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ANZJP Correspondence patient a partner in treatment, the doctor emphasises and reinforces the patient’s strengths as a person instead of his weakness in a dependent, sick role, thus opening up the door for more flexible, appropriate, responsive and responsible drug therapy’ (Gutheil, 1982). Changes in treatment approaches can thus be embraced rather than feared.
Funding
References
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Gutheil TG (1982) The psychology of psycho pharmacology. Bulletin of the Menninger Clinic 46: 321–330. Swoskin MH (2001) Psychoanalysis and medication. Bulletin of the Menninger Clinic 65: 143–159. Winer JA and Andriukaitis SM (1989) Interpersonal aspects of initiating pharmacotherapy. Psychiatric Annals 19: 318–323.
Antipsychotic polypharmacy at admission predicts extended length of stay among state hospital inpatients Jeffrey R Lacasse
and severity level across gender. However, some patients in this sample had originally been committed for forensic reasons, then transferred to civil commitment. This raises the questions of whether APP was being prescribed to men more frequently for real or perceived dangerousness or whether APP was being used because these men were substantially more chronic and symptomatic, although it is difficult to find evidence for this in the data. In attempting to explain the association between APP and length of stay, it could be posited that in extended hospitalizations, clinicians reluctantly resort to APP in an effort to get the patient discharged. Supporting this hypothesis, there were 21 patients (23.9%) prescribed APP after a length of stay of >1 year. However, most patients who received APP were either admitted to the unit already on multiple antipsychotics or had APP initiated at admission (n=52, 59.1%), with an additional 15 patients (17.0%) placed on APP within 6 months. Those prescribed APP at admission had (mean±SD) 76.6±31.0% inpatient days on APP. Thus while APP in a minority of these cases could be interpreted as a response to a lengthy hospitalization, in the majority of cases APP was prescribed early and often continuously. In this sample, APP was often prescribed early in treatment but was associated with longer hospitalizations. Some patients were admitted
Florida State University, Tallahassee, USA Corresponding author: Jeffrey R Lacasse, College of Social Work, 296 Champions Drive, Tallahassee, FL, 323062570, USA. Email: [email protected] DOI: 10.1177/0004867414535674
To the Editor Antipsychotic polypharmacy (APP) is prevalent (Gallego et al., 2012) but undesirable (e.g. Waddington et al., 1998) in the treatment of psychotic disorders. With institutional review board approval, I utilized administrative and clinical records to examine APP among 246 consecutively admitted inpatients at a state hospital in the southeastern USA. Using a definition of ≥2 antipsychotics prescribed ≥60 days continuously, 35.8% (n=88) received APP. Male gender was associated with an increased risk of APP (OR 2.9, 95% CI 1.6–5.4), as was length of stay in years (OR 1.5, 95% CI 1.3–1.9). An association between male gender and APP has been previously documented (Gallego et al., 2012). In the present dataset, there were only minor differences in clinical history
Declaration of interest The author reports no conflicts of interest. The author alone is responsible for the content and writing of the paper.
on a regimen of APP, but continuing this rather than shifting to monotherapy may represent a missed clinical opportunity, as inpatient hospitalization is an ideal setting for major medication changes. The possibility that APP results in high dosing (Gallego et al., 2012) thus impairing functional recovery (Wunderlink et al., 2013) and potentially extending hospitalization should be considered in future research. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Declaration of interest The author reports no conflicts of interest.The author alone is responsible for the content and writing of the paper.
References Gallego JA, Bonetti J, Zhang J, et al. (2012) Prevalence and correlates of antipsychotic polypharmacy: A systematic review and metaregression of global and regional trends from the 1970s to 2009. Schizophrenia Research 138: 18–28. Waddington JL, Youssef HA and Kinsella A (1998) Mortality in schizophrenia: Antipsychotic polypharmacy and absence of adjunctive anticholingerics over the course of a 10-year prospective study. British Journal of Psychiatry 173: 325–329. Wunderlink L, Nieboer RM, Wiersma D, et al. (2013) Recovery in remitted first-episode psychosis at 7 years of follow-up of an early dose reduction/discontinuation or maintenance treatment strategy: long-term followup of a 2-year randomized clinical trial. JAMA Psychiatry 70: 913–920.
Australian & New Zealand Journal of Psychiatry, 48(11)
Downloaded from anp.sagepub.com at University of Birmingham on June 9, 2015
ANZJP Correspondence patient a partner in treatment, the doctor emphasises and reinforces the patient’s strengths as a person instead of his weakness in a dependent, sick role, thus opening up the door for more flexible, appropriate, responsive and responsible drug therapy’ (Gutheil, 1982). Changes in treatment approaches can thus be embraced rather than feared.
Funding
References
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Gutheil TG (1982) The psychology of psycho pharmacology. Bulletin of the Menninger Clinic 46: 321–330. Swoskin MH (2001) Psychoanalysis and medication. Bulletin of the Menninger Clinic 65: 143–159. Winer JA and Andriukaitis SM (1989) Interpersonal aspects of initiating pharmacotherapy. Psychiatric Annals 19: 318–323.
Antipsychotic polypharmacy at admission predicts extended length of stay among state hospital inpatients Jeffrey R Lacasse
and severity level across gender. However, some patients in this sample had originally been committed for forensic reasons, then transferred to civil commitment. This raises the questions of whether APP was being prescribed to men more frequently for real or perceived dangerousness or whether APP was being used because these men were substantially more chronic and symptomatic, although it is difficult to find evidence for this in the data. In attempting to explain the association between APP and length of stay, it could be posited that in extended hospitalizations, clinicians reluctantly resort to APP in an effort to get the patient discharged. Supporting this hypothesis, there were 21 patients (23.9%) prescribed APP after a length of stay of >1 year. However, most patients who received APP were either admitted to the unit already on multiple antipsychotics or had APP initiated at admission (n=52, 59.1%), with an additional 15 patients (17.0%) placed on APP within 6 months. Those prescribed APP at admission had (mean±SD) 76.6±31.0% inpatient days on APP. Thus while APP in a minority of these cases could be interpreted as a response to a lengthy hospitalization, in the majority of cases APP was prescribed early and often continuously. In this sample, APP was often prescribed early in treatment but was associated with longer hospitalizations. Some patients were admitted
Florida State University, Tallahassee, USA Corresponding author: Jeffrey R Lacasse, College of Social Work, 296 Champions Drive, Tallahassee, FL, 323062570, USA. Email: [email protected] DOI: 10.1177/0004867414535674
To the Editor Antipsychotic polypharmacy (APP) is prevalent (Gallego et al., 2012) but undesirable (e.g. Waddington et al., 1998) in the treatment of psychotic disorders. With institutional review board approval, I utilized administrative and clinical records to examine APP among 246 consecutively admitted inpatients at a state hospital in the southeastern USA. Using a definition of ≥2 antipsychotics prescribed ≥60 days continuously, 35.8% (n=88) received APP. Male gender was associated with an increased risk of APP (OR 2.9, 95% CI 1.6–5.4), as was length of stay in years (OR 1.5, 95% CI 1.3–1.9). An association between male gender and APP has been previously documented (Gallego et al., 2012). In the present dataset, there were only minor differences in clinical history
Declaration of interest The author reports no conflicts of interest. The author alone is responsible for the content and writing of the paper.
on a regimen of APP, but continuing this rather than shifting to monotherapy may represent a missed clinical opportunity, as inpatient hospitalization is an ideal setting for major medication changes. The possibility that APP results in high dosing (Gallego et al., 2012) thus impairing functional recovery (Wunderlink et al., 2013) and potentially extending hospitalization should be considered in future research. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Declaration of interest The author reports no conflicts of interest.The author alone is responsible for the content and writing of the paper.
References Gallego JA, Bonetti J, Zhang J, et al. (2012) Prevalence and correlates of antipsychotic polypharmacy: A systematic review and metaregression of global and regional trends from the 1970s to 2009. Schizophrenia Research 138: 18–28. Waddington JL, Youssef HA and Kinsella A (1998) Mortality in schizophrenia: Antipsychotic polypharmacy and absence of adjunctive anticholingerics over the course of a 10-year prospective study. British Journal of Psychiatry 173: 325–329. Wunderlink L, Nieboer RM, Wiersma D, et al. (2013) Recovery in remitted first-episode psychosis at 7 years of follow-up of an early dose reduction/discontinuation or maintenance treatment strategy: long-term followup of a 2-year randomized clinical trial. JAMA Psychiatry 70: 913–920.
Australian & New Zealand Journal of Psychiatry, 48(11)
Downloaded from anp.sagepub.com at University of Birmingham on June 9, 2015
