PRESCRIBING PATTERNS FOR INPATIENTS WITH SCHIZOPHRENIA SPECTRUM DISORDERS IN A PSYCHIATRIC HOSPITAL IN SLOVENIA: RESULTS OF 16-MONTH PROSPECTIVE, NON-INTERVENTIONAL CLINICAL RESEARCH

Background: In Slovenia, there has been no evidence about the prescribing patterns for inpatients with psychotic disorders. The research aims to analyze drug utilization patterns for inpatients with psychotic disorder that are coded as F20-F29 according to International Classification of Diseases (ICD) 10th revision (schizophrenia spectrum disorders). Subjects and methods: Prospective research was conducted at the Psychiatric Hospital Idrija. The medical records of the inpatients admitted over a 12-month period were collected from the beginning to the end of their hospitalization. Results: A total of 311 inpatients with 446 hospitalizations were included, producing a total of 3954 medication prescriptions. Medications prescribed pro re nata (the use of as needed) were also taken into account. Antipsychotics (N=1149, 43% of prescriptions) were the most often prescribed medications, followed by anxiolytics, antiparkinsonians, antidepressants, mood stabilizers and cardiovascular drugs. A total of 256 (82%) inpatients received at least one pro re nata medication. It was observed that the studied population was treated with one antipsychotic on 27 percent of prescriptions. Conclusions: Inpatients with schizophrenia spectrum disorders were exposed to a large number of different drugs. They were not received only psychotropic drugs but also other medications. With the knowledge about medications the implementation of clinical pharmacy services to the psychiatrists would significantly improve medication of inpatients with psychotic disorders and polypharmacotherapy

Analysis of pharmacotherapy in hospitalized patients with schizophrenia spectrum disorders

Antipsihotiki so ključna zdravila za zdravljenje shizofrenije in podobnih psihoz. Zaradi neželenih učinkov in interakcij zdravil predstavlja njihova uporaba določeno tveganje za bolnika. V okviru doktorske disertacije smo načrtovali in izvedli 16–mesečno prospektivno, opazovalno in ne-intervencijsko klinično raziskavo v Psihiatrični bolnišnici Idrija ter tako dobili vpogled v predpisovanje zdravil hospitaliziranim bolnikom s shizofrenijo in podobnimi psihozami. Poleg farmakoterapije smo analizirali tudi značilnosti preiskovane populacije (311 bolnikov). Dokazali smo, da bolniki s shizofrenijo in podobnimi psihozami zaradi značilnosti svoje bolezni kot tudi zaradi pridruženih bolezni in obvladovanja neželenih učinkov antipsihotikov prejemajo več različnih zdravil. Petina predpisov je vsebovala ne-psihotropna zdravila. Analiza farmakoterapije je pokazala, da antipsihotiki, po pričakovanju največkrat uporabljena zdravila, niso bili vedno predpisani v sladu s priporočili (velik delež uporabe klasičnih antipsihotikov, uporaba premajhnih odmerkov, sočasna uporaba več antipsihotikov, predpisovanje za uporabo po potrebi). Dokazali smo, da pri bolnikih s shizofrenijo in podobnimi psihozami zaradi različnih vzrokov pogosto prihaja do zamenjav antipsihotikov (37 %). Nekaterih rezultatov nismo pričakovali: interakcije zdravil niso bile nikoli vzrok zamenjave antipsihotikov, največkrat je bila izvedena takojšnja zamenjava antipsihotikov, ki večinoma ni priporočljiva, več kot 10 % zamenjav antipsihotikov je bilo izvedenih na bolnikovo željo in v zamenjavo so bili vključeni trije ali več antipsihotikov. Potrdili smo, da so bolniki s shizofrenijo in podobnimi psihozami zaradi polifarmakoterapije izpostavljeni velikemu tveganju za potencialne interakcije tipa X in tipa D (88,7 %), več kot polovica bolnikov je imela predpisano neustrezno kombinacijo zdravil, v katero so bili vključeni predvsem antipsihotiki (potencialne interakcije tipa X), ter da obstaja močna povezava med številom predpisanih zdravil in vsemi klinično opaženimi skupinami simptomov in znakov (OR 2.8595% CI 1.84–5.73). Izsledki raziskave potrjujejo, da je potrebno načrtovati neodvisne, prospektivne raziskave s področja predpisovanja/uporabe zdravil pri hospitaliziranih psihiatričnih bolnikih. Pomembna je tudi ugotovitev, da lahko z vključitvijo kliničnega farmacevta v proces zdravljenja izboljšamo kakovost bolnišnične obravnave psihiatričnih bolnikov.Antipsychotics are the most important drugs for the treatment of schizophrenia spectrum disorders. Due to adverse reactions and drug–drug interactions, the use of antipsychotics poses a risk to the patients. As part of the doctoral dissertation, we planned and carried out a 16-month prospective, observative, and non-interventional clinical study in the Psychiatric Hospital Idrija to determine the use of all drugs in a specific population of psychiatric patients. We analysed characteristics and pharmacotherapy of the investigated population (311 patients). We demonstrated that patients receive several different drugs due to the characteristics of psychiatric disorder as well as comorbidities and the management of adverse effects of antipsychotics. 20 % of the prescriptions contained non-psychotropic drugs. The analysis of pharmacotherapy showed that antipsychotics were not always prescribed in accordance with the guidelines (high use of classic antipsychotics, use of underdoses, receiving several antipsychotics at the same time, prescribing pro re nata). We have shown that patients often switch antipsychotics (37 %) due to various reasons. Some results were not expected: drug interactions were never the cause of switching antipsychotics, abrupt switching was most often performed, which is mostly not recommended, more than 10 % of switches were performed at the patient\u27s request and three or more antipsychotics were included in the switching. The prevalence of potential interactions of type X and type D was high (88.7 %), and more than half of patients were exposed to at least one drug combination that should be avoid (interaction of type X). We found out associations between all clinically observed symptoms and signs and several variables, including potential interactions. The dominant variable associated with all groups of symptoms and signs was the number of drugs that patients received (OR 2.8595% CI 1.84–5.73). The results of the study confirm the need to plan independent, prospective studies in the field of prescribing/use of drugs in hospitalised psychiatric patients. It is also important to conclude that by including a clinical pharmacist in the treatment process, we can improve the quality of hospital treatment for psychiatric patients

Switching antipsychotics: Results of 16-month non-interventional, prospective, observational clinical research of inpatients with schizophrenia spectrum disorders

The study aims to identify prescribing and switching patterns of antipsychotics in clinical practice. A 16-month, prospective study was conducted at the Psychiatric Hospital Idrija, Slovenia. Inpatients (N = 311) with schizophrenia spectrum disorders were observed. The causes for switching antipsychotics and switching strategies were analyzed. Analyzing a total of 3954 prescriptions, the collected data confirmed that treatment strategies in this psychiatric hospital are very complex. It was found that 37 percent of inpatients had at least one switch. Moreover, switches that included three or more antipsychotics were detected. The most common causes for switching antipsychotics were adverse reactions and inefficacy or lack of efficacy. Among switching options, abrupt switch was recorded several times. As some patients are receiving several antipsychotics at the same time, it is possible that unusual switching occurs in clinical practice. It seems that the choice of switching strategy is also affected by the cause and urgency for switching an antipsychotic

Switching antipsychotics: Results from 16-month non-interventional, prospective, observational clinical research of inpatients with schizophrenia spectrum disorders

The study aims to identify prescribing and switching patterns of antipsychotics in clinical practice. A 16-month, prospective study was conducted at the Psychiatric Hospital Idrija, Slovenia. Inpatients (N = 311) with schizophrenia spectrum disorders were observed. The causes for switching antipsychotics and switching strategies were analyzed. Analyzing a total of 3954 prescriptions, the collected data confirmed that treatment strategies in this psychiatric hospital are very complex. It was found that 37 percent of inpatients had at least one switch. Moreover, switches that included three or more antipsychotics were detected. The most common causes for switching antipsychotics were adverse reactions and inefficacy or lack of efficacy. Among switching options, abrupt switch was recorded several times. As some patients are receiving several antipsychotics at the same time, it is possible that unusual switching occurs in clinical practice. It seems that the choice of switching strategy is also affected by the cause and urgency for switching an antipsychotic