期刊
SCHIZOPHRENIA RESEARCH
卷 174, 期 1-3, 页码 106-112出版社
ELSEVIER
DOI: 10.1016/j.schres.2016.04.010
关键词
Antipsychotic polypharmacy; Predictors; Service use; Clinical symptoms; Socio-demographic; Socioeconomic
类别
资金
- Clinical Records Interactive Search (CRIS) system
- Guy's and St Thomas' Charity
- Maudsley Charity [BRC-2011-10035]
- Medical Research Council (MRC) Population Health Scientist Fellowship [MR/J01219X/1]
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust
- King's College London
- Medical Research Council [MR/L017105/1, MR/J01219X/1] Funding Source: researchfish
- MRC [MR/L017105/1, MR/L011794/1, MR/J01219X/1] Funding Source: UKRI
Introduction: The predictors of long-term antipsychotic polypharmacy (APP) initiation are poorly understood. Existing research has been hampered by residual confounding, failure to exclude cross-titration, and difficulties in separating the timing of predictors and APP administration. Materials and methods: Using data from the South London and Maudsley (SLaM) case register, we identified all adult patients with serious mental illness (SMI) who were receiving care between 1st July 2011 and 30th June 2012. Exposures measured between 1st July and 31st December 2011 included socio-demographic, socioeconomic, clinical and service use characteristics. We then determined if long-term APP (six or more months) had been initiated between 1st January and 30th June 2012. Multivariable logistic regression models, adjusted for socio-demographic and socioeconomic factors, were built to investigate the associations between the above factors and the initiation of long-term APP. Results: We identified 6857 adults with SMI receiving SLaM care, of whom 115 (1.7%) were newly prescribed long-term APP. In the adjusted models, predictors of long-term APP initiation included: symptoms (severity of hallucinations and/or delusions), previous treatments (clozapine and long-acting injectable antipsychotic agents), service use (more contact with outpatient services, community treatment order receipt), social factors (higher area-level deprivation, homelessness) and socio-demographic status (younger age, not in a relationship). Conclusion: Our findings highlight that certain patient groups are at an increased risk for long-termAPP initiation. Identifying these groups earlier in their treatment could encourage clinicians to employ a broader range of interventions in addition to pharmacotherapy to reduce the risk of APP prescribing. (C) 2016 The Authors. Published by Elsevier B.V.
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