Polimedication: applicability of a computer tool to reduce polypharmacy in nursing homes

ABSTRACTBackground:The risks of polypharmacy can be far greater than the benefits, especially in the elderly. Comorbidity makes polypharmacy very prevalent in this population; thus, increasing the occurrence of adverse effects. To solve this problem, the most common strategy is to use lists of potentially inappropriate medications. However, this strategy is time consuming.Methods:In order to minimize the expenditure of time, our group devised a pilot computer tool (Polimedication) that automatically processes lists of medication providing the corresponding Screening Tool of Older Persons’ potentially inappropriate Prescriptions alerts and facilitating standardized reports. The drug lists for 115 residents in Santa Marta Nursing Home (Fundación San Rosendo, Ourense, Spain) were processed.Results:The program detected 10.04 alerts/patient, of which 74.29% were not repeated. After reviewing these alerts, 12.12% of the total (1.30 alerts/patient) were considered relevant. The largest number of alerts (41.48%) involved neuroleptic drugs. Finally, the patient's family physician or psychiatrist accepted the alert and made medication changes in 62.86% of the relevant alerts. The largest number of changes (38.64%) also involved neuroleptic drugs. The mean time spent in the generation and review of the warnings was 6.26 minute/patient. Total changes represented a saving of 32.77 € per resident/year in medication.Conclusions:The application of Polimedication tool detected a high proportion of potentially inappropriate prescriptions in institutionalized elderly patients. The use of the computerized tool achieved significant savings in pharmaceutical expenditure, as well as a reduction in the time taken for medication review.

The Neuroleptic Malignant Syndrome

Reports of fatal febrile, hypertensive, tachycardic neurotoxic cases followed quickly on the introduction of potent new neuroleptic drugs in the 1970s. Patients became mute, rigid, posturing, and staring, showing the signs of catatonia. Labeled the neuroleptic malignant syndrome (NMS), attention was first given to neuroleptic blockade of dopamine receptors as the cause, but treatments with dopamine agonists (bromocriptine) and muscle relaxants (dantrolene) offered little benefit. When catatonia was recognized, treatments with benzodiazepines (lorazepam, diazepam) and induced seizures (electroshock, ECT) led to clinical relief and the saving of lives. The recognition of NMS as catatonia stimulated a revision of the century-long view of catatonia as a form of schizophrenia, with calls for catatonia to be considered independent of schizophrenia.

Antipsychotic polypharmacy among schizophrenia outpatients

IntroductionSince their introduction by Delay and Deniker in the 1950s, neuroleptic drugs have significantly modified the evolutionary prognosis of schizophrenia. Their combination has also become a widespread practice.ObjectivesThe aim of this study was to analyze the associations of neuroleptic drugs by describing the characteristics of types and doses, understanding the reasons for these associations and studying the relationship existing in such situation regarding adherence to treatment, tolerance and the number of hospitalizations.MethodsOur study was retrospective, descriptive and analytical. It has been conducted from March, 1st to May, 30th 2015 and involved 70 stabilized patients diagnosed with schizophrenia according to DSM 5. Clinical characteristics were collected from patients and their medical records. Evaluations were conducted using PANSS, MARS and GAS.ResultsOverall, 70 male patients were recruited. The mean age was 40 years old: 30% received classical monotherapy while 70% were treated only by an atypical antipsychotic. Among patients receiving two drugs, 85% received classical bitherapy while 9% were under both classical and atypical drugs. Only 6% received atypical bitherapy. Chlorpromazine equivalent doses in case of monotherapy was 325.92 mg/day, while it reached 1148.65 mg/day in case of drugs association. Administration of a combined therapy had poor tolerance rate and all patients suffered from adverse effects. Adherence to treatment was better while receiving monotherapy (88% versus 45%) and the number of hospitalizations was lower with an average of 3 against 10.ConclusionOur study revealed several shortcomings in our current management of patients with schizophrenia and addressed the implication of socioeconomic status on therapeutic outcomes.Disclosure of interestThe authors have not supplied their declaration of competing interest.