TY - JOUR
T1 - Reducing psychotropic pharmacotherapy in patients with severe mental illness
T2 - a cluster-randomized controlled intervention study
AU - Hjorth, Peter
AU - Kilian, Reinhold
AU - Sørensen, Helle Østermark
AU - Eriksen, Susan Engelbrechsen
AU - Davidsen, Annette Sofie
AU - Jensen, Signe Olrik Wallenstein
AU - Munk-Jørgensen, Povl
PY - 2015/4
Y1 - 2015/4
N2 - BACKGROUND: Many patients with mental illness receive psychotropic medicine in high dosages and from more than one drug. One of the consequences of this practice is obesity, which is a contributing factor to increased physical morbidity and premature death.METHODS: Our study was a cluster-randomized intervention study involving 6 facilities and 174 patients diagnosed with severe mental illnesses (73% schizophrenia). The intervention period was 12 months and consisted of teaching sessions with the staff and evaluating the patients' intake of psychotropic medication. At index, 44% met criteria for obesity and 76% met criteria for overweight. Waist circumferences were 108 cm for men and 108 cm for women. Olanzapine, clozapine and quetiapine were the most common prescribed antipsychotics. Mean values of daily doses of antipsychotic were 2.5.RESULTS: The intervention showed no significant differences between the intervention and control group regarding psychotropic treatment. At follow up, independent of intervention, patients receiving antipsychotic polypharmacy had a larger waist circumference compared with patients receiving antipsychotic monotherapy of 9.8 cm (1.5-18.1) (p = 0.028).DISCUSSION AND CONCLUSION: We found both a high prevalence of obesity and that the patients received treatment with antipsychotic polypharmaceutics in high dosages. Active awareness did not change practice and we must think of other ways to restrict treatment with psychotropics in this group of patients.
AB - BACKGROUND: Many patients with mental illness receive psychotropic medicine in high dosages and from more than one drug. One of the consequences of this practice is obesity, which is a contributing factor to increased physical morbidity and premature death.METHODS: Our study was a cluster-randomized intervention study involving 6 facilities and 174 patients diagnosed with severe mental illnesses (73% schizophrenia). The intervention period was 12 months and consisted of teaching sessions with the staff and evaluating the patients' intake of psychotropic medication. At index, 44% met criteria for obesity and 76% met criteria for overweight. Waist circumferences were 108 cm for men and 108 cm for women. Olanzapine, clozapine and quetiapine were the most common prescribed antipsychotics. Mean values of daily doses of antipsychotic were 2.5.RESULTS: The intervention showed no significant differences between the intervention and control group regarding psychotropic treatment. At follow up, independent of intervention, patients receiving antipsychotic polypharmacy had a larger waist circumference compared with patients receiving antipsychotic monotherapy of 9.8 cm (1.5-18.1) (p = 0.028).DISCUSSION AND CONCLUSION: We found both a high prevalence of obesity and that the patients received treatment with antipsychotic polypharmaceutics in high dosages. Active awareness did not change practice and we must think of other ways to restrict treatment with psychotropics in this group of patients.
KW - cluster randomized intervention
KW - mental illness
KW - obesity
KW - psychotropic polypharmacy
U2 - 10.1177/2045125314565361
DO - 10.1177/2045125314565361
M3 - Journal article
C2 - 26240746
SN - 2045-1253
VL - 5
SP - 67
EP - 75
JO - Therapeutic Advances in Psychopharmacology
JF - Therapeutic Advances in Psychopharmacology
IS - 2
ER -