Medication Management in Mental Health

Abstract

Despite advances in clinical and mechanistic understanding, pharmacotherapy used in the management of some people with psychosis remains suboptimal – the unjustified use of poly antipsychotic prescribing (PAP) is a salient example. The aim of this thesis was to investigate the current antipsychotics prescribing trends in the hospital and community settings and to capture data on polypharmacy (PAP), and how these overlap with medicines for more general somatic medical conditions. To achieve these objectives, 4 sub-studies were designed and conducted. Olanzapine was the most commonly used oral antipsychotic across hospital and community settings. For patients receiving long-acting (depot) injectable (LAI) antipsychotics, risperidone long-acting injectable (RLAI) was most commonly prescribed. PAP was found to be more prevalent in the hospital setting rather than in the community, 33.8% vs. 16.9%, respectively. However, when prescribers were asked to estimate the prevalence of PAP among the patients they cared for, their responses varied widely with the highest reported PAP being up to 80%. Generally, clinicians who reported treating 30% and more of their patients with PAP were found to be more likely to have less number of years of experience in the mental health sector, treat more adult inpatients, and reported perceiving PAP as a practice that is supported to some extent by evidence from the literature. However, it was also found in this thesis that PAP was significantly associated to cardiometabolic unwanted effects, which may explain to some extent the minimal support that PAP receives in literature. In conclusion, the incidence of poly antipsychotic prescribing was found to be relatively high in both hospital and community settings with common sets of co-prescribed agents. Similar trends are evident in literature with a general sense that most poly antipsychotic prescribing is not supported by guidelines or evidence of efficacy and safety.