Juliette Lagreula, Philippe de Timary, Laure Elens, Olivia Dalleur
{"title":"抗精神病药物和氯氮平处方模式:精神病住院前后的演变和相关性。","authors":"Juliette Lagreula, Philippe de Timary, Laure Elens, Olivia Dalleur","doi":"10.1177/20451253221112587","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Antipsychotic polypharmacy (APP) prescribing and clozapine underuse are considered inappropriate prescribing in schizophrenia. Psychiatric hospitalisations may be suitable occasions to re-evaluate patient pharmacotherapy and to switch to monotherapy.</p><p><strong>Objectives: </strong>To explore the evolution of APP and other psychotropic prescribing patterns during psychiatric hospitalisations, to detect characteristics associated with APP on admission and at discharge, and to examine clozapine prescribing patterns.</p><p><strong>Design: </strong>We performed a retrospective observational study based on electronic health records.</p><p><strong>Methods: </strong>Data on adult inpatients diagnosed with schizophrenia spectrum disorders were collected retrospectively from 6 Belgian hospitals in 2020-2021.</p><p><strong>Results: </strong>Of the 516 patients included, APP prescribing increased significantly from 47.9% on hospital admission to 59.1% at discharge. On admission and at discharge, APP was associated with prior clozapine use (OR<sub>admission</sub> = 2.53, CI = 1.1-5.84, OR<sub>discharge</sub> = 11.01, CI = 4.45-27.28), treatment with a first-generation antipsychotic (OR<sub>admission</sub> = 26.79, CI = 13.08-54.86, OR<sub>discharge</sub> = 25.2, CI = 12.2-52.04), increased antipsychotic exposure (OR<sub>admission</sub> = 8.93, CI = 5.13-15.56, OR<sub>discharge</sub> = 19.89, CI = 10-39.54), and a greater number of hypno-sedatives (OR<sub>admission</sub> = 1.88, CI = 1.23-2.88, OR<sub>discharge</sub> = 4.18, CI = 2.53-6.91). APP was negatively associated with involuntary admission (OR<sub>admission</sub> = 0.31, CI = 0.14-0.7, OR<sub>discharge</sub> = 0.3, CI = 0.13-0.68). When using an alternative definition of monotherapy (i.e. including patients with an add-on low-dose antipsychotic for sleep disorders), alcohol use disorder (OR<sub>admission</sub> = 0.26, CI = 0.13-0.54) and higher age (OR<sub>discharge</sub> = 0.53, CI = 0.29-0.95) were negatively associated with APP, and living in a residential facility (OR<sub>discharge</sub> = 2.39 CI = 1.21-4.71) and a higher daily dosage of benzodiazepines during the stay (OR<sub>discharge</sub> = 1.32 CI = 1.03-1.69) increased the odds of being discharged on APP. On admission, 9.3% of patients were being treated with clozapine. Although 28.1% of patients were eligible for clozapine treatment, only 11% of patients were discharged with a clozapine prescription. For 7 of the 10 patients with a new clozapine prescription, it was directly prescribed in combination with another antipsychotic, without a prior trial of clozapine monotherapy.</p><p><strong>Conclusion: </strong>Suboptimal prescriptions of antipsychotics in patients with schizophrenia persist after psychiatric hospitalisations and are associated with identifiable characteristics.</p>","PeriodicalId":3,"journal":{"name":"ACS Applied Electronic Materials","volume":" ","pages":"20451253221112587"},"PeriodicalIF":4.3000,"publicationDate":"2022-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/07/0d/10.1177_20451253221112587.PMC9425880.pdf","citationCount":"2","resultStr":"{\"title\":\"Antipsychotic polypharmacy and clozapine prescribing patterns: evolution and correlates before and after a psychiatric hospitalisation.\",\"authors\":\"Juliette Lagreula, Philippe de Timary, Laure Elens, Olivia Dalleur\",\"doi\":\"10.1177/20451253221112587\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Antipsychotic polypharmacy (APP) prescribing and clozapine underuse are considered inappropriate prescribing in schizophrenia. Psychiatric hospitalisations may be suitable occasions to re-evaluate patient pharmacotherapy and to switch to monotherapy.</p><p><strong>Objectives: </strong>To explore the evolution of APP and other psychotropic prescribing patterns during psychiatric hospitalisations, to detect characteristics associated with APP on admission and at discharge, and to examine clozapine prescribing patterns.</p><p><strong>Design: </strong>We performed a retrospective observational study based on electronic health records.</p><p><strong>Methods: </strong>Data on adult inpatients diagnosed with schizophrenia spectrum disorders were collected retrospectively from 6 Belgian hospitals in 2020-2021.</p><p><strong>Results: </strong>Of the 516 patients included, APP prescribing increased significantly from 47.9% on hospital admission to 59.1% at discharge. On admission and at discharge, APP was associated with prior clozapine use (OR<sub>admission</sub> = 2.53, CI = 1.1-5.84, OR<sub>discharge</sub> = 11.01, CI = 4.45-27.28), treatment with a first-generation antipsychotic (OR<sub>admission</sub> = 26.79, CI = 13.08-54.86, OR<sub>discharge</sub> = 25.2, CI = 12.2-52.04), increased antipsychotic exposure (OR<sub>admission</sub> = 8.93, CI = 5.13-15.56, OR<sub>discharge</sub> = 19.89, CI = 10-39.54), and a greater number of hypno-sedatives (OR<sub>admission</sub> = 1.88, CI = 1.23-2.88, OR<sub>discharge</sub> = 4.18, CI = 2.53-6.91). APP was negatively associated with involuntary admission (OR<sub>admission</sub> = 0.31, CI = 0.14-0.7, OR<sub>discharge</sub> = 0.3, CI = 0.13-0.68). When using an alternative definition of monotherapy (i.e. including patients with an add-on low-dose antipsychotic for sleep disorders), alcohol use disorder (OR<sub>admission</sub> = 0.26, CI = 0.13-0.54) and higher age (OR<sub>discharge</sub> = 0.53, CI = 0.29-0.95) were negatively associated with APP, and living in a residential facility (OR<sub>discharge</sub> = 2.39 CI = 1.21-4.71) and a higher daily dosage of benzodiazepines during the stay (OR<sub>discharge</sub> = 1.32 CI = 1.03-1.69) increased the odds of being discharged on APP. On admission, 9.3% of patients were being treated with clozapine. Although 28.1% of patients were eligible for clozapine treatment, only 11% of patients were discharged with a clozapine prescription. For 7 of the 10 patients with a new clozapine prescription, it was directly prescribed in combination with another antipsychotic, without a prior trial of clozapine monotherapy.</p><p><strong>Conclusion: </strong>Suboptimal prescriptions of antipsychotics in patients with schizophrenia persist after psychiatric hospitalisations and are associated with identifiable characteristics.</p>\",\"PeriodicalId\":3,\"journal\":{\"name\":\"ACS Applied Electronic Materials\",\"volume\":\" \",\"pages\":\"20451253221112587\"},\"PeriodicalIF\":4.3000,\"publicationDate\":\"2022-08-23\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/07/0d/10.1177_20451253221112587.PMC9425880.pdf\",\"citationCount\":\"2\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"ACS Applied Electronic Materials\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/20451253221112587\",\"RegionNum\":3,\"RegionCategory\":\"材料科学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2022/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q1\",\"JCRName\":\"ENGINEERING, ELECTRICAL & ELECTRONIC\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"ACS Applied Electronic Materials","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/20451253221112587","RegionNum":3,"RegionCategory":"材料科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2022/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"ENGINEERING, ELECTRICAL & ELECTRONIC","Score":null,"Total":0}
Antipsychotic polypharmacy and clozapine prescribing patterns: evolution and correlates before and after a psychiatric hospitalisation.
Background: Antipsychotic polypharmacy (APP) prescribing and clozapine underuse are considered inappropriate prescribing in schizophrenia. Psychiatric hospitalisations may be suitable occasions to re-evaluate patient pharmacotherapy and to switch to monotherapy.
Objectives: To explore the evolution of APP and other psychotropic prescribing patterns during psychiatric hospitalisations, to detect characteristics associated with APP on admission and at discharge, and to examine clozapine prescribing patterns.
Design: We performed a retrospective observational study based on electronic health records.
Methods: Data on adult inpatients diagnosed with schizophrenia spectrum disorders were collected retrospectively from 6 Belgian hospitals in 2020-2021.
Results: Of the 516 patients included, APP prescribing increased significantly from 47.9% on hospital admission to 59.1% at discharge. On admission and at discharge, APP was associated with prior clozapine use (ORadmission = 2.53, CI = 1.1-5.84, ORdischarge = 11.01, CI = 4.45-27.28), treatment with a first-generation antipsychotic (ORadmission = 26.79, CI = 13.08-54.86, ORdischarge = 25.2, CI = 12.2-52.04), increased antipsychotic exposure (ORadmission = 8.93, CI = 5.13-15.56, ORdischarge = 19.89, CI = 10-39.54), and a greater number of hypno-sedatives (ORadmission = 1.88, CI = 1.23-2.88, ORdischarge = 4.18, CI = 2.53-6.91). APP was negatively associated with involuntary admission (ORadmission = 0.31, CI = 0.14-0.7, ORdischarge = 0.3, CI = 0.13-0.68). When using an alternative definition of monotherapy (i.e. including patients with an add-on low-dose antipsychotic for sleep disorders), alcohol use disorder (ORadmission = 0.26, CI = 0.13-0.54) and higher age (ORdischarge = 0.53, CI = 0.29-0.95) were negatively associated with APP, and living in a residential facility (ORdischarge = 2.39 CI = 1.21-4.71) and a higher daily dosage of benzodiazepines during the stay (ORdischarge = 1.32 CI = 1.03-1.69) increased the odds of being discharged on APP. On admission, 9.3% of patients were being treated with clozapine. Although 28.1% of patients were eligible for clozapine treatment, only 11% of patients were discharged with a clozapine prescription. For 7 of the 10 patients with a new clozapine prescription, it was directly prescribed in combination with another antipsychotic, without a prior trial of clozapine monotherapy.
Conclusion: Suboptimal prescriptions of antipsychotics in patients with schizophrenia persist after psychiatric hospitalisations and are associated with identifiable characteristics.
期刊介绍:
ACS Applied Electronic Materials is an interdisciplinary journal publishing original research covering all aspects of electronic materials. The journal is devoted to reports of new and original experimental and theoretical research of an applied nature that integrate knowledge in the areas of materials science, engineering, optics, physics, and chemistry into important applications of electronic materials. Sample research topics that span the journal's scope are inorganic, organic, ionic and polymeric materials with properties that include conducting, semiconducting, superconducting, insulating, dielectric, magnetic, optoelectronic, piezoelectric, ferroelectric and thermoelectric.
Indexed/Abstracted:
Web of Science SCIE
Scopus
CAS
INSPEC
Portico