Antipsychotic prescription prevalence and metabolic monitoring of patients under chronic treatment
DOI:
https://doi.org/10.31053/1853.0605.v78.n3.32653Keywords:
antipsychotic agents, prevalence, aged, monitoringAbstract
Introduction: Antipsychotics agents increase morbidity and mortality due to their metabolic impact. Information on its prescription and follow-up is scarce. The objective of this study was to estimate the chronic antipsychotic prescription prevalence and to evaluate the metabolic monitoring of patients treated with these medications.
Methods: We examined a retrospective cohort of patients older than 18 years treated in the outpatient setting of a hospital in Argentina. The crude and adjusted prevalence of chronic antipsychotic prescription was estimated by indirect standardization of the World Health Organization population, with its confidence interval (95%). It was evaluated whether the patients had biochemical determinations, systolic blood pressure (SBP), and body mass index (BMI) at the beginning and at 12 months of their treatment.
Results: The crude antipsychotic prescription prevalence was 23.8 ‰ (95% CI 23.0 - 24.6) and the adjusted prevalence was 10.1 ‰ (95% CI 9.5-10.7). 3702 patients were evaluated. The male:female ratio was 0.6. Median age 77.5 years (IQR 25-75: 59.5-86.1). Quetiapine was the most frequently prescribed. Initial determinations: Lipid profile 1804 (48.7%), blood glucose 2034 (54.9%), SBP 2546 (68.8%) and BMI 1584 (42.8%). At 12 months: Lipid profile 680 (18.4%), blood glucose 898 (24.3%), SAT 1609 (43.5%), and BMI 1584 (21.7%).
Conclusions: We observed a higher prevalence of atypical antipsychotic prescription in the elderly and female population and scarce registry of biochemical determinations for adverse effects follow-up.
Downloads
References
1. Daray FM. Neuropsicofarmacología: Conceptos Básicos - 1a Ed. Buenos Aires: Salerno; 2014.
2. Jufe GS. Psicofarmacología Práctica - 4ta. ed. Buenos Aires: Polemos; 2017.
3. Lieberman JA, Stroup TS, McEvoy JP, Swartz MS, Rosenheck RA, Perkins DO, Keefe RS, Davis SM, Davis CE, Lebowitz BD, Severe J, Hsiao JK; Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Investigators. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med. 2005 Sep 22;353(12):1209-23. doi: 10.1056/NEJMoa051688. Epub 2005 Sep 19. Erratum in: N Engl J Med. 2010 Sep 9;363(11):1092-3.
4. Hennekens CH, Hennekens AR, Hollar D, Casey DE. Schizophrenia and increased risks of cardiovascular disease. Am Heart J. 2005 Dec;150(6):1115-21. doi: 10.1016/j.ahj.2005.02.007.
5. American Diabetes Association; American Psychiatric Association; American Association of Clinical Endocrinologists; North American Association for the Study of Obesity. Consensus development conference on antipsychotic drugs and obesity and diabetes. Obes Res. 2004 Feb;12(2):362-8. doi: 10.1038/oby.2004.46.
6. Aguilar E, Coronas R, Caixàs A. Síndrome metabólico en pacientes esquizofrénicos con tratamiento antipsicótico [Metabolic syndrome in patients with schizophrenia and antipsychotic treatment]. Med Clin (Barc). 2012 Nov 17;139(12):542-6. Spanish. doi: 10.1016/j.medcli.2012.05.028.
7. Franch Pato CM, Molina Rodríguez V, Franch Valverde JI. Metabolic syndrome and atypical antipsychotics: Possibility of prediction and control. Rev Psiquiatr Salud Ment. 2017 Jan-Mar;10(1):38-44. English, Spanish. doi: 10.1016/j.rpsm.2016.09.003.
8. Sánchez-Araña Moreno T, Touriño González R, Hernández Fleta JL, León Pérez P. Alta Prevalencia de Síndrome Metabólico En Pacientes Esquizofrénicos: Una Revisión de La Literatura. Psiquiatría Biológica. 2006 August;13(4),127-135. Spanish. doi: 10.1016/s1134-5934(06)75353-2.
9. Chong MY, Tan CH, Fujii S, Yang SY, Ungvari GS, Si T, Chung EK, Sim K, Tsang HY, Shinfuku N. Antipsychotic drug prescription for schizophrenia in East Asia: rationale for change. Psychiatry Clin Neurosci. 2004 Feb;58(1):61-7. doi: 10.1111/j.1440-1819.2004.01194.x.
10. Tohen M, Zhang F, Taylor CC, Burns P, Zarate C, Sanger T, Tollefson G. A meta-analysis of the use of typical antipsychotic agents in bipolar disorder. J Affect Disord. 2001 Jun;65(1):85-93. doi: 10.1016/s0165-0327(00)00162-2.
11. Instituto Nacional de Estadística y Censos. Dirección General de Estadística y Censos. Censo Nacional de Población, Hogares y Vivienda. 2010. Disponible en: http://www.indec.gov.ar/.
12. Ministerio de Desarrollo Social. Gobierno de la Ciudad de Buenos
Aires. Disponible en: https://www.buenosaires.gob.ar/desarrollohumanoyhabitat/institucional-ministerio-de-desarrollo-humano-y-habitat
13. Belló, M, Becerril-Montekio, V. Sistema de salud de Argentina. Salud pública Méx. 2011 Ene;53(Suppl 2 ):s96-s109 53. s96-s109. Disponible en: http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0036-36342011000800006&lng=es
14. Organización Mundial de la Salud. Datos sobre obesidad. OMS: 2020. Disponible en: https://www.who.int/features/factfiles/obesity/facts/es/
15. Hálfdánarson Ó, Zoëga H, Aagaard L, Bernardo M, Brandt L, Fusté AC, Furu K, Garuoliené K, Hoffmann F, Huybrechts KF, Kalverdijk LJ, Kawakami K, Kieler H, Kinoshita T, Litchfield M, López SC, Machado-Alba JE, Machado-Duque ME, Mahesri M, Nishtala PS, Pearson SA, Reutfors J, Saastamoinen LK, Sato I, Schuiling-Veninga CCM, Shyu YC, Skurtveit S, Verdoux H, Wang LJ, Yahni CZ, Bachmann CJ. International trends in antipsychotic use: A study in 16 countries, 2005-2014. Eur Neuropsychopharmacol. 2017 Oct;27(10):1064-1076. doi: 10.1016/j.euroneuro.2017.07.001.
16. Kuo CL, Chien IC, Lin CH. Trends, correlates, and disease patterns of antipsychotic use among elderly persons in Taiwan. Asia Pac Psychiatry. 2016 Dec;8(4):278-286. doi: 10.1111/appy.12230.
17. Rapoport M, Mamdani M, Shulman KI, Herrmann N, Rochon PA. Antipsychotic use in the elderly: shifting trends and increasing costs. Int J Geriatr Psychiatry. 2005 Aug;20(8):749-53. doi: 10.1002/gps.1358.
18. Organización Mundial de la Salud. Envejecimiento y salud. OMS. 2018 Feb. Disponible en: https://www.who.int/news-room/fact-sheets/detail/ageing-and-health
19. Alessi-Severini S, Dahl M, Schultz J, Metge C, Raymond C. Prescribing of psychotropic medications to the elderly population of a Canadian province: a retrospective study using administrative databases. PeerJ. 2013 Sep 17;1:e168. doi: 10.7717/peerj.168.
20. Correll CU, Shaikh L, Gallego JA, Nachbar J, Olshanskiy V, Kishimoto T, Kane JM. Antipsychotic polypharmacy: a survey study of prescriber attitudes, knowledge and behavior. Schizophr Res. 2011 Sep;131(1-3):58-62. doi: 10.1016/j.schres.2011.02.016.
21. Ross E, Barnett R, Tudhope R, Vasudev K. Can We Improve Physical Health Monitoring for Patients Taking Antipsychotics on a Mental Health Inpatient Unit? J Clin Psychopharmacol. 2018 Oct;38(5):447-453. doi: 10.1097/JCP.0000000000000931.
22. Chong MY, Tan CH, Fujii S, Yang SY, Ungvari GS, Si T, Chung EK, Sim K, Tsang HY, Shinfuku N. Antipsychotic drug prescription for schizophrenia in East Asia: rationale for change. Psychiatry Clin Neurosci. 2004 Feb;58(1):61-7. doi: 10.1111/j.1440-1819.2004.01194.x.
23. Brunero S, Wand AP, Lamont S, John L. A point prevalence study of the use of psychotropic medication in an acute general hospital. Int Psychogeriatr. 2016 Jun;28(6):967-75. doi: 10.1017/S104161021500232X.
24. Santamaría B, Pérez M, Montero D, Madurga M, de Abajo FJ. Use of antipsychotic agents in Spain through 1985-2000. Eur Psychiatry. 2002 Dec;17(8):471-6. doi: 10.1016/s0924-9338(02)00705-8.
25. Oteri A, Mazzaglia G, Pecchioli S, Molokhia M, Ulrichsen SP, Pedersen L, Poluzzi E, De Ponti F, Garbe E, Schink T, Herings R, Bezemer ID, Sturkenboom MC, Trifirò G. Prescribing pattern of antipsychotic drugs during the years 1996-2010: a population-based database study in Europe with a focus on torsadogenic drugs. Br J Clin Pharmacol. 2016 Aug;82(2):487-97. doi: 10.1111/bcp.12955. Epub 2016 May 18. Erratum in: Br J Clin Pharmacol. 2017 Jun;83(6):1360.
26. Dhamane AD, Martin BC, Brixner DI, Hudson TJ, Said Q. Metabolic monitoring of patients prescribed second-generation antipsychotics. J Psychiatr Pract. 2013 Sep;19(5):360-74. doi: 10.1097/01.pra.0000435035.45308.03.
27. Lee J, Dalack GW, Casher MI, Eappen SA, Bostwick JR. Persistence of metabolic monitoring for psychiatry inpatients treated with second-generation antipsychotics utilizing a computer-based intervention. J Clin Pharm Ther. 2016 Apr;41(2):209-13. doi: 10.1111/jcpt.12368.
28. Happell B, Platania-Phung C, Gaskin CJ, Stanton R. Use of an electronic metabolic monitoring form in a mental health service - a retrospective file audit. BMC Psychiatry. 2016 Apr 19;16:109. doi: 10.1186/s12888-016-0814-9.
29. Cohn TA, Sernyak MJ. Metabolic monitoring for patients treated with antipsychotic medications. Can J Psychiatry. 2006 Jul;51(8):492-501. doi: 10.1177/070674370605100804.
Downloads
Published
Issue
Section
License
Copyright (c) 2021 Universidad Nacional de Córdoba
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The generation of derivative works is allowed as long as it is not done for commercial purposes. The original work may not be used for commercial purposes.
How to Cite
