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Drug prescription in Italian Residential Facilities

Published online by Cambridge University Press:  11 October 2011

Rodolfo Tomasi
Affiliation:
Servizio Psichiatrico, AS di Bolzano, Bolzano
Giovanni de Girolamo*
Affiliation:
Dipartimento di Salute Mentale, AUSL di Bologna, Bologna
Giovanni Santone
Affiliation:
Clinica Psichiatrica, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, “Umberto I, G.M. Lancisi, G. Salesi”, Ancona
Angelo Picardi
Affiliation:
Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Roma
Rocco Micciolo
Affiliation:
Cattedra di Biostatistica, Università di Trento, Trento
Domenico Semisa
Affiliation:
Dipartimento di Salute Mentale, Bari
Silva Fava
Affiliation:
Servizio di Psicologia Clinica, Distretto di Faenza, ASL di Ravenna, Ravenna
Gruppo Progres
Affiliation:
II Gruppo PROGRES include: Coordinatori Nazionali, G. de Girolamo, A. Picardi, P. Morosini (Progetto Nazionale Salute Mentale, lstituto Superiore di Sanità, Roma); Biostatistico, R. Micciolo (Università di Trento); Coordinatori Regionali, P. Argentino, G. Borsetti, M. Casacchia, P. Ciliberti, G. Civenti, A. Colotto, G. Dell'Acqua, W. Di Munzio, G. Fagnano, A. Fioritti, N. Longhin, M. Miceli, M. Nicotera, M. Pisetta, R. Putzolu, E. Rossi, M.E. Rotunno, D. Semisa, R. Tomasi, P. Tulli, E. Zanalda, Ricercatori: F. Amaddeo, C. Barbini, F. Basile, G. Bazzacco, R. Bracco, A. Calvarese, G. Canuso, E. Caroppo, L. Caserta, M. Colangione, S. Damiani, T. De Donatis, F. Di Donato, V. Di Michele, R. Esposito, M. Facchini, I. Falloon, S. Ferraro, P. Fracchiolla, P. Gabriele, D. Gallicchio, G. Giardina, A. Greco, F. Grilletti, S. Guzzo, A.M. Lerario, M.R. Marinelli, C. Marino, E. Monzani, F. Picco, L. Pinciaroli, C.A. Rossetti, P. Rubatta, G. Santone, F. Scorpiniti, V. Scrofani, M. Stefani, A. Svettini, A. Zaffarano, M. Cellini, A. Galli, K. Pesaresi, G. Pitzalis, L. Tarantino.
*Corresponding
Address for correspondence: Dr. G. de Girolamo, Dipartimento di Salute Mentale, Viale Pepoli 5, 40123 Bologna. Fax: +39-051-658.4178 E-mail: gdg@iss.it

Summary

Aims — To investigate in a representative national sample (N=2,962) of patients living in Residential Facilities (RFs) patterns of polypharmacy as well as related variables, association between diagnoses and therapeutic patterns, and the rate of adverse events. Methods — Structured interviews focusing on each patient were conducted by trained research assistants with the manager and staff of each RF. Patients were rated with the HoNOS and the SOFAS, and comprehensive information about their sociodemographic and clinical status, and their pharmacological regimes were collected. Results — Conventional antipsychotics and second-generation antipsychotics were prescribed to 65% and 43% of the sample, respectively. Benzodiazepines were prescribed to two-thirds of the sample, while antidepressants were the least-used class of psychotropics. Polypharmacy was common: on average, each treated patient was taking 2.7 drugs (±1.1); antipsychotic polypharmacy was also common. Many prescriptions were loosely related to specific diagnoses. Antiparkinsonianian drugs were prescribed to approximately 1/4 of the sample. Mild or severe adverse events in the previous month were reported for 9.9% and 1.4% of the sample, respectively. About 15% of patients suffered from tardive dyskinesia. Conclusions — Psychotropic drug prescription patterns for severe patients living in RFs are only sometimes satisfactory and offer the opportunity of improvement. Specific actions are required to improve prescription patterns for severe patients in RFs.

Declaration of Interest: in the past two years GdG has received two speaker fees from Janssen-Cilag and from Eli Lilly; GS has received one speaker fee from Solvay. RM, AP, SF and RT have received no fees or other financial support from pharmaceutical companies.

Type
Original Papers
Copyright
Copyright © Cambridge University Press 2005

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References

Addington, D.D., Azorin, J.M., Falloon, I.R.H., Gerlach, J., Hirsch, S.R. & Siris, S.G. (2002). Clinical issues related to depression in schizophrenia: an international survey of psychiatrists. Acta Psychiatrica Scandinavian 105, 189195.CrossRefGoogle ScholarPubMed
Barbui, C., D'Avanzo, B., Frattura, L. & Saraceno, B. (1999). QUALYOP Project 2: monitoring the dismantling of Italian psychiatric hospitals. Psychotropic drug use in 1072 inpatients. Pharmacoepidemiology and Drug Safety 8, 331337.3.0.CO;2-H>CrossRefGoogle ScholarPubMed
Barbui, C, Danese, A., Guaiana, G., Mapelli, L., Miele, L., Monzani, E. & Percudani, M. (2002). Prescribing second-generation antipsychotics and the evolving standard of care in Italy. Pharmacopsvchiatry 35, 239243.CrossRefGoogle ScholarPubMed
Basan, A. & Leucht, S. (2004). Valproate for schizophrenia (Cochrane Review). Cochrane Library, Issue 1.Google Scholar
Bellantuono, C, Reggi, V., Rognoni, G. & Muscettola, G. (1981). Comparisons of practice in hospitals and community mental health centers. In Epidemiological Impact of Psychotropic Drugs (ed. Tognoni, G., Bellantuono, C. and Lader, M.). Elsevier: Amsterdam.Google Scholar
Benson, K. & Hartz, A.J. (2000). A comparison of observational studies and randomized, controlled trials. New England Journal of Medicine 342, 18781886.CrossRefGoogle ScholarPubMed
Blanco, C, Laje, G., Olfson, M., Marcus, S.C. & Pincus, H.A. (2002). Trends in the treatment of bipolar disorders by outpatients psychiatrists. American Jurnal of Psychiatry 159, 10051010.CrossRefGoogle Scholar
Botts, S., Hines, H. & Littrell, R. (2003). Antipsychotic polypharmacy in the ambulatory care setting, 1993-2000. Psychiatric Services 54, 10861090.CrossRefGoogle ScholarPubMed
Buchanan, R.W., Kreyenbuhl, J., Zito, J.M. & Lehman, A. (2002). Relationship of the use of adjunctive pharmacological agents to symptoms and level of function in schizophrenia. American Journal of Psychiatry 159, 10351043.CrossRefGoogle Scholar
Castle, D., Morgan, V. & Jablensky, A. (2002). Antipsychotic use in Australia: the patients’ perspective. Australian and New Zealand Journal of Psychiatry 36, 633641.CrossRefGoogle ScholarPubMed
Centorrino, F., Goren, J.L., Hennen, J., Salvatore, P., Kelleher, J.P. & Baldessarini, R.J. (2004). Multiple versus single antipsychotic agents for hospitalized psychiatric patients: case-control study of risks versus benefits. American Journal of Psychiatry 161, 700706.CrossRefGoogle ScholarPubMed
Chong, M., Tan, C.H., Fujii, S., Yang, S., Ungvari, G., Tianmei, S., Chung, E.K., Sim, K., Tsang, H. & Shinfuku, N. (2004). Antipsychotic drug prescription for schizophrenia in East Asia: rationale for change. Psychiatry and Clinical Neuroscience 58, 6167.CrossRefGoogle Scholar
Clark, R.E., Bartels, S.J., Mellman, T.A. & Peacock, W.J. (2002). Recent trends in antipsychotic combination therapy of schizophrenia and schizoaffective disorder: implications for state mental health policy. Schizophrenia Bulletin 28, 7584.CrossRefGoogle ScholarPubMed
Concato, J., Shah, N. & Horwitz, R.I. (2000). Randomized, controlled trials, observational studies, and the hierarchy of research designs. New England Journal of Medicine 342, 18871892.CrossRefGoogle ScholarPubMed
Cosentino, M., Leoni, O., Rispoli, L., Pellegrini, C., Finavera, L., Lecchini, S. & Frigo, G. (1995). A 1- year study of drug prescriptions and adverse drug reactions in psychiatric hospital practice. Pharmacoepidemiology and Drug Safety 5, 377384.3.0.CO;2-F>CrossRefGoogle Scholar
Covell, N.H., Jackson, C.T., Evans, A.C. & Essock, S.M. (2002). Anti-psychotic prescribing practices in Connecticut's public mental health system: rates of changing medications and prescribing styles. Schizophrenia Bulletin 28, 1729.CrossRefGoogle Scholar
Craig, T.J. & Behar, R. (1980). Trends in the prescription of psychotropic drugs (1970-1977) in a state hospital. Comprehensive Psvchiatry 21, 336345.CrossRefGoogle Scholar
de Girolamo, G. & Cappiello, V. (1993). Gli studi di drug-utilization in psichiatria: una review. Rivista di Psichiatria 28, 133142.Google Scholar
de Girolamo, G., Williams, P. & Cappiello, V. (1987) Psychotropic drug utilization and “audit” in two Italian psychiatric services. Psycho-logical Medicine 17, 989997.CrossRefGoogle Scholar
de Girolamo, G., Picardi, A., Micciolo, R., Falloon, I., Fioritti, A. & Morosini, P. for the Italian PROGRES study group (2002). Residential care in Italy: a national survey of non-hospital facilities. British Journal of Psychiatry 181, 220225.CrossRefGoogle Scholar
Escamilla, M.A. (2001). Diagnosis and treatment of mood disorders that co-occur with schizophrenia. Psychiatric Services 52, 911919.CrossRefGoogle ScholarPubMed
Freudenreich, O. & Goff, D.C. (2002). Antipsychotic combination therapy in schizophrenia. A review of efficacy and risks of current combination. Acta Psychiatrica Scandinavica 106, 323330.CrossRefGoogle Scholar
Gruppo Nazionale PROGRES (2001). Le strutture residenziali psichiatriche in Italia. I risultati della fase 1 del progetto PROGRES. Epidemiologia e Psichiatria Sociale 10, 260275.Google Scholar
Harrington, M., Leliott, P., Paton, C, Konsolaki, M., Sensky, T. & Okocha, C. (2002a). Variation between services in polypharmacy and combined high dose of antipsychotic drug prescribed for in-patients. Psychiatric Bulletin 26, 418420.CrossRefGoogle Scholar
Harrington, M., Lelliott, P., Paton, C, Okocha, C, Duffett, R. & Sensky, T. (2002b). The results of a multi-centre audit of the prescribing of antipsychotic drugs for in-patients in the UK. Psychiatric Bulletin 26,414418.CrossRefGoogle Scholar
Kingsbury, S.J., Yi, D. & Simpson, G.M. (2001). Rational and irrational polypharmacy. Psychiatric Services 52, 10331036.CrossRefGoogle ScholarPubMed
Lam, R.W., Peters, R., Sladen-Dew, N. & Altman, S. (1998). A community-based clinic survey of antidepressant use in persons with schizophrenia. Canadian Journal of Psychiatry 43, 513516.CrossRefGoogle ScholarPubMed
Lehman, A.F., Lieberman, J.A., Dixon, L.B., McGIashan, T.H., Miller, A.L., Perkins, D.O. & Kreyenbul, J. (2004). Practice guideline for the treatment of patients with schizophrenia, second edition. Ame-rican Journal of Psychiatry 161, Suppl 2, 156.Google ScholarPubMed
Lelliott, P., Paton, C, Harrington, M., Konsolaki, M., Sensky, T. & Okocha, C. (2002). The influence of patients variables in polypharmacy and combined high dose of antipsychotic drug prescribed for in-patients. Psychiatric Bulletin 26, 411414.CrossRefGoogle Scholar
Levine, J., Chengappa, R., Brar, J.S., Gershon, S., Yablonsky, E., Stapf, D. & Kupfer, D.J. (2000). Psychotropic drug prescription patterns among patiens with bipolar I disorder. Bipolar Disorders 2, 120130.CrossRefGoogle Scholar
Lim, P.Z., Tunis, S.L., Edell, W.S., Jensik, S.E. & Tohen, M. (2001). Medication prescribing patterns for patients with bipolar I disorder in hospital settings: adherence to published practice guidelines. Bipolar Disorders 3, 165173.CrossRefGoogle ScholarPubMed
Lindenmayer, J.P. & Kotsaftis, A. (2000). Use of sodium valproate in violent and aggressive behaviours: a critical review. Journal of Clinical Psychiatry 61, 123128.CrossRefGoogle ScholarPubMed
Martin, A., Van Hoof, T., Stubbe, D., Sherwin, T. & Scahill, L. (2003). Multiple psychotropic pharmacotherapy among child and adolescent enrollees in Connecticut Medicaid Managed Care. Psychiatric Ser-vices 54, 7277.CrossRefGoogle ScholarPubMed
McCue, R.E., Waheed, R. & Urcuyo, L. (2003). Polypharmacy in patients with schizophrenia. Journal of Clinical Psychiatry 64, 984989.CrossRefGoogle ScholarPubMed
Michel, K. & Kolakowska, T. (1981). A survey of prescribing psycho-tropic drugs in two British hospitals. British Journal of Psychiatry 138, 217221.CrossRefGoogle Scholar
Morosini, P.L., Magliano, L., Brambilla, L., Ugolini, S. & Pioli, R. (2000). Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social functioning. Acta Psychiairica Scandinavica 101, 323329.Google ScholarPubMed
Mulholland, C. & Cooper, S. (2000). The symptom of depression in schizophrenia and its management. Advances in Psychiatric Treatment 6, 169177.CrossRefGoogle Scholar
Munizza, C.Tibaldi, G., Bollini, P., Pirfo, E., Punzo, F. & Gramaglia F. (1995). Prescription pattern of antidepressants in out-patient psychiatric practice. Psychological Medicine 25, 771778.CrossRefGoogle Scholar
Muscettola, G., Bollini, P. & Pampallona, S. (1991). Pattern of neuroleptic drug use in Italian mental health services. Pharmacoepidemiology 25, 296301.Google ScholarPubMed
Muscettola, G., Barbato, G., Pampallona, S., Casiello, M. & Bollini P. (1999). Extrapyramidal syndromes in neuroleptic-treated patients: prevalence, risk factors, and association with tardive dyskinesia. Journal of Clinical Psychopharmacology 19, 203208.CrossRefGoogle Scholar
Muscettola, G., Casiello, M., Bollini, P., Sebastiani, G., Pampallona, S. & Tognoni, G. (1987). Pattern of therapeutic intervention and role of psychiatric settings: a survey in 2 regions of Italy. Acta Psychiatrica Scandinavica 75, 5561.CrossRefGoogle Scholar
NICE: National Institute of Clinical Excellence (2002). Clinical Guideline 1. Schizophrenia. Core Interventions in the Treatment and Management of Schizophrenia in Primary and Secondary Care. National Institute of Clinical Excellence: London.Google Scholar
Norusis, M.J. (1998). SPSS for Windows Professional and Advanced Statistics, Release 8.0. SPSS Inc.: Chicago.Google Scholar
Nottested, J.A. & Linaker, O.M. (2003). Psychotropic drug use among people with intellectual disability before and after deinstitutionalization. Journal of Intellectual Disability Research 47, 464471.CrossRefGoogle Scholar
O'Driscoll, C. & Leff, J. (1993). The TAPS Project. 8: Design of the research study on the long-stay patients. British Journal of Psychiatry, Suppl. 19, 1824.Google Scholar
Paton, C, Lelliott, P., Harrington, M., Okocha, C, Sensky, T. & Duffett, R. (2003). Patterns of antipsychotic and anticholinergic prescribing for hospital inpatients. Journal of Psychopharmacology 17, 223229.CrossRefGoogle ScholarPubMed
Percudani, M. & Barbui, C. (2003). Cost and outcome implications of using typical and atypical antipsychotics in ordinary practice in Italy. Journal of Clinical Psychiatry 64, 12931299.CrossRefGoogle ScholarPubMed
Procyshyn, R.M., Kennedy, N.B., Tse, G. & Thompson, B. (2001). Anti-psychotic polypharmacy: a survey of discharge prescriptions from a tertiary care psychiatric institution. Canadian Journal of Psychiatry 46, 334339.CrossRefGoogle Scholar
Ray, J.G. (2002). Evidence in upheaval: incorporating observational data into clinical practice. Archives of Internal Medicine 162, 249254.CrossRefGoogle ScholarPubMed
Rittmannsberger, H. (2002). The use of drug monotherapy in psychiatric inpatient treatment. Progress in Neuro-Psychopharmachology & Biological Psychiatry 26, 547551.CrossRefGoogle ScholarPubMed
Segal, S.P., Cohen, D. & Marder, S.R. (1992). Neuroleptic medication and prescription practices with sheltered-care residents: a 12-year perspective. American Journal of Public Health 82, 846852.CrossRefGoogle ScholarPubMed
Soares, K.V. & McGrath, J.J. (2000). Anticholinergic medication for neuroleptic-induced tardive dyskinesias. Cochrane Library, Issue 2.Google Scholar
Stahl, S.M. (2002a). Antipsychotic polypharmacy: evidence based or eminence based? Acta Psychiatrica Scandinavica 106, 321322.CrossRefGoogle ScholarPubMed
Stahl, S.M. (2002b). Antipsychotic polypharmacy: squandering precious resources? Journal of Clinical Psychiatry 63, 9394.CrossRefGoogle ScholarPubMed
Suzuki, T., Uccida, H., Tanaka, K.F., Nomura, K., Takano, H., Tanabe, A., Watanabe, K., Yagi, G. & Kashima, H. (2204). Revising polypharmacy to a single antipsychotic regimen for patients with chronic schizophrenia. International Journal of Neuropsychopharmacology 7, 110.Google Scholar
Taylor, D., McConnell, D., McConnell, H. & Kerwin, R. (2001). The Maudsley 2001 Prescribing Guidelines. Martin Dunitz: London.Google Scholar
Tibaldi, G., Munizza, C, Bollini, P., Pirfo, E., Punzo, F. & Gramaglia, F. (1997). Utilization of neuroleptic drugs in Italian mental health ser-vices: a survey in Piedmont. Psychiatric Services 48, 213217.Google Scholar
Tognoni, G. (1999). Pharmacoepidemiology of psychotropic drugs in patients with severe mental disorders in Italy. Italian Collaborative Study Group on the Outcome of Severe Mental Disorders. European Journal of Clinical Pharmacology 55, 685690CrossRefGoogle Scholar
Trieman, N. & Leff, J. (2002) Long-term outcome of long-stay psychiatric in-patients considered unsuitable to live in the community. British Journal of Psychiatry 181, 428432.CrossRefGoogle Scholar
Voirol, P., Robert, P.A., Meister, P., Oros, L. & Baumann, P. (1999). Psychotropic drug prescription in a psychiatric university hospital. Pharmacopsychiatry 32, 2937.CrossRefGoogle Scholar
Waddington, J.L., Youssef, H.A. & Kinsella, A. (1998). Mortality in schizophrenia. Antipsychotic polypharmacy and absence of adiunctive anticholinergics over the course of a 10-years prospective study. British Journal of Psychiatry 173, 325329.CrossRefGoogle Scholar
Williams, P., Bellantuono, C, Fiorio, R. & Tansella, M. (1986) Psycho-tropic drugs use in Italy: national trends and regional differences. Psychological Medicine 16, 841850.CrossRefGoogle Scholar
Wilson, W.H., Ban, T.A. & Guy, W. (1985). Pharmacotherapy of chronic hospitalized schizophrenics: prescription practices. Neuropsychobiology 14, 7582.CrossRefGoogle ScholarPubMed
Wing, J.K., Beevor, A.S., Curtis, R.H., Park, S.B., Hadden, S. & Burns, A. (1998). Health of the Nation Outcome Scales (HoNOS). Research and development. British Journal of Psychiatry 172, 1118.CrossRefGoogle ScholarPubMed
Wyosowski, D.K. & Baum, C. (1989). Antipsychotic drug use in the United States, 1976-85. Archives of General Psychiatry 46, 929932.CrossRefGoogle Scholar
Zarate, C.A. & Quiroz, J.A. (2003). Comibination treatment in bipolar disorder: a review of controlled trials. Bipolar Disorders 5, 217225.CrossRefGoogle Scholar
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