulnerable populations: a clinical audit at an acute Australian mental health unit at two-time points

et al. 2017

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BackgroundAntipsychotics are recognised as a critical intervention for schizophrenia and bipolar disorder. Guidelines globally endorse the routine practice of antipsychotic monotherapy, at the minimum effective dose. Even in treatment-resistant schizophrenia, clozapine use is endorsed before combining antipsychotics.This aim of this study was to review antipsychotic polytherapy alone, high-dose therapy alone, polytherapy and high-dose prescribing patterns in adults discharged from an inpatient mental health unit at two time-points, and the alignment of this prescribing with clinical guideline recommendations. Additionally, associations with polytherapy and high-dose antipsychotic prescribing, including patient and clinical characteristics, were explored.MethodsA retrospective clinical audit of 400 adults (200 patients at two different time-points) discharged with at least one antipsychotic. Preliminary findings and education sessions were provided to physicians between Cohorts. Outcomes (polytherapy alone, high-dose therapy alone, polytherapy and high-dose therapy) were compared between study Cohorts using chi-squared and rank-sum tests. Associations between outcomes and covariates were assessed using multivariable logistic regression.ResultsMost patients (62.5%) were discharged on a single antipsychotic within the recommended dose range. There was a clear preference for prescribing second generation antipsychotics, and in this respect, prescribing is aligned with current evidence-based guidelines. However, sub-optimal prescribing practices were identified for both Cohorts in relation to polytherapy and high-dose antipsychotic rates. Involuntary treatment, frequent hospitalisations and previous clozapine use significantly increased the risk of all three prescribing outcomes at discharge.ConclusionsIn a significant minority, antipsychotic prescribing did not align with clinical guidelines despite increased training, indicating that the education program alone was ineffective at positively influencing antipsychotic prescribing practices. Further consideration should be given when prescribing antipsychotics for involuntary patients, people with frequent hospitalisations, and those who have previously trialled clozapine.

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“…[21][22][23] Some of the studies are now 10 or more years old and the higher rate comes from one study of only 59 patients. 23 There have also been studies of the extent of prescription of dual antipsychotics at discharge.…”

Section: Inpatient Staysmentioning

confidence: 96%

“…A Queensland study conducted across 16 acute mental health inpatient services of patients with schizophrenia reported between 9 and 11% of patients on average were discharged on dual antipsychotics, 21 whereas another Western Australian retrospective audit of 229 inpatients with schizophrenia spectrum disorders reported 43% were prescribed dual antipsychotics at discharge. 22 The proportion of therapy that was dual oral therapy compared with depot injections and oral therapy was not reported. 22…”

Section: Inpatient Staysmentioning

confidence: 97%

Prevalence of multiple antipsychotic use and associated adverse effects in Australians with mental illness

Westaway¹,

Sluggett²,

Alderman

et al. 2016

International Journal of Evidence-Based Healthcare

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Use of multiple antipsychotics is common among Australian people with mental illness, despite guidelines recommending that only one antipsychotic should be used in most cases. People taking more than one antipsychotic at a time are more likely to experience side-effects, and to receive higher than recommended antipsychotic doses. Direct trials that aimed to reduce multiple antipsychotic use suggest it is possible to effectively reduce therapy in the majority of people without worsening outcomes. Simple educational programmes targeting health professionals have not been found to be effective; however, complex multifaceted programmes and quality improvement programmes have demonstrated effect.

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Prevalence and nature of antipsychotic polypharmacy among inpatients with schizophrenia spectrum disorders at an Australian mental health service

Cited by 17 publications

References 18 publications

Antipsychotic Use in Community Mental Health Service

Antipsychotic Use in Community Mental Health Service

Antipsychotic prescribing for vulnerable populations: a clinical audit at an acute Australian mental health unit at two-time points

Prevalence of multiple antipsychotic use and associated adverse effects in Australians with mental illness

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