Prevalence of Psychotropic Drugs in Cases of Severe Adverse Drug Reactions Leading to Unplanned Emergency Visits in General Hospitals

Abstract

Introduction The prevalence of psychotropic drug use in our society is increasing especially in older adults, thereby provoking severe adverse drug reactions (ADR). To identify specific patient risk profiles associated with psychotropic drug use in the situation of polymedication.

Methods Cases of ADRs in general emergency departments (ED) collected within the multi-center prospective observational study (ADRED) were analyzed (n=2215). We compared cases with use of psychotropic drugs and without concerning their clinical presentation at the ED.

Results A third of patients (n=731, 33%) presenting to the ED with an ADR took at least 1 psychotropic drug. Patients with psychotropic drug use tended to be older, more often female, and took a higher number of drugs (all p<0.001). The frequency of falls was almost 3 times higher than compared to the non-psychotropic drug group (10.5 vs. 3.9%, p<0.001), and similar syncope was also more often seen in the psychotropic drug users (8.8 vs. 5.5%, p=0.004). The use of psychotropic drugs increased the risk for falls by a factor of 2.82 (OR, 95% CI (1.90–4.18)), when adjusting for gender, age, numbers of pre-existing diseases, and drugs, respectively.

Discussion The association of psychotropic drug use with fall and syncope in combination with polymedication and older age leads to the suspicion that psychotropic drugs might be potentially harmful in specific risk populations such as older adults. It may lead us to thoroughly weigh the benefit against risk in a patient-oriented way, leading to an integrative personalized therapy approach.

Key words

psychopharmacology - adverse drug reaction - emergency - older adults

• References

• 1 Wolf IK, Du Y, Knopf H. Changes in prevalence of psychotropic drug use and alcohol consumption among the elderly in Germany: results of two National Health Interview and Examination Surveys 1997-99 and 2008-11. BMC Psychiatry 2017; 17: 90
• 2 Du Y, Wolf IK, Busch MA. et al. Associations between the use of specific psychotropic drugs and all-cause mortality among older adults in Germany: results of the mortality follow-up of the German National Health Interview and Examination Survey 1998. PloS One 2019; 14: e0210695
• 3 Peterson JF, Kuperman GJ, Shek C. et al. Guided prescription of psychotropic medications for geriatric inpatients. Arch Intern Med 2005; 165: 802-807
• 4 Coupland C, Dhiman P, Morriss R. et al. Antidepressant use and risk of adverse outcomes in older people: population based cohort study. BMJ 2011; 343: d4551
• 5 Schurig AM, Bohme M, Just KS. et al. Adverse drug reactions (ADR) and emergencies. Deutsches Arzteblatt International 2018; 115: 251-258
• 6 Pirmohamed M, James S, Meakin S. et al. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ 2004; 329: 15-19
• 7 Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA 1998; 279: 1200-1205
• 8 Just KS, Dormann H, Böhme M. et al. Personalising drug safety—results from the multi-centre prospective observational study on adverse drug reactions in emergency departments (ADRED). Eur J Clin Pharmacol. 2020; 76 (3): 439-448
• 9 The WHO-UMC System https://www.who-umc.org/media/2768/standardised-case-causality-assessment.pdf
• 10 Panel AGSBCUE, Fick DM, Semla TP. et al. American Geriatrics Society 2015 updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2015; 63: 2227-2246
• 11 Holt S, Schmiedl S, Thurmann PA. Potentially inappropriate medications in the elderly: the PRISCUS list. Deutsches Arzteblatt International 2010; 107: 543-551
• 12 Mottram PG, Wilson K, Strobl J. Antidepressants for depressed elderly. Cochrane Database Syst Rev. 2006 doi.org/10.1002/14651858.CD003491.pub2
• 13 Semel D, Murphy TK, Zlateva G. et al. Evaluation of the safety and efficacy of pregabalin in older patients with neuropathic pain: results from a pooled analysis of 11 clinical studies. BMC Fam Pract 2010; 11: 85
• 14 Arif H, Buchsbaum R, Pierro J. et al. Comparative effectiveness of 10 anti-epileptic drugs in older adults with epilepsy. Arch Neurol 2010; 67: 408-415
• 15 Alexopoulos GS, Streim J, Carpenter D. et al. Using antipsychotic agents in older patients. The Journal of Clinical Psychiatry 2004; 65: 5-99 discussion 100–102; quiz 103–104