Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-20T10:54:52.140Z Has data issue: false hasContentIssue false
  • English
  • Français

Correlates of major medication side effects interfering with daily performance: results from a cross-sectional cohort study of older psychiatric patients

Published online by Cambridge University Press:  28 September 2015

Marit Tveito ,
Christoph U. Correll ,
Jørgen G. Bramness ,
Knut Engedal ,
Bernhard Lorentzen ,
Helge Refsum  and
Gudrun Høiseth
Marit Tveito*
Affiliation:
Department of Geriatric Psychiatry, Diakonhjemmet Hospital, Oslo, Norway Institute of Clinical Medicine, University of Oslo, Oslo, Norway
Christoph U. Correll
Affiliation:
Department of Psychiatry, The Zucker Hillside Hospital, North Shore - Long Island Jewish Health System, Glen Oaks, NY, USA
Jørgen G. Bramness
Affiliation:
Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
Knut Engedal
Affiliation:
Norwegian Advisory Unit for Aging and Health, Vestfold Hospital Trust, Norway
Bernhard Lorentzen
Affiliation:
Department of Geriatric Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
Helge Refsum
Affiliation:
Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway
Gudrun Høiseth
Affiliation:
Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway Division of Forensic Sciences, Norwegian Institute of Public Health, Oslo, Norway
*
Correspondence should be addressed to: Marit Tveito, Department of Geriatric Psychiatry, Diakonhjemmet Hospital, PO Box 85 Vinderen, 0319 Oslo, Norway. Phone: +4722458500; Fax: +4722458501. Email: [email protected].
Get access

Abstract

Background:

Polypharmacy is common among older persons who are also vulnerable to side effects. We aimed to characterize patients who on admission to a geriatric psychiatric hospital had major medication side effects interfering with daily performance.

Methods:

Cross-sectional cohort study of patients consecutively admitted to a geriatric psychiatric hospital from 2006, 06 December to 2008, 24 October. The UKU side effect rating scale was performed, and patients were divided into those with no/minor side effects versus those with major side effects. Blood levels of 56 psychotropic drugs and 27 safety laboratory tests were measured upon admission.

Results:

Of 206 patients included in the analysis, 70 (34%) had major side effects related to drug treatment. The most frequent side effects were asthenia (31%), reduced salivation (31%), concentration difficulties (28%), memory impairment (24%), and orthostatic dizziness (18%). The significant characteristics predicting major side effects were female gender (OR = 2.4, 95% confidence interval (CI) = 1.1–5.5), main diagnosis of affective disorder (OR = 4.3, 95% CI = 1.5–12.3), unreported use of psychotropic medications (OR = 2.0, 95% CI = 1.0–4.1), a higher number of reported psychotropic medications (OR = 1.7, 95% CI = 1.2–2.3), a higher number of reported medications for somatic disorders (OR = 1.2, 95% CI = 1.1–1.5), and a higher score on the Charlson comorbidity index (OR = 1.2, 95% CI = 1.0–1.4) (r2 = 0.238, p < 0.001).

Conclusions:

Clinicians should be especially aware of side effects related to drug treatment in geriatric psychiatric female patients with a high use of psychotropic and other medications and somatic comorbidity. Unreported use of psychotropic medications was also related to the risk for side effects, and clinicians should make an effort to ascertain all medications taken by geriatric psychiatric patients.

Keywords

drug useelderlygeriatric psychiatryside effects
Type
Research Article
Information
International Psychogeriatrics , Volume 28 , Issue 2 , February 2016 , pp. 331 - 340
Copyright
Copyright © International Psychogeriatric Association 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alexopoulos, G. S., Streim, J., Carpenter, D., Docherty, J. P. and Expert Consensus Panel for Using Antipsychotic Drugs in Older Patients. (2004). Using antipsychotic agents in older patients. The Journal of Clinical Psychiatry, 65 (Suppl. 2), 5–99; discussion 100–102; quiz 103–104.Google Scholar
Allard, P., Gram, L., Timdahl, K., Behnke, K., Hanson, M. and Sogaard, J. (2004). Efficacy and tolerability of venlafaxine in geriatric outpatients with major depression: a double-blind, randomised 6-month comparative trial with citalopram. International Journal of Geriatric Psychiatry, 19, 1123–1130.CrossRefGoogle ScholarPubMed
Barbui, C. et al. (2005). Sex differences in the subjective tolerability of antipsychotic drugs. Journal of Clinical Psychopharmacol, 25, 521–526.CrossRefGoogle ScholarPubMed
Bonelli, R. M. et al. (2005). The influence of psychotropic drugs on cerebral cell death: female neurovulnerability to antipsychotics. International Clinical Psychopharmacology, 20, 145–149.Google Scholar
Charlson, M. E., Pompei, P., Ales, K. L. and MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases, 40, 373–383.CrossRefGoogle ScholarPubMed
Drayer, R. A. et al. (2005). Somatic symptoms of depression in elderly patients with medical comorbidities. International Journal of Geriatric Psychiatry, 20, 973–982.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.Google Scholar
Gandhi, T. K. et al. (2000). Drug complications in outpatients. Journal of General Internal Medicine, 15, 149–154.Google Scholar
Gurwitz, J. H. et al. (2003). Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA, 289, 1107–1116.Google Scholar
Haack, S., Seeringer, A., Thurmann, P. A., Becker, T. and Kirchheiner, J. (2009). Sex-specific differences in side effects of psychotropic drugs: genes or gender? Pharmacogenomics, 10, 1511–1526.Google Scholar
Hefner, G. et al. (2015). Side effects related to potentially inappropriate medications in elderly psychiatric patients under everyday pharmacotherapy. European Journal of Clinical Pharmacology, 71, 165–172.Google Scholar
Jyrkka, J., Enlund, H., Korhonen, M. J., Sulkava, R. and Hartikainen, S. (2009). Patterns of drug use and factors associated with polypharmacy and excessive polypharmacy in elderly persons: results of the Kuopio 75+ study: a cross-sectional analysis. Drugs Aging, 26, 493–503.Google Scholar
Kobayashi, Y. et al. (2011). Charlson comorbidity index is an independent prognostic factor among elderly patients with diffuse large B-cell lymphoma. Journal of Cancer Research and Clinical Oncology, 137, 1079–1084.Google Scholar
Konrat, C., Boutron, I., Trinquart, L., Auleley, G. R., Ricordeau, P. and Ravaud, P. (2012). Underrepresentation of elderly people in randomised controlled trials. The example of trials of 4 widely prescribed drugs. PLoS One, 7, e33559.CrossRefGoogle ScholarPubMed
Kurzthaler, I. et al. (2001). Risk profile of SSrIs in elderly depressive patients with co-morbid physical illness. Pharmacopsychiatry, 34, 114–118.Google Scholar
Lingjaerde, O., Ahlfors, U. G., Bech, P., Dencker, S. J. and Elgen, K. (1987). The UKU side effect rating scale. A new comprehensive rating scale for psychotropic drugs and a cross-sectional study of side effects in neuroleptic-treated patients. Acta Psychiatrica Scandinavica Supplementum, 334, 1–100.Google Scholar
Lovheim, H., Sandman, P. O., Kallin, K., Karlsson, S. and Gustafson, Y. (2008). Symptoms of mental health and psychotropic drug use among old people in geriatric care, changes between 1982 and 2000. International Journal of Geriatric Psychiatry, 23, 289–294.Google Scholar
Madhusoodanan, S. and Bogunovic, O. J. (2004). Safety of benzodiazepines in the geriatric population. Expert Opinion on Drug Safety, 3, 485–493.Google Scholar
Maher, R. L., Hanlon, J. and Hajjar, E. R. (2014). Clinical consequences of polypharmacy in elderly. Expert Opinion on Drug Safety, 13, 57–65.CrossRefGoogle ScholarPubMed
Mangoni, A. A. and Jackson, S. H. (2004). Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. British Journal of Clinical Pharmacology, 57, 6–14.CrossRefGoogle ScholarPubMed
Masand, P. S. (2000). Side effects of antipsychotics in the elderly. The Journal of Clinical Psychiatry, 61 (Suppl. 8), 43–49; discussion 50–41.Google ScholarPubMed
McMurdo, M. E., Witham, M. D. and Gillespie, N. D. (2005). Including older people in clinical research. BMJ, 331, 1036–1037.Google Scholar
Mihanovic, M., Bodor, D., Kezic, S., Restek-Petrovic, B. and Silic, A. (2009). Differential diagnosis of psychotropic side effects and symptoms and signs of psychiatric disorders. Psychiatria Danubina, 21, 570–574.Google Scholar
Mottram, P., Wilson, K. and Strobl, J. (2006). Antidepressants for depressed elderly. The Cochrane Database of Systematic of Reviews, CD003491.Google Scholar
Olfson, M., King, M. and Schoenbaum, M. (2015). Benzodiazepine use in the United States. JAMA Psychiatry, 72, 136–142.CrossRefGoogle ScholarPubMed
Rademaker, M. (2001). Do women have more adverse drug reactions? American Journal of Clinical Dermatology, 2, 349–351.Google Scholar
Shah, B. M. and Hajjar, E. R. (2012). Polypharmacy, adverse drug reactions, and geriatric syndromes. Clinics in Geriatric Medicine, 28, 173–186.Google Scholar
Trifiro, G. and Spina, E. (2011). Age-related changes in pharmacodynamics: focus on drugs acting on central nervous and cardiovascular systems. Current Drug Metabolism, 12, 611–620.CrossRefGoogle ScholarPubMed
Turnheim, K. (2004). Drug therapy in the elderly. Experimental Gerontology, 39, 1731–1738.Google Scholar
Tveito, M., Bramness, J. G., Engedal, K., Lorentzen, B., Refsum, H. and Hoiseth, G. (2014). Psychotropic medication in geriatric psychiatric patients: use and unreported use in relation to serum concentrations. European Journal of Clinical Pharmacology, 70, 1139–1145.Google Scholar
Uchida, H., Mamo, D. C., Mulsant, B. H., Pollock, B. G. and Kapur, S. (2009). Increased antipsychotic sensitivity in elderly patients: evidence and mechanisms. The Journal of Clinical Psychiatry, 70, 397–405.CrossRefGoogle ScholarPubMed
Waade, R. B., Molden, E., Refsum, H. and Hermann, M. (2012). Serum concentrations of antidepressants in the elderly. Therapeutic Drug Monitoring, 34, 25–30.Google Scholar