ANTIPSYCHOTICS

The Problem of Antipsychotic Polypharmacy

July 21, 2016

Antipsychotic polypharmacy is still a significant issue for those discharged from US state psychiatric inpatient hospitals. That’s the conclusion of a recent study involving behavioral data from more than 86,000 individuals. It’s particularly true among patients with schizophrenia and those with longer hospitalizations.

“The study provides a national perspective on the prevalence of prescription of antipsychotic medications among psychiatric inpatient discharges from state hospitals,” said coauthor Glorimar Ortiz, MS, senior researcher/statistician at NRI-National Association of State Mental Health Program Directors Research Institute in Virginia. “The results are important because they underscore the current antipsychotic medication prescribing practices involving individuals with severe mental illness that completed mental health inpatient treatment.”

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Researchers reported that 12% of all discharges were prescribed 2 or more antipsychotic medications (unadjusted rate). Of those patients discharged on at least 1 antipsychotic medication, 18% were prescribed two or more antipsychotics (adjusted rate). The unadjusted rate includes those who were not prescribed any such medication in the denominator, the study authors wrote.  

The two strongest predictors of antipsychotic polypharmacy were a schizophrenia diagnosis and an inpatient hospital stay of 3 months or longer. They also found that antipsychotic polypharmacy affects more than 8,000 patients with schizophrenia annually in state psychiatric inpatient hospitals.

The main reason for discharging patients on antipsychotic polypharmacy was to reduce symptoms (37%), the authors observed.

Patients with schizophrenia are often prescribed multiple antipsychotic medications, despite a dearth of evidence that this practice results in superior outcomes to monotherapy and the fact that several schizophrenia treatment guidelines recommend against it, the authors wrote. Over the past few years, attempts have been made to lower the rate of antipsychotic polypharmacy throughout the country.

“Prescribing multiple antipsychotic medications is a costly practice that is not evidence-based for most patients,” said Ms. Ortiz. “This study reveals typical reasons that antipsychotic polypharmacy continues, and offers suggestions for investigating root causes of why prescribing practices often fail to meet required justifications.”

The authors looked at data from the Behavioral Healthcare Performance Measurement System for this cross-sectional study. More than 86,000 patients aged 18 to 64 years discharged from 160 state psychiatric inpatient hospitals in 46 states during 2011 were included in the analysis.

“Our study is very important because it is the first time that data on the use of antipsychotic medications are analyzed using a large sample of discharges, using a national sample of state psychiatric inpatient hospitals,” said Ms. Ortiz.

Previous studies involving state psychiatric hospitals have been performed using small sample sizes and including data for only one state, she explained. “Since our study included data from hospitals in 46 states and territories, regional data analysis was also possible.”

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