Bir psikiyatri yatan hasta kliniğinden taburculukta benzodiyazepin reçetesi yazılmasının belirleyicileri

Amaç: Bu çalışma, bir psikiyatri yatan hasta kliniğinden taburculuk sırasında bir benzodiyazepin ilaç reçetesi yazılmasının klinik ve sosyodemografik belirleyicilerini saptamayı amaçlamaktadır. Benzodiyazepin reçetesi yazmanın klinisyenin etkisinden çok, belli demografik ve klinik özelliklerle ilişkili olacağını varsaydık. Yöntem: Bu geriye dönük dosya taraması kliniğimizde Ocak 2014 - Ocak 2016 arasında yatarak tedavi gören hasta kayıtlarını içermektedir. Bulgular: Değerlendirmeye alınan 1017 hastanın %32.9'una (n=335) taburculuklarında bir benzodiyazepin ilaç reçetesi verilmişti. Analizler benzodiyazepin reçetesi yazmanın üç değişken tarafından öngörüldüğünü gösterdi: Yaş, intihar girişimi ve birincil tanı. Reçete yazmada klinisyenin herhangi bir belirleyiciliğinin olmadığı saptandı. Sonuç: Bulgularımız benzodiyazepinlerin taburculukta sık olarak reçete edildiğine ve tanı, intihar ve yaş değişkenlerinden etkilendiğine işaret etmektedir. Klinisyenlerin reçete yazma uygulamalarını etkileyen potansiyel etkenler konusunda dikkatli olmaları gerekmektedir. Ayrıca klinisyenler yatan hasta kliniğinde BDZ başlarken hastalarının tanısını ve bazı klinik ve demografik özelliklerini gözönünde tutmalıdırlar.

The determinants of benzodiazepine prescription at discharge from a psychiatric inpatient clinic

Objective: The present study aimed to explore the clinical and demographic determinants associated with receiving a benzodiazepine (BDZ) at discharge from a psychiatric inpatient clinic. We hypothesized that BDZ prescribing at discharge would be significantly related to specific demographic and clinical features rather than prescriber effects. Methods: This retrospective chart review comprised records of patients who were hospitalized between January 2014 and January 2016. Results: Of the 1017 patients analyzed, 32.9% (n=335) received a BDZ at discharge. The analysis resulted in three models predictive of BDZ prescription at discharge: age, the presence of suicidal attempt and primary diagnosis. We found that there is no impact of prescriber effects on receiving a BDZ at discharge. Conclusion: Our results indicate that benzodiazepines are being prescribed frequently at discharge, and while prescribing appears to be influenced by diagnosis, suicidality and age. Clinicians need to be alert to potential confounders that may be affecting prescribing practices. In addition, the prescribers should take into account for their patient's diagnosis, some clinical and demographic features when starting a BDZ at inpatient clinic.

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1. Ashton HC. Benzodiazepines: How do they work and how to withdraw (The Ashton Manual). Newcastle, UK: Institute of Neuroscience, Newcastle University, 2002. Available from: http://www.benzo.org.uk/manual/ index.html/
2. Baldwin DS, Aitchison K, Bateson A, Curran HV, Davies S, Leonard B, et al. Benzodiazepines: risks and benefits. A reconsideration. J Psychopharmacol 2013; 27:967-971.
3. Hallahan BP, Murray IT, McDonald C. Benzodiazepine and hypnotic prescribing in an acute adult psychiatric in-patient unit. Psychiatr Bull 2009; 33:12-14.
4. Wheeler A, Kairuz T, Sheridan J, McPhee E. Sedative-hypnotic treatment in an acute psychiatric setting: Comparison with best practice guidance. Pharm World Sci 2007; 29:603-610.
5. McIntosh A, Cohen A, Turnbull N, Esmonde L, Dennis P, Eatock J. Clinical Guidelines and Evidence Review for Panic Disorder and Generalised Anxiety Disorder. London National Collaborating Centre for Primary Care, 2004.
6. Taylor D, Paton C, Kapur S. The Maudsley Prescribing Guidelines. Tenth ed., London: Informa Healthcare, 2009.
7. Peters SM, Knauf KQ, Derbidge CM, Kimmel R, Vannoy S. Demographic and clinical factors associated with benzodiazepine prescription at discharge from psychiatric inpatient treatment. Gen Hosp Psychiatry 2015; 37:595-600.
8. van Hulten R, Leufkens HG, Bakker A. Usage patterns of benzodiazepines in a Dutch community: a 10 year follow up. Pharm World Sci 1998; 20:78-82.
9. Davies SJC, Lennard MS, Ghahramani P, Pratt P, Robertson A, Potokar J. PRN prescribing in psychiatric inpatients - Potential for pharmacokinetic drug interactions. Psychopharmacol 2007; 21:153-160.
10. Duxbury JA, Baker J. The use and nursing management of benzodiazepines in acute, mental health inpatient care: A discussion. J Psychiatr Ment Health Nurs 2004; 11:662-667.
11. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed., text revision (DSM-IV-TR). Washington, DC: APP, 2000.
12. Baldwin DS, Anderson IM, Nutt DJ, Allgulander C, Bandelow B, den Boer JA, et al. Evidencebased pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a Revision of the 2005 Guidelines from the British Association for Psychopharmacology. J Psychopharmacol 2014; 28:403-439.
13. Pollack MH, Van Ameringen M, Simon NM, Worthington JW, Hoge EA, Keshaviah A, et al. A double-blind randomized controlled trial of augmentation and switch strategies for refractory social anxiety disorder. Am J Psychiatry 2014; 171:44-53.
14. Starcevic V. The reappraisal of benzodiazepines in the treatment of anxiety and related disorders. Expert Rev Neurother 2014; 14:1275-1286.
15. Chouinard G. Issues in the clinical use of benzodiazepines: potency, withdrawal, and rebound. J Clin Psychiatry 2004; 65:7-12.
16. National Institute for Health and Care Excellence. NICE clinical guideline 38. Bipolar disorder: the management of bipolar disorder in adults, children and adolescents, in primary and secondary care, 2014.
17. Shih HI, Lin MC, Lin CC, Hsu HC, Lee HL, Chi CH, et al. Benzodiazepine therapy in psychiatric outpatients is associated with deliberate selfpoisoning events at emergency departments - a population-based nested case-control study. Psychopharmacology 2013; 229:665-671.
18. Neutel CI, Patten SB. Risk of suicide attempts after benzodiazepine and/or antidepressant use. Ann Epidemiol 1997; 7:568-574.
19. Fawcett J, Scheftner WA, Fogg L, Clark DC, Young MA, Hedeker D, et al. Time-related predictors of suicide in major affective disorder. Am J Psychiatry 1990; 147:1189-1194.
20. Gaertner I, Gilot C, Heidrich P, Gaertner HJ. A case control study on psychopharmacotherapy before suicide committed by 61 psychiatric inpatients. Pharmacopsychiatry 2002; 35:37-43.
21. American Geriatric Society. American Geriatric Society updated Beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2012; 60:616-631.
22. Billioti de Gage S, Moride Y, Ducruet T, Kurth T, Verdoux H, Tournier M, et al. Benzodiazepine use and risk of Alzheimer's disease: case-control study. BMJ 2014; 349:5205.
23. Yaffe K, Scola M, Boustani M, Fairbanks R. Benzodiazepines and risk of Alzheimer disease. BMJ 2014; 349:5312.
24. Olfson M, King M, Schoenbaum M. Benzodiazepine use in the United States. JAMA Psychiatry 2015; 72:136-142.
25. Lund BC, Bernardy NC, Vaughan-Sarrazin M, Alexander B, Friedman MJ. Patient and facility characteristics associated with benzodiazepine prescribing for veterans with PTSD. Psychiatr Serv 2013; 64:149-155.
26. Noble T, Spiroulias M, White JM. Determinants of benzodiazepine prescribing and administration in a public hospital. Pharmacopsychiatry 1993; 26:11-14.
27. Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med 2008; 4:487-504.
28. Wilson SJ, Nutt DJ, Alford C, Argyropoulos SV, Baldwin DS, Bateson AN, et al. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders. J Psychopharmacol 2010; 24:1577-1601.
29. Lader M. Benzodiazepines revisited - will we ever learn? Addiction 2011; 106:2086-2109.
30. Gillies D, Sampson S, Beck A, Rathbone J. Benzodiazepines for psychosis-induced aggression or agitation. Cochrane Database Syst Rev 2013; 9:CD003079.
31. Mancuso CE, Tanzi MG, Gabay M. Paradoxical reactions to benzodiazepines: literature review and treatment options. Pharmacotherapy 2004; 24:1177-1185.