Abstract
Antipsychotic polypharmacy and prescription of high-dose antipsychotics are often used for the treatment of psychotic symptoms, especially in compulsory psychiatric care although there is lack of evidence to support this practice and related risks for patients. We aimed to investigate prescription patterns in patients with psychosis under compulsory psychiatric treatment in Cyprus and to identify predictors for pharmaceutic treatment patterns. This was a nationwide, descriptive correlational study with cross-sectional comparisons, including 482 patients with compulsory admission to hospital. Sociodemographic and clinical data were collected. Psychotic symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS). Prescribed medication patterns, including use of medication pro re nata (PRN, when required), were recorded. Antipsychotic polypharmacy with a PRN schema was reported in 33.2% (n = 160) of the participants. Polypharmacy without a PRN schema was reported in 5.6% (n = 27) of the participants. We found that 27.2% (n = 131) of the participants were prescribed high-dose antipsychotics without PRN included; and 39.2% (n = 189) prescribed high-dose antipsychotics with PRN included. In the logistic regression analyses, predictors for prescription of high-dose antipsychotics were male gender, positive psychiatric history, receiving state benefits and a negative history of substance use. Male gender was the only predictor for polypharmacy without a PRN schema whereas male gender, negative family psychiatric history, receiving state benefits and the total score on the positive symptoms PANSS subscale were predictors for polypharmacy with a PRN schema included. A high frequency of polypharmacy and use of medication PRN beyond clinical guidelines has been reported for the first time in psychiatric compulsory care in Cyprus; revision in antipsychotic prescription is needed.
Highlights
Antipsychotic polypharmacy and prescription of high-dose antipsychotics are often used for the treatment of psychotic symptoms, especially in compulsory psychiatric care there is lack of evidence to support this practice and related risks for patients
Antipsychotic polypharmacy with a PRN schema was reported in 33.2% (n = 160) of the participants
We found that 27.2% (n = 131) of the participants were prescribed high-dose antipsychotics without PRN included; and 39.2% (n = 189) prescribed high-dose antipsychotics with PRN included
Summary
Management of psychotic symptoms is a challenging clinical task and there is data showing that published treatment guidelines are not always followed by clinicians.[1]. In everyday clinical practice, treatment regimens may include patterns of use that are beyond these guidelines, with polypharmacy becoming a global practice with an approximately 20% frequency of occurrence.[3,6,7] Several reasons have been cited, such as treatment-resistant illness, side-effects as well as the preferences of patients or physicians.[3,6,7] a combination of multiple antipsychotics with high doses of antipsychotics may be prescribed for the remission of symptoms.[8]. As in the case of polypharmacy, prescribing high-dose antipsychotic medications is a practice that is not supported by research data and it is associated with multiple risks, such as the occurrence of extrapyramidal symptoms and increased cardiac problems.[8,12,13]. Previous studies on patterns of antipsychotic prescription have not always included key variables, such as medication provided pro re nata (PRN, when required) and other clinical data, such as the severity of psychotic symptoms.[15,16] PRN medication prescription is when timing of administration is left to the patient or clinician (nurse) as needed, or as the situation arises, in contrast to a scheduled medication plan
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