Cardiac Issues Raised by an Examination of the Antipsychotic Prescribing Practices in the Elderly of St. James's Hospital (SJH), Dublin

2017 ◽  
Vol 41 (S1) ◽  
pp. S659-S659
Author(s):  
B. McCarthy ◽  
C. Power ◽  
B. Lawlor ◽  
E. Greene
Keyword(s):  
Elderly Population ◽  
The Elderly ◽  
Cardiac Risk ◽  
Antipsychotic Treatment ◽  
Qtc Interval ◽  
Prescribing Practices ◽  
Antipsychotic Medications ◽  
Average Change ◽  
Competing Interest ◽  
Current Monitoring

BackgroundAntipsychotic medication use may be associated with prolongation of the QTc interval, increasing the risk of potentially fatal arrhythmias [1]. This is particularly pertinent in the elderly due to comorbid cardiovascular disease and polypharmacy. Attention to the ECG and co-prescribed medications is essential to minimise cardiac risk when prescribing antipsychotics.MethodsOn 23rd February 2016 all inpatients aged over 65 who were prescribed antipsychotic medications were identified as part of a hospital-wide survey. Data was collected from medical and electronic patient notes and medication kardexes.ResultsComplete data was obtained for 36 patients aged over 65 who were newly-prescribed an antipsychotic or had their antipsychotic changed. Of these, 39%(n = 13) had a cardiac history. One quarter did not have an ECG in the 12 months preceding antipsychotic initiation. Of the 28 patients with an ECG, 57% (n = 16) had a QTc > 450ms before starting antipsychotic treatment. Only 11% (n = 4) had an ECG within 24 hours of starting the antipsychotic. The average change of the QTc interval in those with a repeat ECG was 30msecs. 42% (n = 15) were co-prescribed another QTc-prolonging medication.ConclusionCurrent monitoring of QTc interval in an elderly population newly prescribed antipsychotic medications is inadequate and a cause for significant safety concerns. Education and clear guidance is warranted to improve safety and minimise risk in this population.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Anticholinergic burden in inpatient psychogeriatric population – Do we care?

2016 ◽  
Vol 33 (S1) ◽  
pp. S187-S187
Author(s):  
M. Lee ◽  
A. Warren ◽  
B. Zolotarev ◽  
J. Henderson ◽  
M. George
Keyword(s):  
Mental Health ◽  
Cognitive Impairment ◽  
Elderly Population ◽  
The Elderly ◽  
Prescribing Patterns ◽  
Therapeutic Effects ◽  
Older Person ◽  
Health Records ◽  
Competing Interest ◽  
Anticholinergic Burden

BackgroundAlthough recent studies have found that there is significant association between anticholinergic and cognitive impairment, especially in the elderly population, there seems to be minimal emphasis on anticholinergic burden (ACB) when prescribing medications to the inpatient psychogeriatric population.AimTo evaluate the prescribing patterns in Older Person Mental Health Inpatient Unit (OPMHU), whether the ACB Score on admission has been reviewed for lowest possible ACB while maintaining therapeutic effects. A protocol will be developed to ensure that ACB is reviewed for future admissions and discharges.MethodologyFifty patients admitted and discharged from OPMHU are recruited retrospectively from 30th September 2015, excluding outliers and deceased patients. For those who had multiple admissions during that period, only the most recent admission would be included for evaluation. Individual ACB score is calculated on admission and discharge based on pharmacist final medication summary. Their mental health records are also audited for any documented ACB review by the treating team, while making note for any pre-existing cognitive impairment.ResultACB has not been taken into consideration in all patients by the treating team on admission as well as when prescribing medications on discharge. Hence, it is unsurprising that the ACB score showed an increment of 30% on discharge (3.25) when compared to the admission score (2.5).ConclusionThe study found that although ACB poses significant risks on cognitive impairment, this knowledge has not been employed pragmatically. A protocol should be developed to ensure that ACB is evaluated and managed accordingly.Disclosure of interestThe authors have not supplied their declaration of competing interest.

QTc Interval in individuals with schizophrenia receiving antipsychotic as monotherapy or polypharmacy

2017 ◽  
Vol 41 (S1) ◽  
pp. S194-S195
Author(s):  
A. Elliott ◽  
M. Højlund ◽  
T.J. Mørk ◽  
T. Christensen ◽  
R. Jeppesen ◽  
...  
Keyword(s):  
Polymorphic Ventricular Tachycardia ◽  
Antipsychotic Treatment ◽  
Qtc Interval ◽  
Worst Case ◽  
Clinical Interviews ◽  
Schizophrenic Patients ◽  
Observational Cohort ◽  
Competing Interest ◽  
The Impact

IntroductionAntipsychotics are associated with the polymorphic ventricular tachycardia, Torsade's de pointes, which in worst case can lead to sudden cardiac death. The QTc interval is used as a clinical proxy for Torsade's de pointes. QTc interval is prolonged by monotherapy with antipsychotic, but it is unknown if the QTc interval is prolonged further with antipsychotic polypharmacy.ObjectivesTo investigate the associations between QTc interval and antipsychotic mono- and polypharmaceutical treatment, respectively, in schizophrenic patients.AimsTo learn more about the impact of antipsychotics on the QTc interval.MethodsAn observational cohort study of unselected patients with schizophrenia visiting outpatient facilities in the Region of Central Jutland, Denmark. Patients were enrolled from January 2013 through March 2015 with follow-up until June 2015. Data was collected from clinical interviews and clinical case records.ResultsECGs were available in 58 patients receiving antipsychotic treatment. We observed no difference in average QTc interval for the whole sample of patients receiving monotherapy or polypharmacy (P = 0.29). However, women presented longer QTc-interval on polypharmacy than on monotherapy (P = 0.01).ConclusionWe recommend an increased focus on monitoring the QTc interval in woman with schizophrenia receiving antipsychotics as polypharmacy.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Cardiovascular risk assessment in psychiatric inpatient setting

2016 ◽  
Vol 33 (S1) ◽  
pp. s281-s281
Author(s):  
E. Dahmer ◽  
N.C. Lokunarangoda ◽  
K. Romain ◽  
M. Kumar
Keyword(s):  
Cardiovascular Risk ◽  
Psychiatric Inpatient ◽  
Cardiac Risk ◽  
Inpatient Setting ◽  
Qtc Interval ◽  
Cardiac Health ◽  
Psychiatric Units ◽  
Acute Psychiatric Wards ◽  
Competing Interest ◽  
Clinically Significant

ObjectivesTo assess the general cardiac health of inpatients in acute psychiatric units and to evaluate the practice of ECG use in this setting.AimsOverall cardiac risk is assessed using QRISK2. Clinically significant ECG abnormality detection by psychiatric teams are compared with same by cardiologist.MethodsTen percent of patients (n = 113) admitted to five acute psychiatric wards during a period of 13 months across three hospital sites, covering a population of 1.1 million, were randomly selected. Electronic health care records were used to collect all data, in the form of typed entries and scanned notes. An experienced cardiologist, blind to the psychiatrist assessments, performed ECG analysis. The QRISK2 online calculator was used to calculate 10-year cardiovascular risk as recommended by NIHR, UK.ResultsA score of 10% or more indicates a need for further intervention to lower risk.13.5% of patients had a QRISK2 score of 10–20%, 5.2% had a score of 20–30%, and 1 patient had a QRISK2 score > 30%. In total, 19.7% had a QRISK2 of 10% or greater. A total of 2.9% had prolonged QTC interval (> 440 ms), with 2.9% having a borderline QTC (421–440). A total of 34.3% of ECGs were identified by the ward doctors as abnormal, with action being taken on 41.6% of these abnormal ECGs. Cardiologist analysis identified 57.1% of ECGs with abnormalities of potential clinical significance.ConclusionsOne in five patients admitted to psychiatry wards have poor cardiac health requiring interventions. Though QTC interval prolongation is rare, half of patients may have abnormal ECGs that require further analysis.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Antipsychotic Prescribing Practices Amongst the Elderly of St. James's Hospital (SJH), Dublin

2017 ◽  
Vol 41 (S1) ◽  
pp. S663-S663
Author(s):  
C. Power ◽  
B. McCarthy ◽  
B.A. Lawlor ◽  
E. Greene
Keyword(s):  
Best Practice ◽  
The Elderly ◽  
Medical Documentation ◽  
Psychotic Symptoms ◽  
Prescribing Practices ◽  
Next Of Kin ◽  
Pharmacological Interventions ◽  
Antipsychotic Medications ◽  
Number Of Patients ◽  
Antipsychotic Prescribing

IntroductionPsychotic symptoms arise commonly in the context of behavioural and psychological symptoms of dementia (BPSD) in the elderly. While non-pharmacological interventions are preferable to manage such symptoms, antipsychotic medications are frequently used. This is largely unlicensed and associated with significant risks, particularly in dementia (1).ObjectivesTo examine antipsychotic prescribing practices in SJH.MethodsOn 23rd February 2016 all inpatients aged over 65 who were prescribed antipsychotic medications were identified. Demographic and medical data were collected from medical and electronic notes and medication kardexes.ResultsComplete data were available for 53 of 59 identified cases. The cohort had a mean age of 80 (range 65–99) and 62% were male. Seventy-four percent (n = 39) had documented cognitive impairment or dementia. Fifty-eight percent (n = 31) were newly prescribed an antipsychotic following admission. The commonest indications for antipsychotics were: delirium (53%) and BPSD (25%). Haloperidol (56%), quetiapine (19%) and risperidone (8%) were prescribed most frequently. Non-pharmacological interventions were documented in 50% however in many cases it is not clear what these interventions were. Antipsychotic use was discussed with patients and/or next of kin in less than 25% of cases. Adverse effects were noted in 6/36 (17%) with equal incidence of falls, EPSEs and ECG changes.ConclusionPositive and negative aspects of current antipsychotic prescribing practices are highlighted. Antipsychotics were prescribed for a small number of patients for appropriate indications. However, there was poor consideration of non-pharmacological interventions and a lack of consultation with the patient/NOK. This may reflect, in part, inadequate medical documentation. A guideline needs to specifically address these areas of concern to improve safety and promote best practice.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Validity and Reliability of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE)

GeroPsych ◽  
2019 ◽  
Vol 32 (3) ◽  
pp. 145-151
Author(s):  
Mahshid Foroughan ◽  
Zahra Jafari ◽  
Ida Ghaemmagham Farahani ◽  
Vahid Rashedi
Keyword(s):  
Psychometric Properties ◽  
Elderly Population ◽  
Formal Education ◽  
The Elderly ◽  
Cognitive State ◽  
Validity And Reliability ◽  
Internal Reliability ◽  
Dsm Iv ◽  
Test Retest Reliability ◽  
Farsi Version

Abstract. This study examines the psychometric properties of the IQCODE and its applicability in the Iranian elderly population. A group of 95 elderly patients with at least 4 years of formal education who fulfilled the criteria of DSM-IV-TR for dementia were examined by the MMSE and the AMTs. The Farsi version of the IQCODE was subsequently administered to their primary caregivers. Results showed a significant correlation ( p = .01) between the score of the questionnaire and the results of the MMSE ( r = −0.647) and AMTs ( r = −0.641). A high internal reliability of the questionnaire was confirmed by Cronbach’s alpha coefficient (α = 0.927) and test-retest reliability by correlation coefficient ( r = 0.81). This study found that the IQCODE has acceptable psychometric properties and can be used for evaluating the cognitive state in the elderly population of Iran.

Spontaneous Intracerebral Hemorrhage in the Elderly Population

2018 ◽  
Author(s):  
S. Sommaruga ◽  
R. Beekman ◽  
S. Chu ◽  
Z. King ◽  
C. Matouk ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Elderly Population ◽  
The Elderly ◽  
Spontaneous Intracerebral Hemorrhage

Percutaneous Sacroplasty for Sacral Insufficiency Fractures: Case Series and Review of Presentation, Diagnosis, and Treatment

2019 ◽  
Vol 3 ◽  
pp. 4
Author(s):  
Andrew C. Clark ◽  
Devang Butani
Keyword(s):  
Low Back Pain ◽  
Elderly Population ◽  
Case Series ◽  
The Elderly ◽  
Treatment Method ◽  
Open Reduction Internal Fixation ◽  
Low Back ◽  
Insufficiency Fractures ◽  
Invasive Treatment ◽  
Sacral Insufficiency Fractures

Sacral insufficiency fractures (SIFs) are a cause of debilitating low back pain that is often difficult to diagnosis and manage. The diagnosis of SIF is often delayed due to inaccurately attributing symptoms to spondylosis, which is a commonly present in the elderly population where SIFs are most prevalent. Historically, treatment consisted of medical management and open reduction internal fixation reserved for severe cases. However, percutaneous sacroplasty has emerged as a minimally invasive treatment option which provides early pain relief without significant complications. The objective of this article is to raise awareness of SIFs and percutaneous sacroplasty as an effective and safe treatment method.

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