Changes in medication practices for hospitalized psychiatric patients: 2009 versus 2004
Version of Record online: 1 MAR 2010
Copyright © 2010 John Wiley & Sons, Ltd.
Human Psychopharmacology: Clinical and Experimental
Volume 25, Issue 2, pages 179–186, March 2010
How to Cite
Centorrino, F., Ventriglio, A., Vincenti, A., Talamo, A. and Baldessarini, R. J. (2010), Changes in medication practices for hospitalized psychiatric patients: 2009 versus 2004. Hum. Psychopharmacol. Clin. Exp., 25: 179–186. doi: 10.1002/hup.1095
- Issue online: 1 MAR 2010
- Version of Record online: 1 MAR 2010
- Manuscript Accepted: 9 DEC 2009
- Manuscript Received: 1 OCT 2009
We tested the hypothesis that combinations and total daily doses of psychotropics for hospitalized patients diagnosed with major psychiatric disorders are rising.
We evaluated McLean Hospital records of 481 consecutive inpatients with DSM-IV schizophrenia, schizoaffective, or bipolar disorders in 2004 (n = 278) or 2009 (n = 203) to compare characteristics and treatments.
In 2009, Clinical Global Impression (CGI)-severity scores were 6% lower at intake and improved 1.7 times more than in 2004, as hospitalization-length decreased by 12%. Polytherapy (≥ 2 psychotropics) increased in 2009 (affective or schizoaffective disorders > schizophrenia). Total psychotropics/patient (3.1–3.2) remained stable but mood-stabilizers/patient increased markedly and antipsychotics/patient decreased somewhat in 2009. Antipsychotic-choice (2009) ranked: quetiapine, aripiprazole, risperidone, and others; mood-stabilizers ranked: lamotrigine, valproate, lithium, and others (1/4 off-label). In 2009, final total antipsychotic doses (mg/day) increased by 97%, and mood-stabilizers by 75%. Adverse-effect rates fell by half. Factors differing independently for 2009 versus 2004 ranked: (a) more CGI improvement, (b) more mood-stabilizers/patient, (c) lower admission CGI scores, and (c) higher total antipsychotic dose.
Combinations and doses of antipsychotic and mood-stabilizing drugs for inpatients increased markedly (2004 vs. 2009) without consistent correspondence of agents/person and doses, without apparent increase in major adverse effects, and with possibly superior clinical improvement. Copyright © 2010 John Wiley & Sons, Ltd.