July 19, 2016 - In recent years, measures have been introduced to reduce the rate of "antipsychotic polypharmacy"--taking more than one antipsychotic drug--among patients with schizophrenia and other serious mental illnesses. But at least 12 percent of patients are still prescribed multiple antipsychotics after an inpatient stay at a state psychiatric hospital, according to an analysis of U.S. data in the July Journal of Psychiatric Practice®, published by Wolters Kluwer.
"Antipsychotic polypharmacy continues at a high enough rate to impact nearly 10,000 patients with a diagnosis of schizophrenia each year in state psychiatric inpatient hospitals," write Glorimar Ortiz, Vera Hollen, and Lucille Schacht, of the National Association of State Mental Health Program Directors Research Institute (NRI) in Falls Church, Virginia, which supported the study. The results "provide insights into quality initiatives that could help further reduce the use of antipsychotic polypharmacy and reduce practices that are not consistent with best-practice guidelines," the researchers write.
Despite New Best Practice Guidelines, Many Patients Receive Multiple Antipsychotics
The study included data on more than 86,000 adult patients discharged from 160 state psychiatric inpatient hospitals during 2011. Data were obtained from the Behavioral Healthcare Performance Measurement System--a comprehensive proprietary national database maintained by the NRI, representing 80 percent of all US state psychiatric hospitals.
Most schizophrenia treatment guidelines recommend against using antipsychotic polypharmacy, or using it only as a last resort. Taking more than one antipsychotic can increase the risk for complications--including drug interactions, medication side effects, and metabolic disorders--without improving outcomes. More complex medication regimens may also increase the risk that patients won't follow their prescribed treatment.
In 2011, the Joint Commission introduced performance measures to reduce antipsychotic polypharmacy. Those standards defined some situations where using more than one antipsychotic is scientifically validated: multiple failed attempts at single-drug treatment, adjusting doses to work toward single-drug therapy, or to augment the effects of the antipsychotic drug clozapine.
The data showed that 12 percent of patients were discharged with a prescription for multiple antipsychotic drugs. Of the discharged patients who were prescribed at least one antipsychotic medication, 18 percent were prescribed more than one antipsychotic.
The most common reason for antipsychotic polypharmacy was to "reduce symptoms"--cited for 37 percent of patients. Meanwhile, only 36 percent met one of the three criteria established by The Joint Commission for appropriate use of multiple antipsychotics.
Two factors were identified as strong predictors of antipsychotic polypharmacy: a diagnosis of schizophrenia and an inpatient stay of 90 days or more. The researchers note that 40 percent of patients at state psychiatric inpatient hospitals have a diagnosis of schizophrenia, while nearly 20 percent experience a longer hospital stay--"suggesting a high-risk population needing special attention."
The results highlight the need for continued efforts to reduce the rate of antipsychotic polypharmacy. "Low percentages for the three appropriate justifications suggest that implementation of the proposed best practices are taking place at a low rate," Ms. Ortiz and coauthors write. They believe their findings suggest that need for revised standards and definitions that are more appropriate for psychiatric inpatient hospitals.
###
Article "Antipsychotic Medication Prescribing Practices Among Adult Patients Discharged From State Psychiatric Inpatient Hospitals." (doi; 10.1097/PRA.0000000000000163.)
About Journal of Psychiatric Practice
Journal of Psychiatric Practice®, a peer reviewed journal, publishes reports on new research, clinically applicable reviews, articles on treatment advances, and case studies, with the goal of providing practical and informative guidance for clinicians. Mental health professionals will want access to this journal¬--for sharpening their clinical skills, discovering the best in treatment, and navigating this rapidly changing field. John M. Oldham, MD, is the editor in chief and past president of the American Psychiatric Association.
About Wolters Kluwer
Wolters Kluwer is a global leader in professional information services. Professionals in the areas of legal, business, tax, accounting, finance, audit, risk, compliance and healthcare rely on Wolters Kluwer's market leading information-enabled tools and software solutions to manage their business efficiently, deliver results to their clients, and succeed in an ever more dynamic world.
Wolters Kluwer reported 2015 annual revenues of €4.2 billion. The group serves customers in over 180 countries, and employs over 19,000 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands. Wolters Kluwer shares are listed on Euronext Amsterdam (WKL) and are included in the AEX and Euronext 100 indices. Wolters Kluwer has a sponsored Level 1 American Depositary Receipt program. The ADRs are traded on the over-the-counter market in the U.S. (WTKWY).
Wolters Kluwer Health is a leading global provider of information and point of care solutions for the healthcare industry. For more information about our products and organization, visit http://www.wolterskluwer.com, follow @WKHealth or @Wolters_Kluwer on Twitter, like us on Facebook, follow us on LinkedIn, or follow WoltersKluwerComms on YouTube.
Journal
Journal of Psychiatric Practice