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5PSQ-089 Prevalence of prescription of antipsychotic polypharmacy in a psychiatric hospital
  1. J Velasco,
  2. M Martinez de Guzman,
  3. MA de Concepcion Salesa
  1. Hospital Psiquiatrico Roman Alberca, Servicio de Farmacia, El Palmar, Spain


Background Despite a scanty evidence base and the number of adverse associations of antipsychotic combinations reported such as higher mortality, increased risk of side effects, adverse drug interactions, decreased treatment adherence and greater costs, the concurrent use of two or more antipsychotic medications continues to expand.

Purpose To analyse the prevalence of antipsychotic (APS) combination treatments in patients admitted to the Acute and Half-Stay Units, as well as its concomitance with antidepressants and mood stabilisers.

Material and methods Descriptive cross-sectional study.

Information collected: history, sex, age, diagnosis, antipsychotics, antidepressants and mood stabilisers.

Statistical analysis with SPSS, significance level 0.05.

Results Eighty-two patients (56.1% males, 43.9% females; mean age of 42.7±11.3 years, 51.2% with schizophrenia (F20), 19.5% schizoaffective disorder (F25), 14.6% with personality disorder (F60), 7.3% with bipolar disorder (F31) and 7.3% with other diagnoses (according to DSM-IV, ICD-10). 23.2% were in the Short-Stay Unit and the rest (76.8%) in the Half-Stay Unit. Substance addiction was present in 42.7%.

APS per patient was 1.8±0.8, of which 0.2±0.4 were typical and 1.6±0.7 atypical. Number of prescriptions with antipsychotics were 80 (97.6%), of which three (3.7%) contained only typical, 64 (78.0%) atypical and 13 (15.9%) both APS (Chi2=126.7; p<0.01). Thirty-four (42.5%) were prescribed long-acting injectable antipsychotics.

45.1% (0.6±0.8 per patient) were prescribed antidepressants, 36.6% (0.5±0.7) mood stabilisers and 91.5% (1.7±0.9) benzodiazepines.

32.9% (n=27) received antipsychotic monotherapy, two APS 51.2% (n=42%), three APS 11.0% (n=9) and four APS 2.4% (n=2) (Chi2=73.4; p<0.01). The doses were exceeded in six (7.3%) prescriptions according to the relevant Summary of Product Characteristics for these medicinal products.

The prevalence of typical antipsychotics was: clotiapine eight (9.8%), levomepromazine three (3.7%), zuclopenthixol three (3.7%) and haloperidol two (2.4%). The prevalence of atypical APS was: clozapine 13 (15.9%), olanzapine 17 (20.7%), quetiapine 22 26.8%), paliperidone 20 (24.4%), risperidone 25 (30.5%), aripiprazole 25 (30.5%), ziprasidone six (7.3%) and amisulpiride four (4.9%).

Conclusion The high use of antipsychotics (67.1%) which, although it may reflect the complexity and resistance of the treated pathologies, does not agree with the recommendations of the national and international guidelines.

Combining mood stabilisers with atypical antipsychotics or antidepressants when resistant pathology can result in therapeutic synergy and obtain a more favourable result. This combination can accelerate the response to treatment and minimise adverse effects by allowing the use of lower doses of each drug. The particular characteristics of each patient must be considered.

References and/or acknowledgements

No conflict of interest.

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