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

Westaway, Kerrie; Sluggett, Janet K.; Alderman, Christopher P; Procter, Nicholas; Roughead, Elizabeth E

doi:10.1097/xeb.0000000000000082

Cited by 19 publications

(12 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Given the increasing prevalence of antipsychotic polypharmacy, a number of researchers have investigated methods of reducing this practice. Westaway, Sluggett, Alderman, Procter, and Roughead (38) suggested strategies that educate prescribing clinicians about antipsychotic polypharmacy could be an effective way to reduce polypharmacy. In a cluster randomized controlled trial, Thompson and colleagues (39) provided education workbooks and reminders to clinicians when patients were prescribed multiple antipsychotics.…”

Section: Discussionmentioning

confidence: 99%

The Prevalence and Factors Associated With Antipsychotic Polypharmacy in a Forensic Psychiatric Sample

Farrell

Brink

2020

Front. Psychiatry

View full text Add to dashboard Cite

Despite clinical guidelines limiting the use of multiple concomitant antipsychotics to the most exceptional and treatment resistant cases, the prevalence of antipsychotic polypharmacy has been increasing worldwide. There has been minimal research investigating the prevalence of antipsychotic polypharmacy in forensic psychiatric samples and the correlates associated with antipsychotic polypharmacy. This crosssectional study aimed to establish the prevalence of antipsychotic polypharmacy in a forensic psychiatric inpatient sample and to investigate the demographical, clinical, and forensic factors associated with polypharmacy. All patients (N = 142) were prescribed at least one antipsychotic at the time of the study. Antipsychotic polypharmacy was prescribed to 54.93% of patients. Logistic regression results indicated increased length of hospitalization, high/medium security level, treatment with clozapine, and depot antipsychotic prescription were predictive of being placed on an antipsychotic polypharmacy regimen. The results suggest that those who are prescribed multiple antipsychotics are long stay patients who present with higher clinical complexity. The results from this study can be used to inform clinical practice leaders about the prevalence of antipsychotic polypharmacy in a forensic psychiatric institution. More research is needed to understand the clinical justifications for prescribing multiple antipsychotics in a forensic psychiatric sample and ways to safely reduce the prevalence of antipsychotic polypharmacy.

show abstract

Section: Discussionmentioning

confidence: 99%

The Prevalence and Factors Associated With Antipsychotic Polypharmacy in a Forensic Psychiatric Sample

Farrell

Brink

2020

Front. Psychiatry

View full text Add to dashboard Cite

show abstract

“…Patients may be prescribed more than one antipsychotic when they are deemed resistant to the effect of a single antipsychotic, they have more than one psychiatric diagnosis, the clinician is overlapping one medication while another is titrated, or an effective dose of one antipsychotic cannot be achieved because of lack of tolerance or side effects [8]. APP is not actively recommended in current clinical practice guidelines, yet it is extremely common in clinical practice, occurring in up to two-thirds of patients with psychosis [13–16]. …”

Section: Introductionmentioning

confidence: 99%

Antipsychotic polypharmacy and metabolic syndrome in schizophrenia: a review of systematic reviews

et al. 2018

View full text Add to dashboard Cite

BackgroundThere is conflicting evidence on the association between antipsychotic polypharmacy and metabolic syndrome in schizophrenia. We conducted a review of published systematic reviews to evaluate evidence on the association between metabolic syndrome (diabetes, hypertension, and hyperlipidaemia) and exposure to antipsychotic polypharmacy in schizophrenia.MethodsWe searched five electronic databases, complemented by reference screening, to find systematic reviews that investigated the association of antipsychotic polypharmacy in schizophrenia with hypertension, diabetes, or hyperlipidaemia. Selection of reviews, data extraction and review quality were conducted independently by two people and disagreements resolved by discussion. Results were synthesised narratively.ResultsWe included 12 systematic reviews, which reported heterogeneous results, mostly with narrative syntheses and without pooled data. The evidence was rated as low quality. There was some indication of a possible protective effect of drug combinations including aripiprazole for diabetes and hyperlipidaemias, compared to other combinations and/or monotherapy. Only one review reported the association between APP and hypertension. The most frequently reported combinations of medication included clozapine, possibly representing a sample of patients with treatment resistant illness. No included review reported results separately by setting (primary or secondary care).ConclusionsFurther robust studies are needed to elucidate the possible protective effect of aripiprazole. Long-term prospective studies are required for accurate appraisal of diabetes risk, hypertension and hyperlipidaemia in patients exposed to antipsychotic polypharmacy.Electronic supplementary materialThe online version of this article (10.1186/s12888-018-1848-y) contains supplementary material, which is available to authorized users.

show abstract

“…Besides a sedentary lifestyle (7–10), side effects of psychotropic medication (such as weight gain, dyslipidemia, diabetes mellitus, and direct and indirect harm to the vascular system) are associated with these cardiovascular health issues (11–14). Polypharmacy, higher dosages, and longer-term use are associated with higher risk for most of these side effects and somatic diseases (11, 12, 15). A study in people diagnosed with schizophrenia showed that both no exposure as well as high exposure to antipsychotics were associated with higher cardiovascular mortality than either low or moderate exposure (16).…”

Section: Introductionmentioning

confidence: 99%

“…A study in people diagnosed with schizophrenia showed that both no exposure as well as high exposure to antipsychotics were associated with higher cardiovascular mortality than either low or moderate exposure (16). Unfortunately, polypharmacy is very prevalent among people with SMI (15, 17) and the dosage of antipsychotic medication has only increased during the last decades for long-term hospitalized patients (18, 19). Alongside this psychotropic medication, patients use antihypertensive, lipid-lowering, antihyperglycemic and other additional drugs if cardiovascular health issues (whether or not caused by psychotropic medication) are too severe (20–24).…”

Section: Introductionmentioning

confidence: 99%

Less Medication Use in Inpatients With Severe Mental Illness Receiving a Multidisciplinary Lifestyle Enhancing Treatment. The MULTI Study III

et al. 2018

View full text Add to dashboard Cite

Besides having an unhealthy lifestyle contributing to premature mortality, inpatients with severe mental illness (SMI) use high dosages of medication. Previous research has shown improved health after lifestyle improvements in SMI. In addition, we aimed to retrospectively study whether a multidisciplinary lifestyle enhancing treatment (MULTI) was associated with changes in medication use after 18 months, as compared with patients that continued treatment as usual (TAU) and explored mediation by a change in physical activity. We conducted an observational study within a cohort of inpatients with SMI, who received MULTI (N = 65) or continued TAU (N = 49). Data on their somatic and psychotropic medications were collected, converted into defined daily dose (DDD), and analyzed using linear multilevel regression, correcting for baseline value and differences between groups in age, diagnosis, and illness severity. Compared with TAU, the DDD for psychotropic medication significantly decreased with MULTI (B = −0.55, P = 0.02). Changes in total activity did not mediate this association, suggesting that multiple components of MULTI contributed. Corrected between-group analyses for subgroups of medication were not possible due to lack of power and skewed distributions. Within-group data showed a decreased proportion of users as well as median DDD in both groups for almost all medications. In addition to previously reported health improvements after 18 months of MULTI, we observed a significant decrease in dose of psychotropic medication in MULTI compared to TAU. This first study evaluating a wide range of medications indicates a possible effect of lifestyle improvements on medication use in inpatients with SMI. Findings need to be confirmed in future controlled studies, however.

show abstract

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

Cited by 19 publications

References 31 publications

The Prevalence and Factors Associated With Antipsychotic Polypharmacy in a Forensic Psychiatric Sample

The Prevalence and Factors Associated With Antipsychotic Polypharmacy in a Forensic Psychiatric Sample

Antipsychotic polypharmacy and metabolic syndrome in schizophrenia: a review of systematic reviews

Less Medication Use in Inpatients With Severe Mental Illness Receiving a Multidisciplinary Lifestyle Enhancing Treatment. The MULTI Study III

Contact Info

Product

Resources

About