Patient characteristics and process factors associated with antipsychotic polypharmacy in a nationwide sample of psychiatric inpatients in Italy

Psychiatric Unit, United Hospitals of Ancona and Polytechnic University of Marche, Ancona, Italy.
Pharmacoepidemiology and Drug Safety (Impact Factor: 2.9). 05/2011; 20(5):441-9. DOI: 10.1002/pds.2083
Source: PubMed

ABSTRACT The present study investigated: (i) the rate of prescription of antipsychotic (AP) polypharmacy (APP) in a large, representative sample of psychiatric inpatients; and (ii) the relationship between APP prescription and the characteristics of patients and facilities.
The sample included 1022 psychiatric patients scheduled to be discharged from acute inpatient facilities with drug therapies including AP. Demographic and clinical data were obtained from the treating physician or retrieved from patients' records through a standardized Patient Form. Patients were administered the 24-item Brief Psychiatric Rating Scale. Three indicators were used to describe the process of care in the facilities: a Restrictiveness score, a Standardization score, and a Treatment score. A multilevel mixed-effect logistic regression was used to predict APP using patient and facility as the variables.
APP was prescribed to 333 (32.5%) patients, the most common patterns being a first-generation and a second-generation AP (n = 178, 17.6%) or of two first-generation APs (n = 80, 7.8%). Patients with a diagnosis of schizophrenia and poorer insight into illness at admission were significantly more likely to receive APP. The availability of more complex therapeutic interventions in the facility was also associated with APP.
In our nationwide sample of psychiatric inpatients, APP was frequently prescribed to treat the more severe patients. However, it was also associated with process of care characteristics such as delivery of more complex therapeutic interventions, and was therefore not used only to control patient behavior.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background The objective of this study was to characterize real-world treatment patterns in the prescription of antipsychotic polypharmacy (¿2 concurrent antipsychotics) compared with antipsychotic monotherapy for patients with schizophrenia.Methods This study was a retrospective claims-based analysis of patients (aged 13¿64 years) with schizophrenia belonging to an employer-based health plan. Duration of therapy was measured as the number of treatment days over one year following the initial date of antipsychotic therapy. Discontinuation was defined as a 90-day gap in antipsychotic treatment (or in at least one antipsychotic for the polypharmacy group). Logistic regression analyses were used to predict discontinuation within one year. Ordinary Least Squares (OLS) regressions were used to predict duration of therapy (by type of therapy) when controlling for gender, region, number of somatic and psychiatric comorbidities, Deyo-Charlson comorbidity score, and number of psychiatric and somatic medications.ResultsOf the 4,156 patients, 3,188 received monotherapy and 968 received polypharmacy. Mean age was 40 years (37.8 years for polypharmacy vs 40.3 years for monotherapy, p¿<¿0.001). Within one year, 77% of the polypharmacy group and 54% of the monotherapy group discontinued treatment. The average duration of therapy was 163 [SD¿=¿143] days in the polypharmacy group vs 253 [SD¿=¿147] days in the monotherapy group. In both cohorts, patients <25 years had a higher frequency of discontinuations than those ¿26 years. Age and polypharmacy were independent predictors of treatment duration and discontinuation prior to one year.Conclusions One quarter of patients with schizophrenia received antipsychotic polypharmacy. Discontinuation was higher in the polypharmacy group. Age and polypharmacy were significant predictors of treatment discontinuation.
    BMC Psychiatry 11/2014; 14(1):341. DOI:10.1186/s12888-014-0341-5 · 2.24 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective The study evaluated relationships between frontal lobe function in patients with schizophrenia and both their social adjustment and medication, using 22-channel near-infrared spectroscopy (NIRS).Methods One hundred ninety-nine stable patients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision schizophrenia, whose medication had not been changed within the preceding 3 months and who were able to visit our clinics for NIRS, were the study subjects. As a comparator, 144 healthy volunteers who underwent a physical examination and the Mini-International Neuropsychiatric Interview also received NIRS.ResultsThe main outcomes evaluated were frontal lobe oxyhemoglobin concentration (OxHb) measured by NIRS, current medication, social adjustment, and scores on the Brief Psychiatric Rating Scale. The OxHb in schizophrenic patients (0.878 ± 1.1801 mMmm; n = 199) was significantly lower than that in the healthy volunteers (2.085 ± 1.7480 mM mm: n = 100) (p < 0.001). NIRS-measured OxHb values reflected disease severity and degree of social adjustment in schizophrenic patients.Conclusions Patients with higher OxHb values were socially better adjusted than those with lower OxHb values. Patients treated with atypical antipsychotic monotherapy showed lower treatment resistance and better social adjustment than those treated with combination therapy. © 2014 The Authors. Human Psychopharmacology: Clinical and Experimental published by John Wiley & Sons, Ltd.
    Human Psychopharmacology Clinical and Experimental 11/2014; 30(1). DOI:10.1002/hup.2448 · 2.10 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: ObjectiveThis study investigated the prescription patterns for Korean patients with schizophrenia with a particular focus on antipsychotic polypharmacy. All data were gathered from patients presenting at 41 tertiary university hospitals and 8 secondary hospitals.MethodsData from three multicenter studies conducted in Korea were retrospectively reviewed and integrated to identify patients with schizophrenia who had their antipsychotic medication switched to paliperidone extended-release between 2008 and 2009. The rates for antipsychotic polypharmacy, combined use of different antipsychotic classes with a special focus on atypical antipsychotics, and psychotropic polypharmacy using benzodiazepines, mood stabilizers, and other relevant drugs were identified.ResultsOf the 851 Korean patients analyzed in this study, 20.4% (n=173) had been prescribed antipsychotic polypharmacy. Of the 678 patients receiving antipsychotic monotherapy, 6.9% (n=47) were prescribed a typical antipsychotic and 93.1% (n=631) were prescribed an atypical antipsychotic. Of the 173 patients receiving a combination of antipsychotic drugs, only 6.4% (n=11) had been prescribed polypharmacy with typical antipsychotics, while 46.82% (n=81) were prescribed atypical+atypical antipsychotics or typical+atypical antipsychotics. The highest co-prescription rates for other psychotropic drugs in conjunction with antipsychotics included benzodiazepines (30.3%), anticholinergic drugs (28.8%), antidepressants (13.3%), β-blockers (10.1%), and mood stabilizers (8.7%).ConclusionThe present findings demonstrate that the rate of antipsychotic polypharmacy is relatively low in Korea and that Korean clinicians prefer to prescribe atypical, rather than typical, antipsychotic drugs. This suggests that there is a distinct prescription pattern in Korea that is focused on antipsychotic polypharmacy.
    Clinical Psychopharmacology and Neuroscience 08/2014; 12(2):128-36. DOI:10.9758/cpn.2014.12.2.128
    This article is viewable in ResearchGate's enriched format