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Abstract

Objective:

Although U.K. and international guidelines recommend monotherapy, antipsychotic polypharmacy among patients with serious mental illness is common in clinical practice. However, empirical evidence on its effectiveness is scarce. Therefore, the authors estimated the effectiveness of antipsychotic polypharmacy relative to monotherapy in terms of health care utilization and mortality.

Methods:

Primary care data from Clinical Practice Research Datalink, hospital data from Hospital Episode Statistics, and mortality data from the Office of National Statistics were linked to compile a cohort of patients with serious mental illness in England from 2000 to 2014. The antipsychotic prescribing profile of 17,255 adults who had at least one antipsychotic drug record during the period of observation was constructed from primary care medication records. Survival analysis models were estimated to identify the effect of antipsychotic polypharmacy on the time to first occurrence of each of three outcomes: unplanned hospital admissions (all cause), emergency department (ED) visits, and mortality.

Results:

Relative to monotherapy, antipsychotic polypharmacy was not associated with increased risk of unplanned hospital admission (hazard ratio [HR]=1.14; 95% confidence interval [CI]=0.98–1.32), ED visit (HR=0.95; 95% CI=0.80–1.14), or death (HR=1.02; 95% CI=0.76–1.37). Relative to not receiving antipsychotic medication, monotherapy was associated with a reduced hazard of unplanned admissions to the hospital and ED visits, but it had no effect on mortality.

Conclusions:

The study results support current guidelines for antipsychotic monotherapy in routine clinical practice. However, they also suggest that when clinicians have deemed antipsychotic polypharmacy necessary, health care utilization and mortality are not affected.

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Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services

Cover: XXXX

Psychiatric Services
Pages: 650 - 656
PubMed: 31109263

History

Received: 7 November 2018
Revision received: 1 February 2019
Accepted: 21 March 2019
Published online: 21 May 2019
Published in print: August 01, 2019

Keywords

  1. Antipsychotic medication
  2. Antipsychotics
  3. Drug interactions
  4. Polypharmacy
  5. Serious mental illness

Authors

Details

Panagiotis Kasteridis, Ph.D. [email protected]
Centre for Health Economics (Kasteridis, Ride, Gutacker, Goddard, Gravelle, Mason, Rice, Jacobs) and Department of Health Sciences (Doran, Gilbody, Siddiqi), University of York, York, England; Hull York Medical School, York, England (Aylott, Gilbody, Siddiqi); Primary Care and Population Sciences, University of Southampton, Southampton, England (Kendrick); Clinical Practice Research Datalink-Medicines and Healthcare Products Regulatory Agency, London (Williams). Mental health services consultant, York, United Kingdom (Dare).
Jemimah Ride, Ph.D.
Centre for Health Economics (Kasteridis, Ride, Gutacker, Goddard, Gravelle, Mason, Rice, Jacobs) and Department of Health Sciences (Doran, Gilbody, Siddiqi), University of York, York, England; Hull York Medical School, York, England (Aylott, Gilbody, Siddiqi); Primary Care and Population Sciences, University of Southampton, Southampton, England (Kendrick); Clinical Practice Research Datalink-Medicines and Healthcare Products Regulatory Agency, London (Williams). Mental health services consultant, York, United Kingdom (Dare).
Nils Gutacker, Ph.D.
Centre for Health Economics (Kasteridis, Ride, Gutacker, Goddard, Gravelle, Mason, Rice, Jacobs) and Department of Health Sciences (Doran, Gilbody, Siddiqi), University of York, York, England; Hull York Medical School, York, England (Aylott, Gilbody, Siddiqi); Primary Care and Population Sciences, University of Southampton, Southampton, England (Kendrick); Clinical Practice Research Datalink-Medicines and Healthcare Products Regulatory Agency, London (Williams). Mental health services consultant, York, United Kingdom (Dare).
Lauren Aylott, B.Sc.
Centre for Health Economics (Kasteridis, Ride, Gutacker, Goddard, Gravelle, Mason, Rice, Jacobs) and Department of Health Sciences (Doran, Gilbody, Siddiqi), University of York, York, England; Hull York Medical School, York, England (Aylott, Gilbody, Siddiqi); Primary Care and Population Sciences, University of Southampton, Southampton, England (Kendrick); Clinical Practice Research Datalink-Medicines and Healthcare Products Regulatory Agency, London (Williams). Mental health services consultant, York, United Kingdom (Dare).
Ceri Dare, M.P.H.
Centre for Health Economics (Kasteridis, Ride, Gutacker, Goddard, Gravelle, Mason, Rice, Jacobs) and Department of Health Sciences (Doran, Gilbody, Siddiqi), University of York, York, England; Hull York Medical School, York, England (Aylott, Gilbody, Siddiqi); Primary Care and Population Sciences, University of Southampton, Southampton, England (Kendrick); Clinical Practice Research Datalink-Medicines and Healthcare Products Regulatory Agency, London (Williams). Mental health services consultant, York, United Kingdom (Dare).
Tim Doran, M.D.
Centre for Health Economics (Kasteridis, Ride, Gutacker, Goddard, Gravelle, Mason, Rice, Jacobs) and Department of Health Sciences (Doran, Gilbody, Siddiqi), University of York, York, England; Hull York Medical School, York, England (Aylott, Gilbody, Siddiqi); Primary Care and Population Sciences, University of Southampton, Southampton, England (Kendrick); Clinical Practice Research Datalink-Medicines and Healthcare Products Regulatory Agency, London (Williams). Mental health services consultant, York, United Kingdom (Dare).
Simon Gilbody, Ph.D.
Centre for Health Economics (Kasteridis, Ride, Gutacker, Goddard, Gravelle, Mason, Rice, Jacobs) and Department of Health Sciences (Doran, Gilbody, Siddiqi), University of York, York, England; Hull York Medical School, York, England (Aylott, Gilbody, Siddiqi); Primary Care and Population Sciences, University of Southampton, Southampton, England (Kendrick); Clinical Practice Research Datalink-Medicines and Healthcare Products Regulatory Agency, London (Williams). Mental health services consultant, York, United Kingdom (Dare).
Maria Goddard, M.Sc.
Centre for Health Economics (Kasteridis, Ride, Gutacker, Goddard, Gravelle, Mason, Rice, Jacobs) and Department of Health Sciences (Doran, Gilbody, Siddiqi), University of York, York, England; Hull York Medical School, York, England (Aylott, Gilbody, Siddiqi); Primary Care and Population Sciences, University of Southampton, Southampton, England (Kendrick); Clinical Practice Research Datalink-Medicines and Healthcare Products Regulatory Agency, London (Williams). Mental health services consultant, York, United Kingdom (Dare).
Hugh Gravelle, Ph.D.
Centre for Health Economics (Kasteridis, Ride, Gutacker, Goddard, Gravelle, Mason, Rice, Jacobs) and Department of Health Sciences (Doran, Gilbody, Siddiqi), University of York, York, England; Hull York Medical School, York, England (Aylott, Gilbody, Siddiqi); Primary Care and Population Sciences, University of Southampton, Southampton, England (Kendrick); Clinical Practice Research Datalink-Medicines and Healthcare Products Regulatory Agency, London (Williams). Mental health services consultant, York, United Kingdom (Dare).
Tony Kendrick, M.D., F.R.C.G.P.
Centre for Health Economics (Kasteridis, Ride, Gutacker, Goddard, Gravelle, Mason, Rice, Jacobs) and Department of Health Sciences (Doran, Gilbody, Siddiqi), University of York, York, England; Hull York Medical School, York, England (Aylott, Gilbody, Siddiqi); Primary Care and Population Sciences, University of Southampton, Southampton, England (Kendrick); Clinical Practice Research Datalink-Medicines and Healthcare Products Regulatory Agency, London (Williams). Mental health services consultant, York, United Kingdom (Dare).
Anne Mason, B.A., M.A.
Centre for Health Economics (Kasteridis, Ride, Gutacker, Goddard, Gravelle, Mason, Rice, Jacobs) and Department of Health Sciences (Doran, Gilbody, Siddiqi), University of York, York, England; Hull York Medical School, York, England (Aylott, Gilbody, Siddiqi); Primary Care and Population Sciences, University of Southampton, Southampton, England (Kendrick); Clinical Practice Research Datalink-Medicines and Healthcare Products Regulatory Agency, London (Williams). Mental health services consultant, York, United Kingdom (Dare).
Nigel Rice, Ph.D.
Centre for Health Economics (Kasteridis, Ride, Gutacker, Goddard, Gravelle, Mason, Rice, Jacobs) and Department of Health Sciences (Doran, Gilbody, Siddiqi), University of York, York, England; Hull York Medical School, York, England (Aylott, Gilbody, Siddiqi); Primary Care and Population Sciences, University of Southampton, Southampton, England (Kendrick); Clinical Practice Research Datalink-Medicines and Healthcare Products Regulatory Agency, London (Williams). Mental health services consultant, York, United Kingdom (Dare).
Najma Siddiqi, Ph.D.
Centre for Health Economics (Kasteridis, Ride, Gutacker, Goddard, Gravelle, Mason, Rice, Jacobs) and Department of Health Sciences (Doran, Gilbody, Siddiqi), University of York, York, England; Hull York Medical School, York, England (Aylott, Gilbody, Siddiqi); Primary Care and Population Sciences, University of Southampton, Southampton, England (Kendrick); Clinical Practice Research Datalink-Medicines and Healthcare Products Regulatory Agency, London (Williams). Mental health services consultant, York, United Kingdom (Dare).
Rachael Williams, Ph.D.
Centre for Health Economics (Kasteridis, Ride, Gutacker, Goddard, Gravelle, Mason, Rice, Jacobs) and Department of Health Sciences (Doran, Gilbody, Siddiqi), University of York, York, England; Hull York Medical School, York, England (Aylott, Gilbody, Siddiqi); Primary Care and Population Sciences, University of Southampton, Southampton, England (Kendrick); Clinical Practice Research Datalink-Medicines and Healthcare Products Regulatory Agency, London (Williams). Mental health services consultant, York, United Kingdom (Dare).
Rowena Jacobs, Ph.D.
Centre for Health Economics (Kasteridis, Ride, Gutacker, Goddard, Gravelle, Mason, Rice, Jacobs) and Department of Health Sciences (Doran, Gilbody, Siddiqi), University of York, York, England; Hull York Medical School, York, England (Aylott, Gilbody, Siddiqi); Primary Care and Population Sciences, University of Southampton, Southampton, England (Kendrick); Clinical Practice Research Datalink-Medicines and Healthcare Products Regulatory Agency, London (Williams). Mental health services consultant, York, United Kingdom (Dare).

Notes

Send correspondence to Dr. Kasteridis ([email protected]).

Competing Interests

The authors report no financial relationships with commercial interests.

Funding Information

Health Services and Delivery Research Programmehttp://dx.doi.org/10.13039/501100002001: 13/54/40

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