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Polypharmacy in psychiatric treatment. Patterns of psychotropic drug use in Austrian psychiatric clinics

Published online by Cambridge University Press:  16 April 2020

H. Rittmannsberger ,
U. Meise ,
K. Schauflinger ,
E. Horvath ,
H. Donat  and
H. Hinterhuber
H. Rittmannsberger
Affiliation:
Upper Austrian Provincial Mental Hospital Wagner-Jauregg, Wagner-Jauregg-Weg 15 A-4020 Linz, Austria
U. Meise
Affiliation:
Psychiatric University Clinic Innsbruck, Austria
K. Schauflinger
Affiliation:
Upper Austrian Provincial Mental Hospital Wagner-Jauregg, Wagner-Jauregg-Weg 15 A-4020 Linz, Austria
E. Horvath
Affiliation:
Psychiatric Department, Kaiser Franz Josef Hospital Vienna, Austria
H. Donat
Affiliation:
Psychiatric Department, Kaiser Franz Josef Hospital Vienna, Austria
H. Hinterhuber
Affiliation:
Psychiatric University Clinic Innsbruck, Austria
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Summary

There are great variations in the way psychotropic drugs are prescribed. Most experts are in favour of psychopharmacological monotherapy, but little is known about the extent to which it is actually practised. A survey of the psychopharmacological medication of all patients under treatment was carried out in three Austrian psychiatric clinics of various types on two separate days. A psychiatric university clinic, the psychiatric department of a general hospital and a regional mental hospital were selected for the survey.

It was established that only 8% to 22% of the patients underwent psycho-pharmacological monotherapy and that the patients received 2.2 to 3.3 psychotropics on average. Five to 22% of the patients received five or more psychotropic agents. The results are presented in more detail in relation to the diagnoses of schizophrenia and depression.

The rare occurence of monotherapy might be due to unsound treatment regimens in some instances, but much more to a general trend in psychiatry fostering polydrug use.

Keywords

psychotropic drugsmonotherapypolypharmacypsychiatric inpatients
Type
Original article
Information
European Psychiatry , Volume 14 , Issue 1 , March 1999 , pp. 33 - 40
Copyright
Copyright © Elsevier, Paris 1999

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References

Ambühl, BWürmle, OMichel, B. Die Verschreibungspraxis von Psychopharmaka in einer psychiatrischen Universitätsklinik (Psychotropic prescribing practices in a psychiatric university hospital) Psychiatrische Praxis 1993; 20 : 7073.Google Scholar
American Psychiatric Association. Practice guidelines for the treatment of patients with bipolar disorder Am J Psychiatry 1994; 151 : 1–36.CrossRefGoogle Scholar
Andreasen, NCBlack, DW. Lehrbuch Psychiatrie (Psychiatry textbook) Beltz: Psychologie Verlagsunion; 1993.Google Scholar
Azorin, JM. Long-term treatment of mood disorders in schizophrenia Acta Psychiatr Scand 1995; 91 suppl 388 : 20–23.CrossRefGoogle Scholar
Baldessarini, RJViguera, AC. Neuroleptic withdrawal in schizophrenic patients Arch Gen Psychiatry 1995; 52 : 189–222.CrossRefGoogle ScholarPubMed
Buckley, PFMeltzer, HY. Treatment of schizophreniaIn: Schazberg, AFNemeroff, CB eds. The American psychiatric textbook of psychopharmacology Washington: American Psychiatric Press; 1995. p. 236–251.Google Scholar
Clark, AFHolden, NL. The persistence of prescribing habits: a survey and follow-up of prescribing to chronic hospital in-patients Brit J Psychiatry 1987; 150 : 88–91.CrossRefGoogle ScholarPubMed
Collins, EJHogan, TPAwad, AG. The pharmacoepidemiology of treatment-refractory schizophrenia Can J Psychiatry 1992; 37 : 192–195.CrossRefGoogle ScholarPubMed
Craig, TJBehar, R. Trends in the prescription of psychotropic drugs (1970-77) in a state hospital Comprehensive Psychiatry 1980; 21 : 336–345.10.1016/0010-440X(80)90014-0CrossRefGoogle Scholar
Denicoff, KDMeglathery, SBPost, RMTandeciarz, SI. Efficacy of carbamazepine compared with other agents: a clinical practice survey J Clin Psychiatry 1994; 55 : 70–76.Google ScholarPubMed
Edwards, SKumar, VA. Survey of prescribing of psychotropic drugs in a Birmingham psychiatric hospital Brit J Psychiatry 1984; 145 : 502–507.10.1192/bjp.145.5.502CrossRefGoogle Scholar
Famuyiwa, OO. Psychotropic drug prescription in Nigeria Acta Psychiatr Scand 1983; 68 : 73–81.CrossRefGoogle ScholarPubMed
Frances, ADocherty, JPKahn, DA. The expert consensus guideline series. Treatment of bipolar disorder J Clin Psychiatry 1996; 57 suppl 12A : 5–88.Google Scholar
Grohmann, RStrauss, AGehr, CRüther, EHippius, H. Zur Praxis der klinischen Therapie mit Psychopharmaka. Retrospektive Untersuchung der Verordnungsgewohnheiten in einer Psychiatrischen Universitätsklinik (On clinical therapy practice with psychotropics. Retrospective survey of prescribing patterns in a psychiatric university hospital) Pharmakopsychiat 1980; 13 : 1–19.CrossRefGoogle Scholar
Haag, HRüther, EHippius, H. Tardive dyskinesia. WHO expert series on biological psychiatry, Vol. 1 Seattle: Hogrefe & Huber; 1992.Google Scholar
Haase, HJ. Therapie mit Psychopharmaka und anderen psychotropen Medikamenten (Therapy with psychomarmacological agents and other psychotropic drugs) Stuttgart, New York: Schattauer; 1972.Google Scholar
Hemminki, E. Polypharmacy among psychiatric patients Acta Psychiatr Scand 1977; 56 : 347–356.CrossRefGoogle ScholarPubMed
Holloway, F. Prescribing for the long-term mentally ill. A study of treatment practices Brit J Psychiatry 1988; 152 : 511–515.CrossRefGoogle ScholarPubMed
Janicak, PGDavis, JMPreskorn, SHAyd, FJ. Principles and practice of psychopharmacotherapy Baltimore: Williams & Wilkins; 1993.Google Scholar
Kane, JM. Neuroleptic treatment in schizophreniaIn: Nasrallah, HA ed. Handbook of schizophrenia, vol. 2 Amsterdam: Elsevier; 1987. p. 179–202.Google Scholar
Kapur, SRemington, GJones, C.High levels of dopamine D2 receptor occupancy with low-dose haloperidol treatment: a PET study Am J Psychiatry 1996; 153 : 948–950.Google ScholarPubMed
Klein, HERüther, EStaedt, J. Kombinierte Psychopharmakatherapie einschlieblich Behandlung chronischer Schmerzsyndrome (Combined psychotropic therapy including treatment of chronic pain syndromes)In: Rieder, PLaux, GPöldinger, W eds. Neuropsychopharmaka Vienna: Springer; 1992. p. 425–458.Google Scholar
König, WKunow, JKniehl, RReimer, F. Neuroleptics in the treatment of schizophrenia: have there been changes in the dosage regimen? Pharmacopsychiat 1986; 19 : 212–213.10.1055/s-2007-1017200CrossRefGoogle Scholar
Krakowski, MIKunz, MCzobor, PVolvavka, J. Long-term high-dose neuroleptic treatment: who gets it and why? Hosp Commun Psychiatry 1993; 44 : 640–644.Google Scholar
Kramer, MSVogel, WHDijohnson, CDewey, DASheves, PCaviccia, S. Antidepressants in depressed schizophrenic in-patients Arch Gen Psychiatry 1989; 46 : 922–928.CrossRefGoogle Scholar
Laux, G. Aktueller Stand der Behandlung mit Benzodiazepinen (Current state of treament with benzodiazepines) Nervenarzt 1995; 66 : 311–322.Google Scholar
Lipton, AACancro, R. Schizophrenia: clinical featuresIn: Kaplan, HISadock, BJ eds. Comprehensive textbook of psychiatry VI Baltimore: Williams & Wilkins; 1995. p. 968–987.Google Scholar
Mason, AS. Basic principles in the use of antipsychotic agents Hospital Community Psychiatry 1973; 24 : 825–889.Google ScholarPubMed
Mason, ASNerviano, VDeburger, RA. Patterns of antipsychotic drug use in four southeastern state hospitals Dis Nerv System 1977; 38 : 541–547.Google ScholarPubMed
McEvoy, JPHogarty, GESteingard, S. Optimal dose of neuroleptic in acute schizophrenia. A controlled study of the neuroleptic threshold and higher haloperidol dose Arch Gen Psychiatry 1991; 48 : 739–755.CrossRefGoogle ScholarPubMed
Michel, KKolakowska, T. A survey of prescribing of psychotropic drugs in two psychiatric hospitals Brit J Psychiat 1981; 138 : 217–221.CrossRefGoogle ScholarPubMed
Miller, NSGold, MS. Abuse, addiction, tolerance and dependence to benzodiazepines in medical and non-medical populations Am J Drug Alcohol Abuse 1991; 17 : 27–37.CrossRefGoogle Scholar
Mohr, FHubmann, WBender, W. Niedrigdosierte Neuroleptikatherapie - Praxis in der psychiatrischen Akutversorgung? (Low-dosage neuroleptic therapy - practice in psychiatric acute treatment)In: Hofmann, PKulhanek, FMelisch, BZapotocky, HG eds. I. Graz: Conventum Psychiatricum Internationale; 1991.Google Scholar
Möller, HJ. Psychiatrie (Psychiatry) Stuttgart: Kohlhammer; 1992. p. 141–144.Google Scholar
Morgan, RGopalaswamy, AK. Psychotropic drugs: another survey of prescribing patterns Brit J Psychiatry 1984; 144 : 298–302.CrossRefGoogle ScholarPubMed
Muijen, MSilverstone, T. A comparative hospital survey of psychotropic drug prescribing Brit J Psychiatry 1987; 150 : 501–504.CrossRefGoogle ScholarPubMed
Peralta, VCuesta, MJCaro, FMartinez-Larrea, A. Neuroleptic dose and schizophrenic symptoms. A survey of prescribing practices Acta Psychiatr Scand 1994; 90 : 354–357.CrossRefGoogle ScholarPubMed
Prien, RFBalter, MBCaffey, E.M. Hospital surveys of prescribing practices with psychotherapeutic Drugs. A critical examination Arch Gen Psychiatry 1978; 35 : 1271–1275.CrossRefGoogle ScholarPubMed
Reardon, GTRifkin, ASchwartz, AMyerson, ASiris, SG. Changing patterns of neuroleptic dosage over a decade Am J Psychiatry 1989; 146 : 726–729.Google ScholarPubMed
Remington, G. Pharmacotherapy of schizophrenia Can J Psychiatry 1989; 34 : 211–219.CrossRefGoogle ScholarPubMed
Remington, GPollock, BVoineskos, GReed, KCoulter, K. Acutely psychotic patients receiving high-dose haloperidol therapy J Clin Psychopharmacol 1993; 13 : 41–45.CrossRefGoogle ScholarPubMed
Rey, MJSchulz, PCosta, CDick, PTissot, R. Guidelines for the dosage of neuroleptics. I: Chlorpromazine equivalents of orally administered neuroleptics Int Clin Psychopharmacology 1989; 4 : 95–104.CrossRefGoogle ScholarPubMed
Riffer, FHinkel, DZeyringer, RFriedl, EJ.Medikamentöse Therapiestrategien und deren Auswirkungen bei schizophrenen Patienten (Drug therapy strategies and their effects on schizophrenic patients)In: Platz, T ed. Betroffen von Schizophrenie Linz: Edition pro mente; 1995. p. 125–136.Google Scholar
Rittmannsberger, H. Dosage of fluphenacine Am J Psychiatry 1990; 147 : 258–259.CrossRefGoogle Scholar
Rittmannsberger, HSchöny, W. Praktische Durchführung, allgemeine Behandlungsrichtlinien (Practical implementation, general treatment guidelines)In: Riederer, PLaux, GPöldinger, N eds. Neuropsychopharmaka Vol. 4, Neuroleptika Berlin: Springer; 1998. p. 202–225.Google Scholar
Schmidt, LGCzerlinsky, HStöckel, M. Longitudinal assessment of psychotropic drug use in acutely ill psychiatric in-patients Int J Clin Pharmacol Ther Tox 1987; 25 : 244–330.Google Scholar
Schmidt, LGLammers, VStöckel, MMüller-Oerlinghausen, B. Recent trends in prescribing psychotropic drugs at a psychiatric university hospital (1981-84) Pharmacopsychiat 1988; 21 : 126–130.CrossRefGoogle Scholar
Schulz, PRey, MJDick, PTissot, R.Guidelines for the dosage of neuroleptics. II: Changing from daily oral to long-acting injectable neuroleptics Int Clinical Psychopharmacology 1989; 4 : 105–114.CrossRefGoogle ScholarPubMed
Schweizer, ERickels, K. Strategies for treatment of generalized anxiety in the primary care setting J Clin Psychiatry 1997; 58 suppl 3 : 27–31.Google ScholarPubMed
Shepard, CCollins, LFiorentino, DFracchia, JMerlis, S. Polypharmacy in psychiatric treatment. I. Incidence at a state hospital Current Therapy Research 1969; 11 : 765–774.Google Scholar
Stone, CKGarver, DLGriffith, JHirschowitz, JBennett, J. Further evidence of a dose-response threshold for haloperidol in psychosis Am J Psychiatry 1995; 152 : 12101212.Google ScholarPubMed
Strauss, AScherer, JFriedl, FRüther, E. The importance of the quantitative description of drug therapy for drug surveillance in psychiatry Pharmacopsychiat 1985; 18 : 29–30.CrossRefGoogle Scholar
Winstead, DKBlackwell, BEilers, MK. Psychotropic drug use in five city hospitals Dis Nerv System 1976; 37 : 504–509.Google ScholarPubMed
Yosselson-Superstine, SSternik, DLiebenzon, DPrescribing patterns in psychiatric hospitals in Israel Acta Psychiatr Scand 1979; 60 : 477–482.CrossRefGoogle ScholarPubMed
Zito, J.MCraig, TJWanderling, JSiegel, C. Pharmaco-epidemiology in 136 hospitalized schizophrenic patients Am J Psychiatry 1987; 144 : 778–782.Google ScholarPubMed
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