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      Polypharmacy In Psychiatry: A Review

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          Abstract

          Psychiatric polypharmacy refers to the prescription of two or more psychiatric medications concurrently to a patient. It can be categorised as same-class, multi-class, adjunctive, augmentation and total polypharmacy. Despite advances in psychopharmacology and a better understanding of the principles of therapeutics, its practice is increasing rapidly. The prevalence of polypharmacy in psychiatry varies between 13%-90%. There are various clinical and pharmaco-economic factors associated with it. Dealing with polypharmacy requires an understanding of its associated factors. Education, guidelines and algorithms for the appropriate management of various conditions are effective ways to avoid irrational polypharmacy .

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          Appropriate prescribing in elderly people: how well can it be measured and optimised?

          Anne Spinewine, Kenneth Schmader, Nick Barber … (2007)
          Prescription of medicines is a fundamental component of the care of elderly people, and optimisation of drug prescribing for this group of patients has become an important public-health issue worldwide. Several characteristics of ageing and geriatric medicine affect medication prescribing for elderly people and render the selection of appropriate pharmacotherapy a challenging and complex process. In the first paper in this series we aim to define and categorise appropriate prescribing in elderly people, critically review the instruments that are available to measure it and discuss their predictive validity, critically review recent randomised controlled intervention studies that assessed the effect of optimisation strategies on the appropriateness of prescribing in elderly people, and suggest directions for future research and practice.
          Article 0 comments Cited 328 times – based on 0 reviews     Review now
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            National trends in psychotropic medication polypharmacy in office-based psychiatry.

            Ramin Mojtabai, Mark Olfson (2010)
            Psychotropic medication polypharmacy is common in psychiatric outpatient settings and, in some patient groups, may have increased in recent years. To examine patterns and recent trends in psychotropic polypharmacy among visits to office-based psychiatrists. Annual data from the 1996-2006 cross-sectional National Ambulatory Medical Care Surveys were analyzed to examine patterns and trends in psychotropic polypharmacy within nationally representative samples of 13 079 visits to office-based psychiatrists. Office-based psychiatry practices in the United States. Outpatients with mental disorder diagnoses visiting office-based psychiatrists. Number of medications prescribed in each visit and specific medication combinations. There was an increase in the number of psychotropic medications prescribed across years; visits with 2 or more medications increased from 42.6% in 1996-1997 to 59.8% in 2005-2006; visits with 3 or more medications increased from 16.9% to 33.2% (both P < .001). The median number of medications prescribed in each visit increased from 1 in 1996-1997 to 2 in 2005-2006 (mean increase: 40.1%). The increasing trend of psychotropic polypharmacy was mostly similar across visits by different patient groups and persisted after controlling for background characteristics. Prescription for 2 or more antidepressants, antipsychotics, sedative-hypnotics, and antidepressant-antipsychotic combinations, but not other combinations, significantly increased across survey years. There was no increase in prescription of mood stabilizer combinations. In multivariate analyses, the odds of receiving 2 or more antidepressants were significantly associated with a diagnosis of major depression (odds ratio [OR], 3.44; 99% confidence interval [CI], 2.58-4.58); 2 or more antipsychotics, with schizophrenia (OR, 6.75; 99% CI, 3.52-12.92); 2 or more mood stabilizers, with bipolar disorder (OR, 15.46; 99% CI, 6.77-35.31); and 2 or more sedative-hypnotics, with anxiety disorders (OR, 2.13; 99% CI, 1.41-3.22). There has been a recent significant increase in polypharmacy involving antidepressant and antipsychotic medications. While some of these combinations are supported by clinical trials, many are of unproven efficacy. These trends put patients at increased risk of drug-drug interactions with uncertain gains for quality of care and clinical outcomes.
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              Use of medications and polypharmacy are increasing among the elderly.

              Tarja Linjakumpu, Sirpa Hartikainen, Timo Klaukka … (2002)
              To assess changes in medicine use and polypharmacy, two cross-sectional surveys were carried out among community-dwelling persons aged 64 years or over in 1990-91 (n = 1,131) and 1998-99 (n = 1,197) in the municipality of Lieto in southwestern Finland. In addition to drug use, the questionnaire included items on social background, quality of life, and home nursing services. Among those surveyed, 78% in 1990-1991 and 88% in 1998-1999 (P =.001) used prescription drugs during 7 days prior to the interview. The most commonly used medications were for the cardiovascular and central nervous systems. The number of medications per person increased from 3.1 (SD 2.8) to 3.8 (SD 3.1) (P =.0001), and polypharmacy (concominant use of over five medications) increased from 19 to 25% (P =.006). These changes were most prominent among persons aged 85 years or over, especially among women. Polypharmacy is a complex and worrying phenomenon that merits more research.
              Article 0 comments Cited 106 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Mens Sana Monogr
                Journal ID (iso-abbrev): Mens Sana Monogr
                Journal ID (publisher-id): MSM
                Title: Mens Sana Monographs
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 0973-1229
                ISSN (Electronic): 1998-4014
                Publication date (Print): Jan-Dec 2013
                Volume: 11
                Issue: 1
                Pages: 82-99
                Affiliations
                [* ] Research Associate, Lokmanya Tilak Medical College and Sion General Hospital, Sion, Mumbai 400 022, India
                [** ] D.P.M. Assistant Professor of Psychiatry, M.G.M. Medical College and Hospital, M.G.M. University of Health Sciences, Sector 18, Kamothe, New Mumbai 410 209, India
                [*** ] D.P.M Professor of Psychiatry, Lokmanya Tilak Medical College and Sion General Hospital, Sion, Mumbai 400 022, India
                [**** ] FRCPC University of Western Ontario, Regional Mental Health Care, 467, Sunset Drive, St. Thomas, Ontario, N6H3V9, Canada
                Author notes
                Address correspondence to: Dr. Amresh Shrivastava, University of Western Ontario, Regional Mental Health Care, 467, Sunset Drive, St. Thomas, Ontario, N6H3V9, Canada. E-mail: dr.amresh@ 123456gmail.com
                Article
                Publisher ID: MSM-11-82
                DOI: 10.4103/0973-1229.104497
                PMC ID: 3653237
                PubMed ID: 23678240
                SO-VID: 88efe353-f867-4591-94b0-db0389005284
                Copyright © Copyright: © Mens Sana Monographs
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 29 August 2012
                Date revision received : 07 December 2012
                Date accepted : 07 December 2012
                Categories
                Subject: Psychiatry, Mental Health and Psychoanalysis

                ScienceOpen disciplines: Neurology
                Keywords: drug combinations,multiple medications,polypharmacy,psychopharmacology
                Data availability:
                ScienceOpen disciplines: Neurology
                Keywords: drug combinations, multiple medications, polypharmacy, psychopharmacology

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