Subscribe to RSS
DOI: 10.1055/a-1321-7866
Antipsychotische Polypharmazie in der Behandlung von Patientinnen und Patienten mit Schizophrenie am Beispiel von neun psychiatrischen Fachkliniken des Landschaftsverbandes Rheinland
Antipsychotic Polypharmacy in the Treatment of Patients with Schizophrenia in Nine Psychiatric Hospitals of the Landschaftsverband Rheinland, Germany![](https://www.thieme-connect.de/media/psychiat-praxis/202105/lookinside/thumbnails/938_10-1055-a-1321-7866-1.jpg)
Zusammenfassung
Hintergrund Für die Behandlung von Menschen mit Schizophrenien wird vorrangig antipsychotische Monotherapie empfohlen. Antipsychotische Polypharmazie (APP) wird dennoch oft eingesetzt und dient als Qualitätsindikator.
Ziel der Arbeit Das Auftreten von APP an 9 psychiatrischen Kliniken des LVR zu untersuchen und die Nutzbarkeit als Qualitätsindikator zu diskutieren.
Material und Methoden Es wurden Behandlungsdaten von stationären und teilstationären Fällen mit der Hauptdiagnose ICD-10 F20.x im Zeitraum 6/2016 bis 6/2017 hinsichtlich der APP-Rate analysiert.
Ergebnisse Bei 6788 Behandlungsfällen wurde eine APP-Rate von 55,5 % ermittelt. Männliches Geschlecht, längere Verweildauer, keine Zwangsunterbringung und der Standort der Klinik waren mit APP assoziiert.
Diskussion Die APP-Rate ist im Vergleich bisherigen Ergebnissen hoch und weist erhebliche Unterschiede zwischen den Kliniken auf. Die Verwendung des Qualitätsindikators APP wird diskutiert.
Abstract
Background Antipsychotics are the cornerstone in the treatment of schizophrenia and are primarily recommended as monotherapy by evidence-based guidelines. Nevertheless, antipsychotic polypharmacy (APP) is prevalent in routine practice and APP is also used as a quality indicator since 2016 in quality management programs.
Objective Based on routine data of nine psychiatric hospitals of the Landschaftsverband Rheinland (LVR)/Germany the prevalence of APP was determined and correlated with factors of routine healthcare in order to monitor the adoption of APP and to discuss its feasibility as a quality indicator.
Materials and Methods All cases with schizophrenia (ICD-10 F20.x; ≥ 18 years) discharged between June 1st, 2016, and June 1st, 2017, (in-patient and day clinic) were extracted from an established research database shared by all nine hospitals and analyzed regarding APP prevalence at the time of discharge.
Results Based on 6,788 cases, the prevalence of APP was 55.5 % with an average of 2.4 antipsychotics (SD = 0.6) administered simultaneously. In multivariate analyses, significant predictors for APP were: gender (male > female), the number of days in hospital (long > short), involuntary treatment (no > yes) and the location of the hospital.
Conclusions We found a high proportion of polypharmacy in inpatient schizophrenia patients and significant differences between hospitals. The use of the results as a quality indicator (criteria ≥ 2 antipsychotics) remains dependent on the background of the individual treatment courses, which cannot be adequately represented by the existing routine data. The LVR has been using the quality indicator of ≥ 3 antipsychotics since 2018, which is discussed as a more appropriate approach for future evaluations.
Schlüsselwörter
antipsychotische Kombinationstherapie - Polypharmazie - Schizophrenie - Versorgungsforschung - QualitätsindikatorKeywords
antipsychotic combination therapy - polypharmacy - schizophrenia - healthcare research - quality indicator- Supplementary material
Zusätzliches Material finden Sie unter:
Publication History
Article published online:
20 January 2021
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
Literatur
- 1 Hasan A, Falkai P, Wobrock T. et al. World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia, part 1: update 2012 on the acute treatment of schizophrenia and the management of treatment resistance. The world journal of biological psychiatry: the official journal of the World Federation of Societies of Biological Psychiatry 2012; 13: 318-378
- 2 DGPPN. S3-Leitlinie Schizophrenie. 2019. Langfassung Version 1.0, zuletzt geändert am 15. März 2019, verfügbar unter: https://www.awmf.org/leitlinien/detail/ll/038-009.html
- 3 Galling B, Vernon JA, Pagsberg AK. et al. Efficacy and safety of antidepressant augmentation of continued antipsychotic treatment in patients with schizophrenia. Acta psychiatrica Scandinavica 2018; 137: 187-205
- 4 Gallego JA, Bonetti J, Zhang JP. et al. Prevalence and correlates of antipsychotic polypharmacy: A systematic review and meta-regression of global and regional trends from the 1970s to 2009. Schizophrenia Research 2012; 138: 18-28
- 5 Galling B, Roldan A, Hagi K. et al. Antipsychotic augmentation vs. monotherapy in schizophrenia: systematic review, meta-analysis and meta-regression analysis. World Psychiatry 2017; 16: 77-89
- 6 Messer T, Schmauss M. Polypharmazie in der Behandlung psychischer Erkrankungen. Wien, New York: Springer; 2006
- 7 Fleischhacker WW, Heikkinen ME, Olie JP. et al. Effects of adjunctive treatment with aripiprazole on body weight and clinical efficacy in schizophrenia patients treated with clozapine: a randomized, double-blind, placebo-controlled trial. The international journal of neuropsychopharmacology/official scientific journal of the Collegium Internationale Neuropsychopharmacologicum (CINP) 2010; 13: 1115-1125
- 8 Benkert O, Hippius H. Kompendium der psychiatrischen Pharmakotherapie. Berlin, New York, Heidelberg: Springer; 2015
- 9 Leucht S, Leucht C, Huhn M. et al. Sixty Years of Placebo-Controlled Antipsychotic Drug Trials in Acute Schizophrenia: Systematic Review, Bayesian Meta-Analysis, and Meta-Regression of Efficacy Predictors. AJ Psychiatry 2017; 174: 927-942
- 10 Schmidt-Kraepelin C, Puschner B, Loos S. et al. Antipsychotische Polypharmazie bei Patienten mit Schizophrenie und hoher Versorgungsinanspruchnahme. Psychiat Prax 2013; 40: 380-384
- 11 Assion HJ, Schweppe A, Reinbold H. et al. Pharmacological treatment for schizoaffective disorder: A comparison with schizophrenia and bipolar disorder. Der Nervenarzt 2019; 90: 1-8
- 12 Toto S, Grohmann R, Bleich S. et al. Psychopharmacological Treatment of Schizophrenia Over Time in 30 908 Inpatients: Data From the AMSP Study. Int J Neuropsychoph 2019; 22: 560-573
- 13 Janssen B, Weinmann S, Berger M. et al. Validation of Polypharmacy Process Measures in Inpatient Schizophrenia Care. Schizophrenia Bull 2004; 30: 1023-1033
- 14 Lehmann I, Engemann S, Zielasek J. et al. Regionale Entwicklung und Implementierung von Qualitätsindikatoren für die stationäre psychiatrisch-psychotherapeutische Versorgung. Berlin: Deutscher Kongress für Versorgungsforschung (DKVF); 2018
- 15 Großimlinghaus I. Evidenzbasierte sektorübergreifende Qualitätsindikatoren sind praktikabel – Pro. Psychiat Prax 2018; 45: 62-63
- 16 Landschaftsverband Rheinland. Steckbrief Klinikverbund. LVR; 2018. https://www.lvr.de/media/wwwlvrde/klinikhph/klinikverbund/dokumente_132/Steckbrief_Klinikverbund.pdf Abrufdatum 04.10.2019
- 17 Correll CU, Gallego JA. Antipsychotic polypharmacy: a comprehensive evaluation of relevant correlates of a long-standing clinical practice. Psychiatr Clin North Am 2012; 35: 661-681
- 18 Correll CU, Rummel-Kluge C, Corves C. et al. Antipsychotic combinations vs monotherapy in schizophrenia: a meta-analysis of randomized controlled trials. Schizophrenia Bull 2009; 35: 443-457
- 19 Tiihonen J, Mittendorfer-Rutz E, Majak M. et al. Real-World Effectiveness of Antipsychotic Treatments in a Nationwide Cohort of 29823 Patients With Schizophrenia. JAMA psychiatry 2017; 74: 686-693
- 20 Matsui K, Tokumasu T, Takekita Y. et al. Switching to antipsychotic monotherapy vs. staying on antipsychotic polypharmacy in schizophrenia: A systematic review and meta-analysis. Schizophr Res 2019; 209: 50-57
- 21 Schmidt-Kraepelin C, Feyerabend S, Engelke C. et al. A randomized double-blind controlled trial to assess the benefits of amisulpride and olanzapine combination treatment versus each monotherapy in acutely ill schizophrenia patients (COMBINE): methods and design. Eur Arch Psychiatry Clin Neurosci 2019; DOI: 10.1007/s00406-019-01063-4.