Trends in Antipsychotic Polypharmacy and Potential Overtreatment with Antipsychotics: A Naturalistic Cohort Study of People in Long-term Care

Abstract

Background Due to the side effects of antipsychotics, overtreatment is an important concern. Previous research focused on antipsychotic polypharmacy and excessively high doses. In this study, the aim is to map changes over the years in potential overtreatment, antipsychotic polypharmacy, total antipsychotic dose, and subjective side effect burden. Moreover, the association of the total dose and antipsychotic polypharmacy with the subjective side effect burden will be investigated. Study design Data from a naturalistic longitudinal cohort were used (PHAMOUS, 2013–2021). Potential overtreatment was defined as a antipsychotic dose equivalent to > 5 mg risperidone or antipsychotic polypharmacy, in combination with a high subjective side effect burden. Mixed effect models were used to investigate trends in potential overtreatment, antipsychotic polypharmacy, total antipsychotic dose, and subjective side effect burden and to assess the association of total dose and antipsychotic polypharmacy with subjective side effect burden. Study results Overall, 15,717 observations nested in 5,107 participants were used. One-third of the participants were potentially overtreated, which did not change over time. The prevalence of a dose above the equivalent of 5 mg risperidone decreased, antipsychotic polypharmacy prevalence increased, and the subjective side effect burden decreased. A higher dose and antipsychotic polypharmacy were associated with higher subjective side effect burden. Conclusion Potentially overtreated patients should be revaluated to assess whether changes are needed. To assess whether a patient is truly overtreated, their clinical history, number of relapses, patients’ preferences, overall functioning, previous attempts to reduce antipsychotic treatment, and previous severity of disease should be taken into account.