Antipsychotic polypharmacy and adverse drug reactions among adults in a London mental health service, 2008–2018
Antipsychotic polypharmacy (APP) occurs commonly but it is unclear whether it is associated with an increased risk of adverse drug reactions (ADRs). Electronic health records (EHRs) offer an opportunity to examine APP using real-world data. In this study, we use EHR data to identify periods when pat...
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| Veröffentlicht in: | Psychological medicine 2023-07, Vol.53 (9), p.4220-4227 |
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| creator | Yang, Justin C. Thygesen, Johan H. Werbeloff, Nomi Hayes, Joseph F. Osborn, David P. J. |
| description | Antipsychotic polypharmacy (APP) occurs commonly but it is unclear whether it is associated with an increased risk of adverse drug reactions (ADRs). Electronic health records (EHRs) offer an opportunity to examine APP using real-world data. In this study, we use EHR data to identify periods when patients were prescribed 2 + antipsychotics and compare these with periods of antipsychotic monotherapy. To determine the relationship between APP and subsequent instances of ADRs: QT interval prolongation, hyperprolactinaemia, and increased body weight [body mass index (BMI) ⩾ 25].
We extracted anonymised EHR data. Patients aged 16 + receiving antipsychotic medication at Camden & Islington NHS Foundation Trust between 1 January 2008 and 31 December 2018 were included. Multilevel mixed-effects logistic regression models were used to elucidate the relationship between APP and the subsequent presence of QT interval prolongation, hyperprolactinaemia, and/or increased BMI following a period of APP within 7, 30, or 180 days respectively.
We identified 35 409 observations of antipsychotic prescribing among 13 391 patients. Compared with antipsychotic monotherapy, APP was associated with a subsequent increased risk of hyperprolactinaemia (adjusted odds ratio 2.46; 95% CI 1.87-3.24) and of registering a BMI > 25 (adjusted odds ratio 1.75; 95% CI 1.33-2.31) in the period following the APP prescribing.
Our observations suggest that APP should be carefully managed with attention to hyperprolactinaemia and obesity. |
| doi_str_mv | 10.1017/S0033291722000952 |
| format | Article |
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We extracted anonymised EHR data. Patients aged 16 + receiving antipsychotic medication at Camden & Islington NHS Foundation Trust between 1 January 2008 and 31 December 2018 were included. Multilevel mixed-effects logistic regression models were used to elucidate the relationship between APP and the subsequent presence of QT interval prolongation, hyperprolactinaemia, and/or increased BMI following a period of APP within 7, 30, or 180 days respectively.
We identified 35 409 observations of antipsychotic prescribing among 13 391 patients. Compared with antipsychotic monotherapy, APP was associated with a subsequent increased risk of hyperprolactinaemia (adjusted odds ratio 2.46; 95% CI 1.87-3.24) and of registering a BMI > 25 (adjusted odds ratio 1.75; 95% CI 1.33-2.31) in the period following the APP prescribing.
Our observations suggest that APP should be carefully managed with attention to hyperprolactinaemia and obesity.</description><identifier>ISSN: 0033-2917</identifier><identifier>EISSN: 1469-8978</identifier><identifier>DOI: 10.1017/S0033291722000952</identifier><identifier>PMID: 35485715</identifier><language>eng</language><publisher>Cambridge, UK: Cambridge University Press</publisher><subject>Adult ; Antipsychotic Agents - adverse effects ; Antipsychotics ; Body mass index ; Body weight ; Clinical outcomes ; Computerized medical records ; Critical incidents ; Drug-Related Side Effects and Adverse Reactions - epidemiology ; Electronic health records ; Electronic medical records ; Health records ; Health services ; Humans ; Hyperprolactinemia ; Hyperprolactinemia - chemically induced ; Hyperprolactinemia - drug therapy ; London ; Mental disorders ; Mental health ; Mental Health Services ; Natural language processing ; Obesity ; Original ; Original Article ; Polypharmacy ; Prescribing ; Prescription drugs ; Psychotropic drugs ; Regression analysis</subject><ispartof>Psychological medicine, 2023-07, Vol.53 (9), p.4220-4227</ispartof><rights>Copyright © The Author(s), 2022. Published by Cambridge University Press</rights><rights>Copyright © The Author(s), 2022. Published by Cambridge University Press. This work is licensed under the Creative Commons Attribution License https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>The Author(s) 2022 2022 The Author(s)</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c424t-6b9d41054f6751be945fbd60ff49f3a225175ab2a214aa0a5e24d369317239be3</cites><orcidid>0000-0002-5485-615X ; 0000-0002-7479-3459 ; 0000-0003-2286-3862 ; 0000-0003-2881-4906 ; 0000-0003-2519-1539</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.cambridge.org/core/product/identifier/S0033291722000952/type/journal_article$$EHTML$$P50$$Gcambridge$$Hfree_for_read</linktohtml><link.rule.ids>164,230,314,780,784,885,12846,27924,27925,30999,55628</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35485715$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yang, Justin C.</creatorcontrib><creatorcontrib>Thygesen, Johan H.</creatorcontrib><creatorcontrib>Werbeloff, Nomi</creatorcontrib><creatorcontrib>Hayes, Joseph F.</creatorcontrib><creatorcontrib>Osborn, David P. J.</creatorcontrib><title>Antipsychotic polypharmacy and adverse drug reactions among adults in a London mental health service, 2008–2018</title><title>Psychological medicine</title><addtitle>Psychol. Med</addtitle><description>Antipsychotic polypharmacy (APP) occurs commonly but it is unclear whether it is associated with an increased risk of adverse drug reactions (ADRs). Electronic health records (EHRs) offer an opportunity to examine APP using real-world data. In this study, we use EHR data to identify periods when patients were prescribed 2 + antipsychotics and compare these with periods of antipsychotic monotherapy. To determine the relationship between APP and subsequent instances of ADRs: QT interval prolongation, hyperprolactinaemia, and increased body weight [body mass index (BMI) ⩾ 25].
We extracted anonymised EHR data. Patients aged 16 + receiving antipsychotic medication at Camden & Islington NHS Foundation Trust between 1 January 2008 and 31 December 2018 were included. Multilevel mixed-effects logistic regression models were used to elucidate the relationship between APP and the subsequent presence of QT interval prolongation, hyperprolactinaemia, and/or increased BMI following a period of APP within 7, 30, or 180 days respectively.
We identified 35 409 observations of antipsychotic prescribing among 13 391 patients. Compared with antipsychotic monotherapy, APP was associated with a subsequent increased risk of hyperprolactinaemia (adjusted odds ratio 2.46; 95% CI 1.87-3.24) and of registering a BMI > 25 (adjusted odds ratio 1.75; 95% CI 1.33-2.31) in the period following the APP prescribing.
Our observations suggest that APP should be carefully managed with attention to hyperprolactinaemia and obesity.</description><subject>Adult</subject><subject>Antipsychotic Agents - adverse effects</subject><subject>Antipsychotics</subject><subject>Body mass index</subject><subject>Body weight</subject><subject>Clinical outcomes</subject><subject>Computerized medical records</subject><subject>Critical incidents</subject><subject>Drug-Related Side Effects and Adverse Reactions - epidemiology</subject><subject>Electronic health records</subject><subject>Electronic medical records</subject><subject>Health records</subject><subject>Health services</subject><subject>Humans</subject><subject>Hyperprolactinemia</subject><subject>Hyperprolactinemia - chemically induced</subject><subject>Hyperprolactinemia - drug therapy</subject><subject>London</subject><subject>Mental disorders</subject><subject>Mental health</subject><subject>Mental Health Services</subject><subject>Natural language processing</subject><subject>Obesity</subject><subject>Original</subject><subject>Original Article</subject><subject>Polypharmacy</subject><subject>Prescribing</subject><subject>Prescription drugs</subject><subject>Psychotropic drugs</subject><subject>Regression analysis</subject><issn>0033-2917</issn><issn>1469-8978</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>IKXGN</sourceid><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp1kc1u1DAUhS0EokPhAdggS2xYEPBvEq9QVfEnjcQCWFs3tjNxldipnYw0u74Db8iT4FGH8idWXpxzP99zD0JPKXlFCW1efyaEc6ZowxghREl2D22oqFXVqqa9jzZHuTrqZ-hRzleEUE4Fe4jOuBStbKjcoOuLsPg5H8wQF2_wHMfDPECawBwwBIvB7l3KDtu07nByYBYfQ8YwxbAr4jouGfuAAW9jsDHgyYUFRjw4GJcBZ5f23riXuOzXfr_5xghtH6MHPYzZPTm95-jru7dfLj9U20_vP15ebCsjmFiqulNWUCJFXzeSdk4J2Xe2Jn0vVM-BMUkbCR0DRgUAAemYsLxWvFyDq87xc_Tmljuv3eSsKYslGPWc_ATpoCN4_acS_KB3ca8pKYyWskJ4cSKkeL26vOjJZ-PGEYKLa9asli3jJZkq1ud_Wa_imkLJp1nLGVOkbURx0VuXSTHn5Pq7bSjRx0b1P42WmWe_x7ib-FlhMfATFKYuebtzv_7-P_YHl1mrTw</recordid><startdate>20230701</startdate><enddate>20230701</enddate><creator>Yang, Justin C.</creator><creator>Thygesen, Johan H.</creator><creator>Werbeloff, Nomi</creator><creator>Hayes, Joseph F.</creator><creator>Osborn, David P. 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J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c424t-6b9d41054f6751be945fbd60ff49f3a225175ab2a214aa0a5e24d369317239be3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adult</topic><topic>Antipsychotic Agents - adverse effects</topic><topic>Antipsychotics</topic><topic>Body mass index</topic><topic>Body weight</topic><topic>Clinical outcomes</topic><topic>Computerized medical records</topic><topic>Critical incidents</topic><topic>Drug-Related Side Effects and Adverse Reactions - epidemiology</topic><topic>Electronic health records</topic><topic>Electronic medical records</topic><topic>Health records</topic><topic>Health services</topic><topic>Humans</topic><topic>Hyperprolactinemia</topic><topic>Hyperprolactinemia - chemically induced</topic><topic>Hyperprolactinemia - drug therapy</topic><topic>London</topic><topic>Mental disorders</topic><topic>Mental health</topic><topic>Mental Health Services</topic><topic>Natural language processing</topic><topic>Obesity</topic><topic>Original</topic><topic>Original Article</topic><topic>Polypharmacy</topic><topic>Prescribing</topic><topic>Prescription drugs</topic><topic>Psychotropic drugs</topic><topic>Regression analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yang, Justin C.</creatorcontrib><creatorcontrib>Thygesen, Johan H.</creatorcontrib><creatorcontrib>Werbeloff, Nomi</creatorcontrib><creatorcontrib>Hayes, Joseph F.</creatorcontrib><creatorcontrib>Osborn, David P. 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J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Antipsychotic polypharmacy and adverse drug reactions among adults in a London mental health service, 2008–2018</atitle><jtitle>Psychological medicine</jtitle><addtitle>Psychol. Med</addtitle><date>2023-07-01</date><risdate>2023</risdate><volume>53</volume><issue>9</issue><spage>4220</spage><epage>4227</epage><pages>4220-4227</pages><issn>0033-2917</issn><eissn>1469-8978</eissn><abstract>Antipsychotic polypharmacy (APP) occurs commonly but it is unclear whether it is associated with an increased risk of adverse drug reactions (ADRs). Electronic health records (EHRs) offer an opportunity to examine APP using real-world data. In this study, we use EHR data to identify periods when patients were prescribed 2 + antipsychotics and compare these with periods of antipsychotic monotherapy. To determine the relationship between APP and subsequent instances of ADRs: QT interval prolongation, hyperprolactinaemia, and increased body weight [body mass index (BMI) ⩾ 25].
We extracted anonymised EHR data. Patients aged 16 + receiving antipsychotic medication at Camden & Islington NHS Foundation Trust between 1 January 2008 and 31 December 2018 were included. Multilevel mixed-effects logistic regression models were used to elucidate the relationship between APP and the subsequent presence of QT interval prolongation, hyperprolactinaemia, and/or increased BMI following a period of APP within 7, 30, or 180 days respectively.
We identified 35 409 observations of antipsychotic prescribing among 13 391 patients. Compared with antipsychotic monotherapy, APP was associated with a subsequent increased risk of hyperprolactinaemia (adjusted odds ratio 2.46; 95% CI 1.87-3.24) and of registering a BMI > 25 (adjusted odds ratio 1.75; 95% CI 1.33-2.31) in the period following the APP prescribing.
Our observations suggest that APP should be carefully managed with attention to hyperprolactinaemia and obesity.</abstract><cop>Cambridge, UK</cop><pub>Cambridge University Press</pub><pmid>35485715</pmid><doi>10.1017/S0033291722000952</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-5485-615X</orcidid><orcidid>https://orcid.org/0000-0002-7479-3459</orcidid><orcidid>https://orcid.org/0000-0003-2286-3862</orcidid><orcidid>https://orcid.org/0000-0003-2881-4906</orcidid><orcidid>https://orcid.org/0000-0003-2519-1539</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Psychological medicine, 2023-07, Vol.53 (9), p.4220-4227 |
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| source | MEDLINE; Applied Social Sciences Index & Abstracts (ASSIA); Cambridge University Press Journals Complete |
| subjects | Adult Antipsychotic Agents - adverse effects Antipsychotics Body mass index Body weight Clinical outcomes Computerized medical records Critical incidents Drug-Related Side Effects and Adverse Reactions - epidemiology Electronic health records Electronic medical records Health records Health services Humans Hyperprolactinemia Hyperprolactinemia - chemically induced Hyperprolactinemia - drug therapy London Mental disorders Mental health Mental Health Services Natural language processing Obesity Original Original Article Polypharmacy Prescribing Prescription drugs Psychotropic drugs Regression analysis |
| title | Antipsychotic polypharmacy and adverse drug reactions among adults in a London mental health service, 2008–2018 |
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