Çınar YENİLMEZ, GÜLCAN GÜLEÇ, Alev BÜYÜKKINACI, Ali DAYI, Hülya Turgut, Yasemin ULUDAĞ TEKİN, Sevil AKBABA

Polypharmacy among inpatients of a university psychiatry clinic: A retrospective study

Amaç: Psikiyatride çoklu ilaç kullanımına (ÇİK) sıkça başvurulduğu ve bunun son dönemlerde giderek arttığı belirtilmektedir. Bu çalışmada, bir üniversitenin psikiyatri kliniğinde yatan hastalarda ÇİK sıklığını ve belirlenen tanı gruplarına göre ÇİK düzeyini saptamayı amaçladık. Yöntem: Çalışmamızda, Eskişehir Osmangazi Üniversitesi Tıp Fakültesi Psikiyatri Servisinde, Ocak 2010-Ocak 2011 tarihleri arasında yatarak tedavi görmüş 201 hastanın dosyaları geriye dönük olarak incelenmiştir. Her dosyadan, hastaların son yatıştaki tanısı, taburcu edilirken reçete edilen ilaçlar, yatış süresi, daha önce başka yatışlarının olup olmadığı ve demografik verileri kaydedilmiş ve istatistiksel olarak incelenmiştir. Tekrarlayan yatışı olanların son yatışı değerlendirilmiştir. Bulgular: Dosyaları incelenen 201 hastanın son yatışları değerlendirildiğinde; taburcu edilme sırasında 145 (%72.1) hastada ÇİK saptandı. En çok ÇİK uygulaması (%60) psikotik bozukluklarda iken, hasta başına düşen ilaç sayısı ise 2.2ydi. ÇİK kentte yaşayanlarda, yatış süresi uzun olanlarda ve daha önceki yatış sayısı fazla olanlarda anlamlı olarak daha yüksekti. Sonuç: Çalışmamızda oldukça yüksek bulunan ÇİK sıklığı, tedavi protokollerine uyumun beklenilen ölçüde olmadığını göstermektedir. Kanıta dayalı psikiyatrinin gelişmesiyle uygulanan çoklu ilaç kullanımının yarar/zarar oranının belirlenmesi gerekli görünmektedir. Ancak bu şekilde, uygulanan ÇİKin doğru bir yaklaşım olup olmadığı ve tedavi protokollerinin bu yönde değiştirilip değiştirilmeyeceğiyle ilgili sorular cevaplanabilecektir.

Bir üniversite hastanesinde yatarak tedavi gören hastalarda çoklu ilaç kullanımı: Geriye dönük bir çalışma

Polypharmacy among inpatients of a university psychiatry clinic: a retrospective study Objective: It has been reported that polypharmacy was frequent and increased lately. In our study, our purpose was to define the prevalence of polypharmacy and the level of polypharmacy according to the specified diagnostic groups. Method: The files of 201 inpatients admitted between January 2010 and January 2011 were evaluated retrospectively. For every patients last admission, prescribed drugs at that admission, time period of that admission, the number of past admissions and demographic data were evaluated and statistical analysis was performed. Results: In the evaluation of the last admissions of 201 inpatients, it was detected that 145 (72.1%) patients had been given polypharmacy at discharge. Polypharmacy was mostly used in psychotic patients (60%) and number of drugs used per patient was 2.2. Polypharmacy was significantly more frequent in patients living in cities, with a longer hospital stay and in patients with higher number of past admissions. Conclusion: Our finding of high percentage of polypharmacy shows that treatment algorithms are not followed as much as expected. With the development of the evidence based psychiatry, it is necessary to define ratios of benefits and harms while using polypharmacy. Only by this way, questions about if polypharmacy is a suitable approach or if the treatment algorithms can be changed accordingly may be answered.

PDF

___

1. Uluoğlu C. Psikiyatrik hastalıklarda polifarmasi ne zaman akılcıdır? Klinik Psikiyatri Dergisi 2007; 10:151-164 (Article in Turkish).
2. Ibrahima IA, Kangb E, Danskyc KH. Polypharmacy and possible drug-drug interactions among diabetic patients receiving home health care services. Home Health Care Serv Q 2005; 24:87-99.
3. Pau AK. Polypharmacy problems: drug interactions in the multidrug therapy of HIV infection. The PRN Notebook 2002; 7:4-9.
4. Brazeau S. Polypharmacy and elderly. The Canadian Journal of CME 2001; 85-94.
5. Ingracia T. Polypharmacy syndrome (Iatrogenesis: In Stassi ME(Editor). FENCE Student Manual. Warrensburg, Missouri: Missouri Center for Career Education, University of Central Missouri, 2009, 222-228.
6. Muir AJ, Sanders LS, Wilkinson WE, Schmader K. Reducing medication regimen complexity. J Gen Intern Med 2001; 16:77- 82.
7. Lacro JP, Dunn LB, Dolder CR, Leckband SG, Jeste DV. Prevalence of and risk factors for medication nonadherence in patients with schizophrenia: a comprehensive review of recent literature. J Clin Psychiatry 2002; 63:892-909.
8. Rupnow MFT, Greenspan A, Gharabawi GM, Kosik-Gonzalez C, Zhu Y, Stahl SM. Incidence and costs of polypharmacy: data from a randomized, double-blind, placebo-controlled study of risperidone and quetiapine in patients with schizophrenia or schizoaffective disorder. Curr Med Res Opin 2007; 23:2815- 2822.
9. Mojtabai R, Olfson M. National trends in psychotropic medication polypharmacy in office-based psychiatry. Arch Gen Psychiatry 2010; 67:26-36.
10. Schorr SG, Loonen AJM, Brouwers JRBJ, Taxis K. A cross sectional study of prescribing patterns in chronic psychiatric patients living in sheltered housing facilities. Int J Clin Pharmacol Ther 2008; 46:146-150.
11. Ensari H, Ceylan ME, Kılınç E, Kenar J. Türkiyedeki ruh hastalıkları hastanelerindeki psikofarmakolojik tedavilerin kalite yönünden değerlendirilmesi. Klinik Psikofarmakoloji Bülteni 2004; 14:68-78 (Article in Turkish).
12. Jordanova V, Maric NP, Alikaj V, Bajs M, Cavic T, Iosub D, Mihai A, Szalontay A, Sartorius N. Prescribing practices in psychiatric hospitals in Eastern Europe. Eur Psychiatry 2011; 26:414-418.
13. Dilbaz N, Çavuş S.Y. Depresyon tedavisinde yetersiz yanıt durumunda güçlendirme tedavileri. Klinik Psikofarmakoloji Bulteni 2010; 20 (Ek):4-14 (Article in Turkish).
14. Wada K, Yamada N, Hamamura T, Suzuki H, Nakano Y, Kuroda S. Add-on polytherapy with antidepressants and its significance in inpatients with major depression. Psychiatry Clin Neurosci 1999; 53:557-562.
15. Glezer A, Byatt N, Cook R Jr, Rothschild AJ. Polypharmacy prevalence rates in the treatment of unipolar depression in an outpatient clinic. J Affect Disord 2009; 117:18-23.
16. Verdoux H, Tournier M, Bégaud B. Antipsychotic prescribing trends: a review of pharmaco-epidemiological studies. Acta Psychiatr Scand 2010; 121:4-10.
17. Centorrino F, Cincotta SL, Talamo A, Fogarty KV, Guzzetta F, Saadeh MG, Salvatore P, Baldessarini RJ. Hospital use of antipsychotic drugs: polytherapy. Compr Psychiatry 2008; 49:65-69.
18. Bret P, Bret MC, Queuille E. Prescribing patterns of antipsychotics in 13 French psychiatric hospitals. Encephale 2009; 35:129-138.
19. Dussias P, Kalali AH, Citrome L. Polypharmacy of schizophrenia. Psychiatry (Edgmont) 2010; 7:1719.
20. Mahan S, Holloway J, Bamburg JW, Hess JA, Fodstad JC, Matson JL. An examination of psychotropic medication side effects: does taking a greater number of psychotropic medications from different classes affect presentation of side effects in adults with ID? Res Dev Disabil 2010; 31:1561-1569.
21. Correll CU, Frederickson AM, Kane JM, Manu P. Does antipsychotic polypharmacy increase the risk for metabolic syndrome? Schizophr Res 2007; 89:91-100.
22. Cerit C, Vural M, Bosgelmez S, Özten E, Aker AT, Yıldız M. Metabolic Syndrome with different antipsychotics: a multicentre cross-sectional study. Psychopharmacol Bull 2010; 43:22-36.
23. Carnahan RM, Lund BC, Perry PJ, Chrischilles EA. Increased risk of extrapyramidal side-effect treatment associated with atypical antipsychotic polytherapy. Acta Psychiatr Scand 2006; 113:135- 141.
24. Kontis D, Theochari E, Kleisas S, Kalogerakou S, Andreopoulou A, Psaras R, Makris Y, Karouzos C, Tsaltas E. Doubtful association of antipsychotic polypharmacy and high dosage with cognition in chronic schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2010; 34:1333-1341.
25. Elie D, Poirier M, Chianetta J, Durand M, Grégoire C, Grignon S. Cognitive effects of antipsychotic dosage and polypharmacy: a study with the BACS in patients with schizophrenia and schizoaffective disorder. J Psychopharmacol 2010; 24:1037-1044.
26. Baandrup L, Gasse C, Jensen VD, Glenthoj BY, Nordentoft M, Lublin H, Fink-Jensen A, Lindhardt A, Mortensen PB. Antipsychotic polypharmacy and risk of death from natural causes in patients with schizophrenia: a population-based nested case-control study. J Clin Psychiatry 2010; 71:103-108.
27. Weinmann S, Read J, Aderhold V. Influence of antipsychotics on mortality in schizophrenia: systematic review. Schizophr Res 2009; 113:1-11.
28. Prudent M, Dramé M, Jolly D, Trenque T, Parjoie R, Mahmoudi R, Lang PO, Somme D, Boyer F, Lanièce I, Gauvain JB, Blanchard F, Novella JL. Potentially inappropriate use of psychotropic medications in hospitalized elderly patients in France: çross sectional analysis of the prospective, multicentre SAFEs cohort. Drugs Aging 2008; 25:933-946.
29. Vasudev A, Harrison R. Prescribing safely in elderly psychiatric wards: survey of possible drug interactions. Psychiatrist 2008; 32:417-418.
30. Baranzini F, Poloni N, Diurni M, Ceccon F, Colombo D, Colli C, Ferrari G, Callegari C. Polypharmacy and psychotropic drugs as risk factors for falls in long-term care setting for elderly patients in Lombardy. Recenti Prog Med 2009; 100:9-16.
31. Santone G, Bellantuono C, Rucci P, Picardi A, Preti A, de Girolamo G. Patient characteristics and process factors associated with antipsychotic polypharmacy in a nationwide sample of psychiatric inpatients in Italy. Pharmacoepidemiol Drug Saf 2011; 20: 441-449.
32. Böke Ö, Sarısoy G, Akbaş S, Aker S, Korkmaz S, Aker AA, Bahçe Z, Çelik C, Şahin AR. Yatan hastalarda çoklu antipsikotik kullanımı: Geriye dönük bir çalışma. Klinik Psikofarmakoloji Bülteni 2006; 16:167-173 (Article in Turkish).
33. Hatıloğlu U, Karadağ H, Akkoyunlu S, Güriz O , Kahiloğulları AK, Örsel S. Şizofrenide ve diğer psikotik bozukluklarda çoklu ilaç kullanımı: Uzun etkili antipsikotik ilaçların rolü. Klinik Psikiyatri Dergisi 2010; 13:101-107 (Article in Turkish).
34. Özalmete ÖA, Ceylan ME, Özalmete O, Sevim ME. Şizofreni tedavisinde çoklu ilaç kullanımının nedenleri. Klinik Psikofarmakoloji Bülteni 2009; 19(1):68-74 (Article in Turkish).
35. Honer WG, Procyshyn RM, Chen EY, MacEwan GW, Barr AM. A translational research approach to poor treatment response in patients with schizophrenia: Clozapine-antipsychotic polypharmacy. J Psychiatry Neurosci 2009;34:433-442.