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Region Hovedstaden - en del af Københavns Universitetshospital

Antipsychotic polypharmacy: Exploring the gap between evidence and practice

Projekt: Typer af projekterProjekt

  1. Antipsychotic polypharmacy: Exploring the gab between evidence and practise

    Publikation: Bog/antologi/afhandling/rapportPh.d.-afhandling

  2. Evaluation of a multifaceted intervention to limit excessive antipsychotic co-prescribing in schizophrenia out-patients

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  3. Exploring regional variation in antipsychotic coprescribing practice: a Danish questionnaire survey

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  4. Association of antipsychotic polypharmacy with health service cost: a register-based cost analysis

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  5. How dosing might influence the conclusion in an antipsychotic polypharmacy effectiveness trial

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  6. Antipsykotisk polyfarmaci i behandlingen af skizofreni - en medicinsk tekonologivurdering

    Publikation: Bidrag til bog/antologi/rapportBidrag til bog/antologiForskningpeer review

Vis graf over relationer
Antipsychotic polypharmacy (concomitant prescription of more than one antipsychotic drug) is very common
in the treatment of schizophrenia, despite lacking evidence to support this widespread use. An array of possible
combinations exists and only a minority of these has been properly investigated experimentally. The
lack of evidence regarding efficacy, adverse effects and safety is reflected in national and international clinical
guidelines recommending antipsychotic monotherapy as the main treatment regimen with antipsychotic
polypharmacy reserved for treatment resistant patients, who have also failed a trial of clozapine monotherapy
of sufficient dose and duration. Antipsychotic polypharmacy is a complex phenomenon and this thesis
aims to explore some of it’s poorly investigated aspects. Paper 1 is a register-based nested case-control
study investigating the association between treatment with antipsychotic polypharmacy in patients with
schizophrenia and risk of death from natural causes. When controlling for possible confounders including
substance abuse and somatic co-morbidity there was no increased risk of death from natural causes in
schizophrenia patients treated with antipsychotic polypharmacy as compared to monotherapy. A significantly
increased risk of death from natural causes in patients treated with both antipsychotics and long-acting benzodiazepines
was detected, but this finding should be interpreted with caution because of the observational
design of the study. Paper 2 is a national questionnaire survey investigating regional differences in treatment
setting characteristics and in clinician’s beliefs and attitudes towards antipsychotic polypharmacy and clinical
guidelines. Treatment settings with low frequency of antipsychotic co-prescribing were characterized by
raised knowledge/awareness of local antipsychotic treatment guidelines, frequent local educational and research
activities, and perception of a less harassed working environment. This study was also observational
in nature which limited the possibility of drawing causal conclusions. Paper 3 is a quasi-experimental study
investigating the effect of a multifaceted educational intervention aimed at psychiatric health care staff with
reduction in antipsychotic co-prescribing frequency as the primary outcome measure. No effect of the intervention
could be detected, but it was discovered that this negative finding was partly attributable to organizational
structural changes that had taken place during the intervention period. Future studies aiming to improve
prescribing practices should take into account the importance of the organizational context. Due to the
negative outcome of the study, a health economic analysis was considered irrelevant.
FinansieringskildeForskningsråd (Offentlig)
ForskningsprogramSundhedsstyrelsen MTV pulje
Beløb2.000.000,00 Danske Kroner

ID: 32283280