No abstract available.
Anticonvulsants* ; Drug Therapy* ; Polypharmacy*

Background: Polypharmacy has been linked to multiple undesirable effects notably medication, non-compliance and adverse drug reactions. Objective: This case-control study aimed to determine the association between polypharmacy and dementia among Filipino elderly patients in a tertiary care hospital in Metro Manila, Philippines. Methods: The average daily use of medications was compared between cases and controls composed of admitted Filipino elderly patients with and without dementia, respectively, while controlling for co-morbidities and sociodemographic factors. Data collection was accomplished by obtaining relevant information from medical records. These underwent descriptive statistical analysis, chi-square test, and logistic regression. The odds ratio between dementia and polypharmacy was ultimately determined, among other variables. Results: The incidence of polypharmacy is 12.6% greater in those with diagnosed dementia vis-à-vis those without. Although multivariate logistic regression analysis showed that the odds ratio of dementia was 1.474 (95% CI 0.834–2.604) for those considered to experience polypharmacy compared to patients using four or less drugs, none of the variables identified, including polypharmacy, have p-values of less than 0.05. Conclusion The risk of developing dementia does not have a statistically significant association with the number of regularly administered medications in the Filipino elderly. Other variables also revealed no significant correlation on both bivariate and multivariate analyses. This may be the first study to report such an absence of association, particularly in the Philippines, and thus calls for further research and investigation on this subject.
Polypharmacy ; Dementia ; Case-Control Studies

OBJECTIVE: Patterns of clinical use of antipsychotics have changed greatly in the past decade. The authors' goal was to examine these patterns in an inpatient unit at a university hospital between 1997, 2003-2004, and 2009-2010. METHODS: We evaluated medication use in inpatients treated with antipsychotic drugs during 2009-2010 (n=379) and compared the results with inpatients treated with antipsychotics in 2003-2004 (n=379) and inpatients treated with antipsychotics in 1997 (n=165). RESULTS: The distribution of psychiatric diagnoses in 2009-2010 was different from that in 2003-2004 and 1997. The proportion of patients with schizophrenia spectrum disorders was higher in 2009-2010 (p=0.013, p<0.001). An atypical agent was prescribed for 98.7% (n=374) of patients in 2009-2010. This represents a significant proportional increase over both 2003-2004 (93.7%, n=355; p<0.001) and 1997 (57.6%, n=95; p<0.001). In 2009-2010 the number of patients receiving prescriptions of two or more antipsychotics in combination was 16.1% (n=61), which represents a significant proportional increase over 2003-2004 (9.0%, n=34; p=0.007) and 1997 (4.8%, n=8; p=0.001). CONCLUSION: The present study demonstrates that atypical antipsychotic medications have replaced typical antipsychotic medications. Polypharmacy increased markedly despite limited empirical evidence of cost-risk-benefit relationships.
Antipsychotic Agents ; Humans ; Inpatients ; Polypharmacy ; Prescriptions ; Schizophrenia

Background: Quality of Life (QoL) is an indicator of an elderly patient’s health status in achieving optimum care. However, no available local studies focused on QoL in elderly patients with polypharmacy. Better knowledge on this may help healthcare practitioners design and modify interventions that will suit elderly patients’ needs to improve both care and well-being. This study examined the QoL of elderly patients with polypharmacy and evaluated its relationship with demographic and clinical profile. Methods: A descriptive cross-sectional study was done among 333 elderly patients with polypharmacy seen at Region 1 Medical Center-Family and Community Medicine Out-Patient Department (R1MC-FCM OPD) from January to June 2019 using a self-administered EuroQoL-5 Dimension 5-Level (EQ-5D-5L) questionnaire to elicit the domains of QoL. The following statistical tests were utilized: Frequency count and percentage for analyzing gathered data; Spearman’s rank correlation for determining correlation between ordinal and continuous variables; and Mann-Whitney U and Kruskal-Wallis H tests for comparison of mean ranks. All analyses were performed using SPSS version 25. Results: Majority of the respondents were 60-69 years old (59.5%), female (55.3%), married (65.5%), attained at least elementary level education (38%), diagnosed with two illnesses (53%), taking four medications (65.5%) with an average monthly income below Php 10,000.00 (82.6%). Most of the respondents reported “no problems” in all five dimensions of EQ-5D-5L; however, decrease in usual activities (49.8%), pain (49.5%), and mobility (39%) were noted to be the common problems. Lower EQ-5D index and EQ-Visual Analogue Scale (EQ-VAS) scores were observed among respondents aged 80-90 years old, attained at least elementary level education, with three diagnosed illnesses, taking more than four medications, suffering mild cognitive impairment, partially dependent on activities in daily living, and mildly depressed (p <0.05). Conclusion The quality of life was reduced in the ageing population with low educational attainment, polypharmacy, multimorbidity, functional incapacity, cognitive impairment, and emotional problem.
Quality of Life ; Polypharmacy ; Outpatients ; Tertiary Care Centers

INTRODUCTIONPolypharmacy is very common in the psychiatric setting despite the lack of evidence to justify its use. The objective of this study was to review the prescription patterns in a tertiary mental health institute in Asia and evaluate the impact of a treatment algorithm for patients with first-episode psychosis (FEP) on the use of polypharmacy.

MATERIALS AND METHODSA treatment algorithm was implemented for patients accepted into an Early Psychosis Intervention Programme (EPIP) and the prescription patterns of these patients were compared with a comparator group (pre-EPIP) before the use of the algorithm. The prescribing pattern was established at 2 points: at baseline after the diagnosis was made, and 3 months later.

RESULTSThere were 68 subjects in the comparator group and 483 EPIP patients; the latter were on the average younger. None in the comparator group was diagnosed to have an affective psychosis. There was a significant reduction in the rate of antipsychotic polypharmacy, prolonged use of benzodiazepines and anticholinergic medication in EPIP patients. This group also had an increase in the use of second-generation antipsychotics and received lower doses of antipsychotics.

CONCLUSIONThe implementation of a treatment algorithm coupled with audit has changed the trend towards polypharmacy among patients with FEP.

Adult ; Algorithms ; Antipsychotic Agents ; administration & dosage ; Female ; Humans ; Male ; Polypharmacy ; Psychotic Disorders ; drug therapy

The author reviews general principles and guidelines regarding the drug treatment of geriatric depression. Older depressed patients are more prone to drug adverse reactions and drug-drug interactions than younger patients because of pharmacokinetic and pharmacodynamic changes resulting from age-related physiological changes, physical illnesses, polypharmacy, and various other factors. Therefore, a careful evaluation for physical illnesses and drugs needed to be made before strating antidepressant medication and "start low, go slow" dosing principle should be kept in mind. All classes of antidepressants available for younger depressed patients could be used for the geriatric patients. Choice of specific antidepressant drugs depend on potential adverse reactions and interactions of each agent, subtype or severity of depression, and comorbid diseases, such as stroke, dementia, Parkinson's disease, and heart disease. ECT must be also considered for antidepressant-resistant severe geraitric depression.
Antidepressive Agents ; Dementia ; Depression* ; Heart Diseases ; Humans ; Parkinson Disease ; Polypharmacy ; Stroke

Multimorbidity is one of the common clinical characteristics in older patients and its occurrence rises with age. With the increase of older population, physicians should know the clinical significance of multimorbidity in managing older patients. Multimorbidity focuses on the findings of multiple diseases in a single patient and interactions between diseases and a patient. It has been reported that the prevalence of multimorbidity is over 50% in elderly people and co-occurrence of certain chronic diseases is often observed in patients with multimorbidity. Multimorbidity is significantly associated with higher mortality, increased disability, impaired quality of life, and increased medical costs. Unfortunately, current guidelines do not address enough for older patients with multimorbidity. Simple and fragmented approach for multiple medical conditions in older patients may lead to many clinical problems including polypharmacy, iatrogenic events, and increased medical cost. Accordingly, comprehensive geriatric assessment and multidimensional approach for this population should be encouraged.
Adult* ; Aged ; Chronic Disease ; Geriatric Assessment ; Humans ; Mortality ; Polypharmacy ; Prevalence ; Quality of Life

PURPOSE: Patients with epilepsy experience the impairment of Quality of life (QOL). The objective of this study was to investigate the 'Quality of Life' in epileptic patients and the influences of clinical factors upon QOL in epileptic patients. METHODS: Total 138 epileptic patients (male : 77, female : 61) were recruited for the study. The Quality of Life in Epilepsy (QOLIE)-89 was applied to evaluate QOL in epileptic patients. We gathered data about clinical variables (seizure type, frequency, duration of disease, number of antiepileptic drug, and depression) and socio-demographic variables (age, sex, marriage, employment, and education), and compared each variables in use of QOLIE-89 score. RESULTS: Depression influenced negatively the most of all subscales (16 of 20 subscales) and overall score (p<0.01), and was the most significant inverse predictor of QOL in patients with epilepsy. Patients who were seizure-free in the past year reported better QOL than those with seizure-doing (p<0.05). Patients with polypharmacy showed lower scores at overall QOL, health discouragement, language, and overall score than those with monopharmacy (p<0.05). Male showed lower score than female at the scale of sexual relation (p<0.05), but higher scores at scales of health perception, overall health, and physical health (p<0.05). Highly-educated group (> or =16 year) had higher score at overall score and emotional well-being (p<0.05). However, age, marital state, employment, seizure type, and duration of disease did not affect QOL significantly. CONCLUSIONS: Sex, education, number of AEDs, depression, and seizure free state were major socio-clinical factors affecting QOL in patients with epilepsy. It is suggested that physician should recognize these factors and manage appropriately for improving the QOL.
Depression ; Education ; Employment ; Epilepsy ; Female ; Humans ; Male ; Marriage ; Polypharmacy ; Quality of Life* ; Seizures ; Weights and Measures

BACKGROUND: Although the poor short-term outcome of antiepileptic drug (AED) treatment may represent long-term AED refractoriness in general, the same hypothesis in temporal lobe epilepsy (TLE) has yet to come up as an important subject to be investigated. We examined to decide early drug intractability and aid treatment plan. METHODS: From a prospective patient cohort of Yonsei Epilepsy Clinic, 121 newly-referred TLE patients were selected to participate in this study. First, we divided the patients into two groups according to their second one-year remission at two year of AED treatment. One group was the remission group (RG) and the other was the non-remission group (NRG). Second, we evaluated clinical characteristics influencing remission between the two groups. RESULTS: Nineteen patients (15.7%) were RG whereas 102 (84.3%) were NRG. The six month remission and terminal remission at the first year of AED treatment and the first one year remission rate in patients with RG was significantly higher than those with NRG (P<0.05). In patients with NRG, the number of complex partial seizures and secondary generalized seizures, the annual frequency of secondary generalized seizures prior to AED treatment, polypharmacy, new drug use, and drug side effects were significantly higher (p<0.05) than RG. CONCLUSIONS: The earlier seizure outcome may influence the later prognosis of AED treatment in non-lesional TLE. The prognosis during the second year of AED treatment is influenced by drug treatment and the number of generalized seizures.
Anticonvulsants ; Cohort Studies ; Epilepsy ; Epilepsy, Temporal Lobe* ; Humans ; Polypharmacy ; Prognosis* ; Prospective Studies ; Seizures ; Temporal Lobe*

OBJECTIVE: Although antipsychotic polypharmacy is widely used in the pharmacotherapy of schizophrenia, its effectiveness is controversial. In particular, clinicians tend to avoid switching to monotherapy in patients who have been prescribed polypharmacy. In the present study, the authors investigate whether there is difference in time to discontinuation of antipsychotics between patients on previous monotherapy or polypharmacy. METHODS: Pooled analysis was conducted on two 24-week, multicenter, open-label, non-comparative studies that were originally designed to investigate the effectiveness of switching to paliperidone extended-release (ER) in patients with schizophrenia. Patients were divided into two groups according to previously prescribed antipsychotics, that is, to a polypharmacy group or a monotherapy group. The primary outcome measure was time to discontinuation of paliperidone ER. In addition, the authors sought to identify clinical variables that influence time to discontinuation. RESULTS: Before switching to paliperidone ER, 535 of 673 (79.5%) patients were prescribed antipsychotic monotherapy, and the remaining 138 (20.5%) patients were prescribed antipsychotic polypharmacy. No significant differences in time to discontinuation of paliperidone ER were observed between the polypharmacy and monotherapy groups. Personal and social performance scale score was the only factor found to influence time to discontinuation of paliperidone ER. No differences in psychopathology or adverse effects were found between the monotherapy and polypharmacy groups. CONCLUSION: Our results suggest that number of antipsychotics prescribed before switching to monotherapy does not influence clinical prognosis in patients with schizophrenia.
Antipsychotic Agents ; Drug Therapy ; Humans ; Outcome Assessment (Health Care) ; Polypharmacy* ; Prognosis ; Psychopathology ; Schizophrenia ; Treatment Outcome