Antipsychotic and anticholinergic drug prescribing pattern in psychiatry:Implications for evidence - based practice

2011 ◽  
Vol 26 (S2) ◽  
pp. 1221-1221
Author(s):  
K.A.J. Al Khaja ◽  
R.P. Sequeira ◽  
M.K. Al-Haddad ◽  
A.R. Al-Offi
Keyword(s):  
Psychotic Disorders ◽  
Anticholinergic Drug ◽  
High Dose ◽  
Evidence Based ◽  
Prescribing Pattern ◽  
Retrospective Audit ◽  
Prescribing Practice ◽  
Study Population ◽  
Oral Antipsychotic ◽  
Long Acting

ObjectivesTo determine the antipsychotic prescribing pattern and the prevalence of concurrent anticholinergic prescribing for patients with psychotic disorders.MethodsA retrospective audit of prescriptions issued for outpatients at the Psychiatric Hospital in Bahrain.ResultsAntipsychotic monotherapy was prescribed for 89.2% patients, whereas polytherapy with two- and three- drugs in 10.4 and 0.4%, respectively. Atypical antipsychotics were prescribed more often (67.7%) than typical antipsychotics. Risperidone and haloperidol were the most frequently prescribed antipsychotics. Majority of the study population (93.2%) were prescribed an oral antipsychotic, whereas 3.1% each were on depot preparation or on depot plus an oral antipsychotic. Long-acting risperidone injection was the only depot preparation prescribed. The mean antipsychotic dose expressed as chlorpromazine equivalents (CPZeq; mg/day) was 242 (220 for monotherapy and 414 for polytherapy). The prevalence of high dose antipsychotic (mean CPZeq>1000 mg/day) was 1.8%, prescribed at a mean CPZeq dose of 1531 (1925 for monotherapy and 1137 for polytherapy) mainly attributed to haloperidol. Anticholinergics were co-prescribed for almost two third of patients receiving antipsychotics, particularly for those on polytherapy (monotherapy 57.3%; polytherapy 87.5%). Antipsychotic polytherapy, high dose of antipsychotics and co-prescription of an oral with a depot antipsychotic preparation were strongly associated with concurrent prescription of anticholinergics. Procyclidine and orphenadrine were the most often prescribed anticholinergics.ConclusionAntipsychotic monotherapy is the common practice for outpatients with psychotic disorders. Some of the antipsychotic polytherapies, dosage strategies, and high prevalence of anticholinergic use are therapeutic issues that need to be addressed to foster evidence-based prescribing practice.

scholarly journals Antipsychotic long-acting injections: Prescribing practice in the UK

2009 ◽  
Vol 195 (S52) ◽  
pp. s37-s42 ◽  
Author(s):  
Thomas R. E. Barnes ◽  
Amber Shingleton-Smith ◽  
Carol Paton
Keyword(s):  
Demographic Variables ◽  
High Dose ◽  
Clinical Settings ◽  
Audit Data ◽  
Younger Age ◽  
Prescribing Practice ◽  
The Usa ◽  
Oral Antipsychotic ◽  
Long Acting ◽  
The Uk

BackgroundData from the USA, Australia and Europe suggest that the proportion of patients with schizophrenia prescribed an antipsychotic long-acting injection (LAI) varies from around a quarter to a third. Use of LAIs has been associated with male gender and younger age.AimsTo characterise the use of LAIs in people with schizophrenia in three clinical settings in the UK.MethodThe study used audit data from quality improvement programmes conducted by the Prescribing Observatory for Mental Health.ResultsLong-acting injections were found to be prescribed for between a quarter and a third of patients, depending on the clinical setting. Flupentixol, risperidone and zuclopenthixol were most commonly prescribed and were combined with an oral antipsychotic in half of cases, frequently constituting high-dose prescribing. The use of LAIs was not consistently associated with age, gender or ethnicity.ConclusionsAntipsychotic LAIs are commonly prescribed. We did not replicate previous findings with respect to demographic variables associated with their use.

scholarly journals Five-year follow-up of an evidence-based prescribing intervention

2008 ◽  
Vol 32 (5) ◽  
pp. 183-186 ◽  
Author(s):  
David Meagher ◽  
Ananth Pullela ◽  
Marek Meisinger ◽  
Niamh Geaney ◽  
Sinead O'Brien
Keyword(s):  
Clinical Implications ◽  
High Dose ◽  
Evidence Based ◽  
Community Mental Health Service ◽  
Prescribing Practices ◽  
Multidisciplinary Intervention ◽  
Prescribing Practice ◽  
Multifaceted Interventions ◽  
The Impact

Aims and MethodWe studied the impact of an evidence-based multidisciplinary intervention to reduce six sub-optimal aspects of psychotropic prescribing, combined as a Prescribing Practice Quality (PPQ) score over a 5-year follow-up period in a community mental health service.ResultsSub-optimal prescribing practices were significantly reduced after 1 year and these improvements were sustained at 5-year follow-up. The PPQ scores were significantly reduced (P<0.001) in both the overall population attending at each follow-up point as well as in the ever-present population (n=163). Use of high-dose antipsychotics and thioridazine ceased entirely; use of sedative hypnotic agents was less amenable to reduction.Clinical ImplicationsMultifaceted interventions can achieve sustained improvements in prescribing practices in real-world settings.

Evaluation of the effectiveness and acceptability of the long-acting oral antipsychotic penfluridol: Illustrative case series

2021 ◽  
pp. 026988112110505
Author(s):  
Danielle Dunnett ◽  
Ebenezer Oloyede ◽  
Oluwakemi Oduniyi ◽  
Barbara Arroyo ◽  
Olubanke Dzahini ◽  
...  
Keyword(s):  
Psychotic Disorders ◽  
Case Series ◽  
Median Number ◽  
Illustrative Case ◽  
The United Kingdom ◽  
Duration Of Illness ◽  
National Health Service Trust ◽  
Oral Antipsychotic ◽  
Long Acting

Aim: In this study, we sought to determine clinical outcomes at 1 year for patients prescribed penfluridol in an inner London National Health Service Trust. Using noninterventional data, we describe the use, effectiveness and safety of this treatment modality. Results: We retrospectively followed up 17 patients prescribed penfluridol as part of routine clinical practice. All patients took penfluridol once weekly. Of these patients, 12 (70.6%) were considered treatment resistant. The average duration of illness for this cohort was 10 years (SD = 6.7). At 1 year, nine (53%) patients remained on treatment. Median survival time was not reached at 1-year follow-up; mean time on penfluridol was 251 days (95% confidence interval (CI), 184–318). The mean number of admissions to hospital in the year following penfluridol initiation was 0.6 compared with 0.8, 1 year before initiation ( p = 0.465). The median number of bed days 1 year before penfluridol initiation was 24, whereas in the year following penfluridol initiation, it was 0 ( p = 0.514). Clinical Implications: Although penfluridol is unlicensed in the United Kingdom, limited data suggest that this long-acting oral therapy has the potential to be used safely and effectively for the treatment of psychotic disorders. However, more data are required to establish the place of penfluridol and other potential long-acting oral antipsychotic formulations in the treatment of psychotic disorders.

scholarly journals Antipsychotic and Anticholinergic Drug Prescribing Pattern in Psychiatry: Extent of Evidence-Based Practice in Bahrain

2012 ◽  
Vol 03 (04) ◽  
pp. 409-416 ◽  
Author(s):  
Khalid A. J. Al Khaja ◽  
Mohammed K. Al-Haddad ◽  
Reginald P. Sequeira ◽  
Adel R. Al-Offi
Keyword(s):  
Evidence Based Practice ◽  
Anticholinergic Drug ◽  
Evidence Based ◽  
Drug Prescribing ◽  
Prescribing Pattern

scholarly journals Reducing high dose antipsychotic therapy (HDAT) in a community mental health team (CMHT)

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S110-S111
Author(s):  
Richard Walsh ◽  
Sonn Patel ◽  
Valentina Loddo ◽  
Rebecca Fahy ◽  
Elizabeth Walsh
Keyword(s):  
Antipsychotic Medication ◽  
Cumulative Dose ◽  
Best Practice ◽  
Baseline Survey ◽  
High Dose ◽  
Antipsychotic Therapy ◽  
Daily Dose ◽  
Prescribing Practice ◽  
Oral Antipsychotic ◽  
The Impact

AimsThe consensus statement (CR190) of The Royal College of Psychiatrists states that the benefit of prescribing HDAT does not outweigh the risk of the increased side effect burden. HDAT is defined as the “daily dose of a single antipsychotic exceeding the upper limit for that drug as stated in the Summary of Product Characteristic (SPC) or British National Formulary (BNF),” and as the cumulative daily dose of two or more antipsychotics (for combined prescription). The prevalence of HDAT has been shown to vary widely and protocols for monitoring poorly implemented. In 2018 we completed a baseline survey of the prevalence of HDAT within our CMHT. We assessed our prescribing practice as compared to seven best practice audit criteria, which were adopted. Our aim is to resurvey closing the audit loop to 1) establish the current prevalence of HDAT and 2) assess the impact the intervention on prescribing practice.MethodMulti-disciplinary case notes for all registered patients were studied. A database was created including sociodemographic details, chart diagnosis, and medication. The proportion of patients prescribed antipsychotic medication was identified. The dose of each medication was converted into a percentage of BNF maximum recommended dose for that drug. For combined antipsychotic prescription, the cumulative dose was obtained adding the single percentages together. Exceeding 100% was regarded as HDAT. All HDAT patients were assessed against identified audit criteria as outlined by the Humber NHS Foundation Trust.ResultOf a total of 246 patients, 177 (72%) were prescribed antipsychotic medication. Of these, 14 (8%) were in receipt of HDAT. This compared to 68% prescribed antipsychotics and 9% in receipt of HDAT in the baseline audit. The average cumulative dose for every category (oral medication, depot and both) was calculated with a range from 1% to 168% (mean = 70%) for oral antipsychotic (single/combined), 1% to 193% (mean = 50%) for depots and 20% to 257% (mean = 95%) for combination of oral and depot. This compares with ranges of 1.6% to 215% (mean = 44.3%) for oral antipsychotic (single/combined), 0.04% to 100% (mean = 25.8%) for depots and 21% to 425% (mean = 119.6%) for combination of oral and depot in the baseline audit. Similar to the baseline survey no patient met all seven audit criteria but there was better adherence overall with best practice guidance. Blood and ECG monitoring were the most consistent parameters measured.ConclusionLower HDAT was achieved post intervention. Results, whilst positive, indicate the need for ongoing audit to maintain best standards.

The Novel Antipsychotic Drug Cariprazine and Cognition Enhancing Drugs: Indications for Their Use as an Add-on Therapy in Schizophrenia

2020 ◽  
Vol 26 ◽  
Author(s):  
Felix-Martin Werner ◽  
Rafael Coveñas
Keyword(s):  
Clinical Trials ◽  
Maintenance Therapy ◽  
Antipsychotic Drug ◽  
Cognitive Functions ◽  
Antipsychotic Drugs ◽  
Psychotic Disorders ◽  
Therapeutic Effects ◽  
Treatment Resistant ◽  
Long Acting ◽  
Novel Antipsychotic

Background: Schizophrenia and schizoaffective disorder are treated with antipsychotic drugs. Some patients show treatment-resistant forms of psychotic disorders and, in this case, they can be treated with clozapine. In these patients and based on previous reviews on novel antipsychotic drugs, it is important to know whether an add-on therapy with new drugs can ameliorate the positive and negative schizophrenic scale (PANSS) total score. Objective: The aim of this review is to suggest an appropriate treatment for patients with treatment-resistant forms of psychotic disorders. A combination of current available antipsychotic drugs with novel antipsychotic or modulating drugs might improve negative schizophrenic symptoms and cognitive function and thereby social functioning and quality of life. Results: The mechanisms of action, the therapeutic effects and the pharmacokinetic profiles of novel antipsychotic drugs such as cariprazine, brexipiprazole and lumateperone are up-dated. Published case reports of patients with treatmentresistant psychoses are also discussed. These patients were treated with clozapine but a high PANSS total score was observed. Only an add-on therapy with cariprazine improved the score and, above all, negative schizophrenic symptoms and cognitive functions. To ensure a constant antipsychotic drug concentration, long-acting injectable antipsychotic drugs may be a choice for a maintenance therapy in schizophrenia. New modulating drugs, such as receptor positive allosteric modulators (N-methyl-D-aspartate receptor; subtype 5 of the metabotropic glutamatergic receptor) and encenicline, an alpha7 nicotinic cholinergic receptor agonist, are being investigated in preclinical and clinical trials. Conclusion: In clinical trials, patients with treatment-resistant forms of psychosis should be examined to know whether a combination therapy with clozapine and a novel antipsychotic drug can ameliorate the PANSS total score. In schizophrenia, long-acting injectable antipsychotic drugs are a safe and tolerable maintenance therapy. In further clinical studies, it should be investigated whether patients with treatment-resistant forms of psychoses can improve negative schizophrenic symptoms and cognitive functions by an add-on therapy with cognition enhancing drugs.

scholarly journals The impact of COVID-19 on antipsychotic prescriptions for patients with schizophrenia in Australia

2021 ◽  
pp. 000486742110257
Author(s):  
Steve Kisely ◽  
Dante Dangelo-Kemp ◽  
Mark Taylor ◽  
Dennis Liu ◽  
Simon Graham ◽  
...  
Keyword(s):  
Human Services ◽  
Primary Outcome ◽  
Medical Consultation ◽  
Australian Government ◽  
Provider Type ◽  
Study Population ◽  
Secondary Objective ◽  
Long Acting ◽  
The Impact ◽  
Pharmaceutical Benefits Scheme

Objective: To assess the impact, in the Australian setting, of the COVID-19 lockdown on antipsychotic supplies for patients with schizophrenia following a prescription from a new medical consultation when compared to the same periods in the previous 4 years. A secondary objective was to assess the volume of all antipsychotic supplies, from new and repeat prescriptions, over these same periods. Methods: A retrospective pharmaceutical claims database study was undertaken, using the Department of Human Services Pharmaceutical Benefits Scheme 10% sample. The study population included all adult patients with three or more supplies of oral or long-acting injectable antipsychotics for the treatment of schizophrenia at any time between 1 June 2015 and 31 May 2020. The primary outcome compared volumes of dispensed antipsychotics from new prescriptions (which require a medical consultation) between 1 April and 31 May each year from 2016 to 2020. This was to analyse the period during which the Australian Government imposed a lockdown due to COVID-19 (April to May 2020) when compared the same periods in previous years. Results: There was a small (5.7%) reduction in the number of antipsychotics dispensed from new prescriptions requiring a consultation, from 15,244 to 14,372, between April and May 2019 and the same period in 2020, respectively. However, this reduction was not statistically significant ( p = 0.75) after adjusting for treatment class, age, gender, location and provider type. Conclusion: The COVID-19 restrictions during April and May 2020 had no significant impact on the volume of antipsychotics dispensed from new prescriptions for patients with schizophrenia when compared to the volume of antipsychotics dispensed from new prescriptions during the same period in previous years.

Prescribing practices in psychiatric hospitals in Eastern Europe

2011 ◽  
Vol 26 (7) ◽  
pp. 414-418 ◽  
Author(s):  
V. Jordanova ◽  
N.P. Maric ◽  
V. Alikaj ◽  
M. Bajs ◽  
T. Cavic ◽  
...  
Keyword(s):  
Eastern Europe ◽  
Western Europe ◽  
Atypical Antipsychotics ◽  
Psychiatric Care ◽  
Anticholinergic Drug ◽  
Psychiatric Hospitals ◽  
Evidence Based ◽  
Prescribing Practices ◽  
The Mean ◽  
Clinical Records

AbstractBackgroundThere has been no evidence about the prescribing practices in psychiatric care in Eastern Europe.AimsTo examine the patterns of psychotropic prescribing in five countries of Eastern Europe.MethodWe conducted a one-day census of psychiatric treatments used in eight psychiatric hospitals in Albania, Croatia, Macedonia, Serbia and Romania. We examined clinical records and medication charts of 1304 patients.ResultsThe use of polypharmacy was frequent across all diagnostic groups. Only 6.8% of patients were on monotherapy. The mean number of prescribed drugs was 2.8 (SD 0.97) with 26.5% receiving two drugs, 42.1% receiving three drugs and 22.1% being prescribed four or more psychotropic drugs. Typical antipsychotics were prescribed to 63% and atypical antipsychotics to 40% of patients with psychosis. Older generations of antidepressants were prescribed to 29% of patients with depression. Anxiolitic drugs were prescribed to 20.4% and benzodiazepines to 68.5% of patients. One third of patients received an anticholinergic drug on a regular basis.ConclusionsOlder generation antipsychotics and antidepressants were used more frequently than in the countries of Western Europe. Psychotropic polypharmacy is a common practice. There is a need for adopting more evidence-based practice in psychiatric care in these countries.

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