Polypharmacy in psychiatric practice in the Canary Islands

BACKGROUND: Polypharmacy with psychoactive drugs is an increasingly common and debatable contemporary practice in clinical psychiatry based more upon experience than evidence. The objective of this study was to evaluate the prevalence and conditioners of polypharmacy in psychiatric patients. METHOD: A cross-sectional survey was carried out using the Canary Islands Health Service Clinical Records Database. A representative sample (n = 2,647) of patients with mental disorders receiving psychotropic medication was studied. RESULTS: The mean number of psychoactive drugs prescribed was 1.63 ± 0.93 (range 1–7). The rate of polypharmacy was 41.9%, with 27.8% of patients receiving two drugs, 9.1% receiving three, 3.2% receiving four, and 1.8% of the patients receiving five or more psychotropic drugs. Multiple regression analysis shows that variables sex and diagnosis have a predictive value with regard to the number of psychotropic drug used, being men and schizophrenic patients the most predisposed. Benzodiazepines were the more prevalent drugs in monotherapy, while anticonvulsants and antipsychotics were the more used in combination with other treatment. A questionable very high degree of same-class polypharmacy was evidenced, while multi-class, adjunctive and augmentation polypharmacy seem to be more appropriate. CONCLUSIONS: Almost half of the psychiatric patients are treated with several psychotropics. Polypharmacy is common and seems to be problematic, especially when same class of drugs are prescribed together. Some diagnoses, such as schizophrenia, are associated with an increase risk of Polypharmacy but there is a lack of evidence based indicators that allows for quality evaluation on this practice

The development of polypharmacy. A longitudinal study

Background. To date, only a few studies have been carried out on the development and progress of polypharmacy in relation to morbidity in general practices in The Netherlands. Objective. The aim of this study was to investigate the relationship between an increase in long-term drug use and the incidence and severity of some chronic diseases, particularly in the elderly. Methods. Data on medication and morbidity of 1544 elderly people were collected for the period 1994-1997 from three family practices in the medication and morbidity Registration Network of Groningen (RNG) in the northern part of The Netherlands. Polypharmacy is defined as the long-term simultaneous use of two or more drugs; long-term is defined as >240 days in a year. We looked for differences in incidences of some chronic diseases in those subgroups of the elderly in whom multiple long-term drug use respectively increased, stayed constant or did not exist. Polypharmacy at the end of the period was predicted using regression analysis. Results. Polypharmacy occurred in 42% of the elderly at the end of 1997, with major polypharmacy 1>5 drugs) in only 4%. The average number of drugs used long-term increased from 1.3 to 1.8 in 4 years. Predictors for the increase of polypharmacy were the number of drugs at the start, age, diabetes, coronary ischaemic diseases and use of medication without a clear indication (P Discussion. Polypharmacy showed a slow increase over 4 years: almost 20% of the elderly developed polypharmacy, i.e. going from no drugs or one drug to two or more drugs. Polypharmacy develops mainly in elderly patients who already use several drugs, who are known to suffer from cardiovascular diseases, diabetes or stomach symptoms, those who often take drugs (especially sedatives/hypnotics) without clear indication and those who develop hypertension or atrial fibrillation over time

Adverse drug reactions and polypharmacy in the elderly in general practice

Objectives: The risk of adverse drug reactions (ADRs) increases with the number of drugs used. Most studies refer to potential interactions; the results regarding the severity of occurring and registered ADRs are inconsistent. Therefore, we examined the relevance of drug-induced problems in the elderly in general practice and their association with polypharmacy. Design: Retrospective cross-sectional analysis of prospectively collected data. Setting: Three family practices participating in the medication and morbidity Registration Network Groningen (RNG). Methods: From 2185 elderly patients (>64 years) medication and morbidity data were collected over the period of 2 years (1994 and 1995). Polypharmacy was defined as the long-term simultaneous use of two or more drugs. Adverse reactions recognised as such were coded as a separate 'diagnosis' A85. The most risky drug groups and the most prevalent diseases in relation to ADRs were studied. Results: The incidence of ADRs in general practice was 5.7 per 100 elderly patients and the prevalence 6.1 per 100. Moderate polypharmacy was more frequent in the elderly who experienced adverse effects; no other differences in degree of polypharmacy could be found. The elderly who experienced adverse reactions used overall more different drugs (14.4 +/- 7.6, of which 1.5 +/- 1.5 were used long term) than the other elderly patients (8.1 +/- 5.7, of which 1.0 +/- 1.5 were long term). The incidence of ADRs increased non-significantly with the number of drugs used long term. Antibiotics, anti- hypertensives and non-steroidal anti-inflammatory drugs were mainly responsible for gastrointestinal complaints (nausea, diarrhoea and stomach pain) and rash. In the cases of treating urinary tract infections and sleeping disorders: there was a significantly high risk of ADRs. Slightly more at risk for adverse drug reactions were older patients with coronary heart disease or asthma/chronic obstructive pulmonary disease. Conclusion: Most of the ADRs observed in general practice turn out to be rather harmless. This is in agreement with outpatient studies, though not with hospital studies. An increased risk of adverse effects with the number of drugs used simultaneously, as reported in other studies, was not confirmed in our study. This study however is limited to actually registered effects