Unerwünschte Arzneimittelwirkungen in der Gerontopsychiatrie

Abstract

Zusammenfassung Ziel der Studie war es zu überprüfen, ob die Verordnung „potenziell inadäquater Wirkstoffe“ (PIW) mit einem erhöhten Risiko für unerwünschte Arzneimittelwirkungen (UAW) einhergeht. Methodik 304 stationäre gerontopsychiatrische Patienten wurden in die Studie eingeschlossen. Anhand der klinischen Daten und Verlaufsdokumentationen wurden Hinweise auf UAW identifiziert. Der Kausalzusammenhang der UAW und der verordneten Wirkstoffe wurde von Experten bewertet. Ergebnisse Vor der stationären Aufnahme erhielten ca. 30 % aller Patienten ≥ 1 PIW, bei Entlassung waren es 22 %. Risikofaktoren für die Verordnung ≥ 1 PIW waren zunehmende Anzahl verordneter Wirkstoffe und Schizophrenie. Protektiv wirkten daher die Faktoren Demenz und zunehmendes Lebensalter. Die Verordnung von ≥ 1 PIW führte zu einem 5-fach erhöhten Risiko für das Auftreten von ≥ 1 UAW; das Risiko für UAW stieg mit der Zahl der PIW. Die Verordnung von ≥ 1 PIW ging mit einem 4-fach erhöhten Risiko für das Auftreten schwerwiegender UAW einher. Bei Einnahme von ≥ 2 PIW war das Risiko hierfür sogar um ein 10-Faches erhöht. Schlussfolgerungen Die PRISCUS-Liste bildet wesentliche Risiken für das Auftreten von UAW in der Gerontopsychiatrie ab.

Drug Safety Profiles of Geriatric Patients Referred to Consultation Psychiatry in the Emergency Department—A Retrospective Cohort Study

“… 5 , 13 Similar to these investigations, delirium, dementia, and depression were identified as the most common psychiatric diagnoses in our study. Furthermore, in terms of age, sex, and somatic comorbidities, our study population showed great similarities with those from previous analyses that focused on geriatric psychiatric inpatients 11 , 17 …”

“…6 In our study, 28.3 % of all patients were affected by new prescription of a PRISCUS-PIM. Overall, PRISCUS-PIMs accounted for 22.6 % of all new prescriptions, which was considerably higher than the 5.7 % of all prescriptions detected by Seifert et al 17 However, a comparison between the two studies is difficult since the Seifert et al study referred exclusively to inpatients and also included medications for the treatment of somatic comorbidities. In addition, the comparatively high proportion of new prescriptions of therapeutic alternatives to PRISCUS-PIMs in our study and the fact that discontinuation of PRISCUS-PIMs was recommended in 8.3 % of all patients can be viewed as indicators of an adequate pharmacotherapy safety within the psychiatric consultation service at our hospital.…”

“…5,13 Similar to these investigations, delirium, dementia, and depression were identified as the most common psychiatric diagnoses in our study. Furthermore, in terms of age, sex, and somatic comorbidities, our study population showed great similarities with those from previous analyses that focused on geriatric psychiatric inpatients 11,17 Frequency and characteristics of PIM prescriptions have been quite extensively studied in both inpatient and outpatient settings. [18][19][20] PIM prescription rates differed significantly, which can be attributed to different settings and study designs.…”

“… 11 Seifert and colleagues showed that 5.7 % of all prescriptions on gerontopsychiatric wards involved PRISCUS-listed drugs. 17 A large study from Taiwan detected that 32.4 % of all patients in the ED received at least one PRISCUS-listed drug. 21 Dormann et al identified a proportion of 16.6 % PRISCUS-PIMs among drug prescriptions in a German ED.…”

Drug safety in older patients with alcohol use disorder: a retrospective cohort study

“…In the field of geriatric psychiatry, several studies have examined the frequency and risk factors for PIM prescriptions in inpatients. 19 , 28 , 29 In a multicenter, retrospective analysis, Hefner et al reported that 33.9% of geriatric psychiatric patients received PRISCUS-PIMs. 28 Previous studies described polypharmacy and a diagnosis of schizophrenia as predisposing factors for PIM prescriptions.…”