Abstract
Introduction. Antipsychotic drugs are widely used in treating mental disorders during acute psychotic episodes, as well as in the maintenance therapy. In this regard, adherence of drug treatment to the principles of rational use of medications is an important requirement for prescribing antipsychotics. Despite the urgency of the matter, by now no studies have addressed the issues of prescribing psychotropic drugs for outpatients in Azerbaijan. The purpose of the study is to investigate the practice of using antipsychotic drugs for outpatients and factors for the choice of the medication dose and the use of polypharmacotherapy.
Methods. In total, 253 patients with various mental disorders receiving outpatient treatment at the Mental Health Center took part in this study. The authors analyzed their sociodemographic characteristics, clinical data, and information on the prescribed treatment.
Results. Neither sociodemographic nor clinical factors had a significant influence on the choice of drugs. The vast majority of outpatients received therapy with atypical antipsychotics, where risperidone was the most frequently prescribed. The doses were generally lower than those recommended in the official guidelines; only 3.2 % of patients were treated with relatively high doses. Higher doses of drugs were prescribed to the patients diagnosed with schizophrenia and associated with the use of polypharmacotherapy. In turn, psychopharmacotherapy was associated with the use of traditional neuroleptics.
Discussion. The results suggest that the treatment in the outpatient care system provides great opportunities for the rational use of antipsychotic drugs and can largely personalize pharmacotherapy.
References
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McMillan S. S, Jacobs S., Wilson L., et al. Antipsychotic prescribing for vulnerable populations: a clinical audit at an acute Australian mental health unit at two-time points. BMC Psychiatry, 2017, V. 17, p. 139. DOI: 10.1186/s12888-017-1295-1
Rasulov A. R. Development of mental health system in Azerbaijan. Kazanskii meditsinskii jurnal – Kazan Medical Journal, 2017, V. 98, no. 4, pp. 656–661 (in Russian).
Rational use of Drugs: Report of the Conference of Experts, Nairobi, 25–29 November 1985. Geneva: World Health Organization, 1987. 329 p.
Fleischhacker W. W., Uchida H. Critical review of antipsychotic polypharmacy in the treatment of schizophrenia. International Journal of Neuropsychopharmacology. 2014. V. 17, Issue 7, pp. 1083–1093. DOI: 10.1017/S1461145712000399
Saddichha S., Chaturvedi S. K. Clinical practice guidelines in psychiatry: More confusion than clarity? A critical review and recommendation of a unified guideline. ISRN Psychiatry, 2014. Article ID 828917. DOI: 10.1155/2014/828917
Paton C., Barnes T. R. E., Cavanagh M.-R, Taylor D., Lelliott P. High-dose and combination antipsychotic prescribing in acute adult wards in the UK: The challenges posed by p.r.n. prescribing. The British Journal of Psychiatry, 2008, V. 192, Issue 6, pp. 435–439. DOI: 10.1192/bjp.bp.107.042895
Romstadt N., Wonson E. Outcomes comparison of long-acting injectable antipsychotic initiation in treatment-naïve veterans in the inpatient versus outpatient setting. The Mental Health Clinician, 2018, V. 8, no. 1, pp. 24–27. DOI: 10.9740/mhc.2018.01.024
Edlinger M., Rettenbacher M. A., Kemmler G., Biedermann F., Widschwendter C. G., Fleischhacker W. W., Hofer A. Prescribing practice in inpatients versus outpatients with schizophrenia initiating treatment with second-generation antipsychotics: A naturalistic follow-up study. Journal of Clinical Psychopharmacology, 2016, V. 36, Issue 6, pp. 621–627. DOI: 10.1097/JCP.0000000000000573
Barbui C., Biancosino B., Esposito E., et al. Factors associated with antipsychotic dosing in psychiatric inpatients: a prospective study. International Clinical Psychopharmacology, 2007, V. 22, Issue 4, pp. 221–225. DOI: 10.1097/YIC.0b013e3281084ea8
Harder D. W., Strauss J. S., Greenwald D. F., Kokes R. F., Ritzler B. A., Gift T. E. Life events and psychopathology severity: comparisons between psychiatric outpatients and inpatients. Journal of Clinical Psychology, 1989, V. 45, pp. 202–209.
Warnke I., Rössler W., Herwig U. Does psychopathology at admission predict the length of inpatient stay in psychiatry? Implications for financing psychiatric services. BMC Psychiatry, 2011, V. 11, p. 120.
Tiihonen J., Walhbeck K., Lönnqvist J., et al. Effectiveness of antipsychotic treatments in a nationwide cohort of patients in community care after first hospitalisation due to schizophrenia and schizoaffective disorder: observational follow-up study. BMJ, 2006, V. 333, p. 224. DOI: 10.1136/bmj.38881.382755.2F
Harrow M., Jobe T. H., Faull R. N. Do all schizophrenia patients need antipsychotic treatment continuously throughout their lifetime? A 20-year longitudinal study. Psychological Medicine, 2012, V. 42, Issue 10, pp. 2145–2155. DOI: 10.1017/S0033291712000220
Offord S., Lin J., Wong B., Mirski D., Baker R. A. Impact of oral antipsychotic medication adherence on healthcare resource utilization among schizophrenia patients with Medicare coverage. Community Mental Health Journal, 2013, V. 49, Issue 6, pp. 625–629. DOI: 10.1007/s10597-013-9638-y
How to investigate drug use in health facilities: Selected drug indicators. Geneva: World Health Organization, 1993. 92 p.
Gaebel W., Riesbeck M., Janssen B., Schneider F., Held T., Mecklenburg H., Sass H. Atypical and typical neuroleptics in acute schizophrenia and related delusional disorders. Drug choice, switching and outcome under naturalistic treatment conditions. European Archives of Psychiatry and Clinical Neuroscience, 2003, V. 253, pp. 175–184.
Bernardo M., Coma A., Ibáñez C., Zara C., Bari J. M., Serrano-Blanco A. Antipsychotic polypharmacy in a regional health service: a population-based study. BMC Psychiatry, 2012, V. 12, p. 42. DOI: 10.1186/1471-244X-12-42
Satterthwaite T. D., Wolf D. H., Rosenheck R. A., Gur R. E., Caroff S. N. A meta-analysis of the risk of acute extrapyramidal symptoms with intramuscular antipsychotics for the treatment of agitation. The Journal of Clinical Psychiatry, 2008, V. 69 (12), pp. 1869–1879.
Zhang J.-P., Gallego J. A., Robinson D. G., Malhotra A. K., Kane J. M., Correll C. U. Efficacy and safety of individual second-generation vs first-generation antipsychotics in first-episode psychosis: a systematic review and meta-analysis. International Journal of Neuropsychopharmacology, Collegium Internationale Neuropsychopharmacologicum, 2013, V. 16, Issue 6, pp. 1205–1218. DOI: 10.1017/S1461145712001277
Gründer G., Heinze M., Cordes J., Mühlbauer B., Juckel G., Schulz C., Rüther E., Timm J. Effects of first-generation antipsychotics versus second-generation antipsychotics on quality of life in schizophrenia: a double-blind, randomised study. The Lancet Psychiatry, 2016, V. 3, Issue 8, pp. 717–729. DOI: 10.1016/S2215-0366(16)00085-7
Ponizovsky A. M., Marom E., Ben-Laish M., Barash I., Weizman A., Schwartzberg E. Trends in the use of antipsychotics in the Israeli inpatient population, 2004–2013. Israel Journal of Health Policy Research, 2016, V. 5, pp. 16. DOI: 10.1186/s13584-016-0074-7
Meltzer H. Y. New trends in the treatment of schizophrenia. CNS & Neurological Disorders – Drug Targets, 2017, V. 16, Issue 8, pp. 900–906. DOI: 10.2174/1871527316666170728165355
Li M. Antipsychotic-induced sensitization and tolerance: Behavioral characteristics, developmental impacts, and neurobiological mechanisms. Journal of Psychopharmacology, 2016, V. 30, Issue 8, pp. 749–770.
Hanssens L., De Hert M., Wampers M., et al. Pharmacological treatment of ambulatory schizophrenic patients in Belgium. Clinical Practice and Epidemiology in Mental Health, 2006, V. 2, p. 11. DOI: 10.1186/1745-0179-2-11
Buckley P. F., Correll C. U. Strategies for dosing and switching antipsychotics for optimal clinical management. The Journal of Clinical Psychiatry, 2008, V. 69, Suppl. 1, pp. 4–17.
Volavka J., Vevera J. Very long-term outcome of schizophrenia. The International Journal of Clinical Practice, 2018, V. 72, Issue 7, e13094. DOI: 10.1111/ijcp.13094
Moilanen J. M., Haapea M., Jääskeläinen E., Veijola J. M., Isohanni M. K., Koponen H. J., Miettunen J. Long-term antipsychotic use and its association with outcomes in schizophrenia – the Northern Finland Birth Cohort 1966. European Psychiatry, 2016, V. 36, pp. 7–14. DOI: 10.1016/j.eurpsy.2016.03.002
Uchida H., Suzuki T., Takeuchi H., Arenovich T., Mamo D. C. Low dose vs standard dose of antipsychotics for relapse prevention in schizophrenia: Meta-analysis. Schizophrenia Bulletin, 2011, V. 37, Issue 4, pp. 788–799. DOI: 10.1093/schbul/sbp149
Fisher M. D., Reilly K., Isenberg K., Villa K. F. Antipsychotic patterns of use in patients with schizophrenia: polypharmacy versus monotherapy. BMC Psychiatry, 2014, V. 14, p. 341. DOI: 10.1186/s12888-014-0341-5
McMillan S. S, Jacobs S., Wilson L., et al. Antipsychotic prescribing for vulnerable populations: a clinical audit at an acute Australian mental health unit at two-time points. BMC Psychiatry, 2017, V. 17, p. 139. DOI: 10.1186/s12888-017-1295-1