To be valid, a prescription must be issued for a legitimate medical purpose, by a practitioner in the usual course of his or her professional practice. Cite this article. Agitation was the most common clinical indication for antipsychotic prescribing in the emergency department (n=4/5, 75%) (Supplementary Tables 4and5). Metabolic adverse effects occur most frequently with olanzapine and clozapine., For patients in which cost is a factor for deciding an antipsychotic, FGAs may be more cost-effective due to the generic status of most medications. Lastly, special considerations are warranted for young and pregnant individuals, as well as adults over age 65.. Pharmacological and non-pharmacological interventions to prevent delirium in critically ill patients: a systematic review and network meta-analysis. Ray WA, Meredith S, Thapa PB, Meador KG, Hall K, Murray KT. Two reviewers (NJ, SJM) completed a calibration exercise on ten studies to achieve>75% interrater agreement prior to data extraction. Ask about video and phone sessions. Psychopharmacology. However, some healthcare professionals reported having low in-depth knowledge of guideline recommendations on the use of antipsychotics in the setting of delirium. There are no declared competing interests from any of the contributing authors. Newly initiated in-hospital antipsychotics continued at discharge in non-psychiatric patients. Studies describing perceptions of healthcare professionals on antipsychotic medication prescribing were evaluated by deductive qualitativethematic analysis utilizing the Theoretical Domains Framework (TDF). Antipsychotic prescribing patterns during and after critical illness: a prospective cohort study. Overview What are antipsychotics? Of 4528 studies screened, we included 80 studies. Disagreements regarding study selection were resolved through discussion between the reviewers. HHS Vulnerability Disclosure, Help Those studies meeting inclusion criteria subsequently underwent full-text review to determine inclusion for data extraction. Atypical antipsychotics are widely prescribed as sedatives or sleep aids, again despite a lack of . 1). Antipsychotic prescribing patterns during and after critical illness: a prospective cohort study. The use of antipsychotics in young children is declining but doctors continue to prescribe these medications off-label for conditions not approved by the Food and Drug Administration and without the recommended psychiatric consultation, a Rutgers study found. Curr Pharm Des. Unfortunately, they are commonly continued at hospital discharge and at follow-ups thereafter. To date, questions remain as to whether there are differences in the prescribing pattern, safety, and impact of a . 2016;44(10):18057. Oh ES, Needham DM, Nikooie R, Wilson LM, Zhang A, Robinson KA, et al. We defined antipsychotic prescribing or deprescribing practices in acute care as perceived (i.e., participant reported) or measured prescribing or deprescribing practices in patients who did not have a psychiatric diagnosis, dementia, or cognitive dysfunction (e.g., developmental disorders) where chronic antipsychotic medication use may be clinically indicated. We investigated the prevalence and trends of antipsychotic prescription for outpatients aged 17 years receiving a first antipsychotic prescription from 2006 to 2012 based on a large-scale dispensation dataset. This study population was selected to reflect the population that is typically involved in the prescribing process of antipsychotic medications. Statistics from the National Institute of Mental Health suggest that 3 in every 100 people in the United States experience psychosis. The online version contains supplementary material available at 10.1186/s12913-022-08650-7. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Given the observed increase in mood stabilizer/anticonvulsant prescribing, future monitoring for all psychotropic . Thiboutot ZPM, Williamson DR, Rose L, Mehta S, Gueneette MD, Cook D, Burry L. Antipsychotic drug use and screening for delirium in mechanically ventilated patients in Canadian intensive care units: an observational study. Tardive dyskinesia and new antipsychotics. Boncyk CS, Farrin E, Stollings JL, Rumbaugh K, Wilson JE, Marshall M, et al. One reviewer (NJ) completed analysis for all included studies with second reviewer (SJM) verifying the data for accuracy. We included studies for adult patients (as defined in the primary study) that were hospitalized at or presenting to an acute care facility (e.g., critically ill, medical, surgical ward patients, or emergency department) and all healthcare professionals including, but not limited to physicians, nurses, and pharmacists. Lexi-Drugs. One study reported on both the intensive care and inpatient setting. In both the intensive care and inpatient setting, quetiapine was reported in all studies to be most oftenantipsychotic continued at hospital discharge (intensive care, n=12/12, 100%; inpatient, n=6/6, 100%). A Comparison of free online machine language translators. 2018;169(7):46773. The authors of this scoping review received no specific funding for this work. Can Cannabis or CBD Improve ADHD Treatment Gaps? 2015;4(9): e001666. Only those studies that satisfied all inclusion criteria were selected for data extraction. Our study expands on healthcare professional prescribing perceptions specific to antipsychotic medications. Supplementary Table 10. Objectives: Identify the appropriate indications for the various antipsychotic medications. Protocols, editorials, opinion pieces, systematic or scoping reviews were excluded. The scoping review research questions and methods for study selection and data charting were developed using the methodology described by Arksey and OMalley and the Scoping Review Methods Manual proposed by the Joanna Briggs Institute [27, 28]. Patients may experience a range of symptoms, including: nausea, vomiting, restlessness, anxiety, insomnia, fatigue/malaise, myalgia, diaphoresis, rhinitis, paresthesia, gastrointestinal distress, headaches, and nightmares. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. 2022;12(6): e057585. Reportedantipsychotic medication prescribing indications included studies by acute care setting. Disagreements regarding study selection were resolved through discussion between the reviewers. Supplementary Table 2. DynaMed [Internet]. As with every aspect of medical care, a physician's prescription practices should be guided by medical knowledge, best-practices, professional guidelines and consensus standards. WFSBP Task Force on Treatment Guidelines for Unipolar Depressive Disorders. Page VJ, Ely EW, Gates S, Zhao XB, Alce T, Shintani A, et al. Those studies meeting inclusion criteria subsequently underwent full-text review to determine inclusion for data extraction. Two studies described a pharmacist-based intervention either in the form of an electronic handoff tool or the use of prescriptive authority to deprescribe antipsychotic medications once the acute clinical indication had resolved. Defining antipsychotic medication prescribing practices and the perceptions surrounding antipsychotic medication use in the acute care setting is essential to developing effective, sustainable, and collaborative multidisciplinary antipsychotic deprescribing strategies to promote appropriateness in prescribing and deprescribing during patient hospitalization [24,25,26]. Antipsychotic medications are frequently prescribed in acute care for clinical indications other than primary psychiatric disorders such as delirium. For patients with schizophrenia, the associations Practice Guideline for the Treatment of Patients with Schizophrenia updated in 2020 further advises: All patients with schizophrenia should have an evidence-based and patient-centered treatment plan in place that includes both nonpharmacological and pharmacological treatments., Dont routinely prescribe two or more antipsychotics concurrently.. No studies were identified reporting on antipsychotic prescribing at hospital discharge in the emergency room setting. Most included studies describe perspectives in the intensive caresetting (n=18/29, 62%). Perceived antipsychotic prescribing practices differed from actual measured antipsychotic prescribing practices and may impact how antipsychotic medications are prescribed at hospital discharge. Jaworska N, Moss SJ, Krewulak KD, Stelfox Z, Niven D, Ismail Z, et al. Was 21.99. Stuart MM, Smith ZR, Payter KA, Martz CR, To L, Swiderek JL, et al. Pharmacist-driven discontinuation of antipsychotics for ICU delirium: a quasi-experimental study. Girard TD, Jackson JC, Pandharipande PP, Pun BT, Thompson JL, Shintani AK, et al. Evaluation of discontinuation of atypical antipsychotics prescribed for ICU delirium. Phenothiazines, thioxanthenes, butyrophenones, dibenzoxazepines, dibenzodiazepines, diphenylbutylpiperidines. As there were no studies identified that reported on the perceptions of patients and their families regarding antipsychotic prescribing practices, we were unable to report on these outcomes that were outlined in our published protocol [29]. Review of deprescribing processes and development of an evidence-based, patient-centred deprescribing process. Articles not available in English were translated using Google Translate, which has been reported as a reliable tool for translating documents for systematic reviews [37, 38]. Extrapyramidal dysfunction occurs most frequently with haloperidol, fluphenazine, and thiothixene., Due to binding affinity to multiple serotonin 5-HT receptors, SGAs are known to cause metabolic adverse effects at higher rates than FGAs. There are no declared competing interests from any of the contributing authors. 2018;34(4):58598. Supplementary Table 7. Devlin JW, Smithburger P, Kane JM, Fraser GL, Skrobik Y. Background Antipsychotic medications are frequently prescribed in acute care for clinical indications other than primary psychiatric disorders such as delirium. Pharmacological interventions for the treatment of delirium in critically ill adults. 2008;21(2). The lack of antipsychotic prescribing protocols to support these screening tools were cited as influencing how and when antipsychotics were prescribed. Perceived antipsychotic prescribing practices differ from actual measured antipsychotic prescribing practices in acute care with more frequent prescribing of atypical antipsychotic medications in-hospital and at hospital discharge. Reference lists of identified studies were additionally searched for relevant studies. Accessibility The objective of this scoping review was to characterize antipsychotic medication prescribing practices, to describe healthcare professional perceptions on antipsychotic prescribing and deprescribing practices, and to report on antipsychotic deprescribing strategies within acute care. The scoping review protocol was registered (Open Science Framework:10.17605/OSF.IO/W635Z), and published as an open-access publication prior to data abstraction [29]. The authors gratefully acknowledge the help of librarian Diane Lorenzetti in establishing the search strategy for this study. Jasiak KD, Middleton EA, Camamo JM, Erstad BL, Snyder LS, Huckleberry YC. Intended and unintended consequences of constraining clinician prescribing: the case of antipsychotics. Conference abstracts were included if they met all inclusion criteria even if full articles related to the conference abstracts were not found. The protocol was registered on Open Science Framework prior to data abstraction (10.17605/OSF.IO/W635Z). Most studies were conducted in North America (n=42/80, 53%), Europe (n=16/80, 20%), or Asia (n=8/80, 10%) and evaluated the intensive care (n=49/80, 61%), inpatient non-intensive care setting (n=27/80, 34%) or emergency department setting (n=5/80, 6%) (Supplementary Fig. Review of deprescribing processes and development of an evidence-based, patient-centred deprescribing process. All authors are in agreeance to act as guarantors of this work. Supplementary Table 3. Extrapyramidal symptoms (EPS) and endocrine effects have been associated with receptor antagonism on the dopamine D, Sedation has been associated with receptor antagonism on the histamine H, Anticholinergic adverse effects have been associated with receptor antagonism on the muscarinic M. official website and that any information you provide is encrypted Article Few current studies are available that address in-hospital deprescribing strategies to reduce ongoing antipsychotic medication prescribing at hospital discharge [4749]. Straus SE, Tetroe J, Graham I. Methods: Twenty-eight participants from eight different professional groups with a role in shaping treatment decisions in dementia care were recruited and interviewed. Supplementary Table 8. These medications are safe to use for months, years, or even a lifetime. PubMed Central Evaluation of measured (i.e., actual) antipsychotic prescribing practices identified 34 studies (intensive care, n=20/34, 59%; inpatient n=14/34, 42%; emergency department n=0/34, 0%). Start CME Tools Psychopharmacology is the scientific study of the effect of medications on the mind and behavior. Most included studies describe perspectives in the intensive caresetting (n=18/29, 62%). However, in-hospital deprescribing strategies are infrequently implemented [23]. Diagnostic criteria for schizophrenia. Supplementary Table 12. Tomichek JE, Stollings JL, Pandharipande PP, Chandrasekhar R, Ely EW, Girard TD. Hatta K, Kishi Y, Wada K, Odawara T, Takeuchi T, Shiganami T, et al. American Geriatrics Society Expert Panel on Postoperative Delirium in Older A. American Geriatrics Society abstracted clinical practice guideline for postoperative delirium in older adults. Three (n=3/80, 4%) studies described antipsychotic medication deprescribing strategies in the acute care settings (Supplementary Table 12). Oh ES, Needham DM, Nikooie R, Wilson LM, Zhang A, Robinson KA, et al. 2019;10:1179557319863813. Studies were summarized following validated guidelines for narrative synthesis of quantitative studies [30, 39]. Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada, Natalia Jaworska,Stephana J. Moss,Karla D. Krewulak,Zara Stelfox,Daniel J. Niven&Kirsten M. Fiest, Alberta Health Services, Calgary, AB, Canada, Natalia Jaworska,Karla D. Krewulak,Daniel J. Niven,Zahinoor Ismail&Kirsten M. Fiest, Faculty of Health, Dalhousie University, Halifax, NS, Canada, Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada, Daniel J. Niven,Zahinoor Ismail&Kirsten M. Fiest, OBrien Institute for Public Health, University of Calgary, Calgary, AB, Canada, Department of Psychiatry, University of Calgary, Calgary, AB, Canada, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada, Departments of Pharmacy and Medicine, Leslie Dan Faculty of Pharmacy, Sinai Health System, University of Toronto, Toronto, Canada, You can also search for this author in Studies were selected that reported on either antipsychotic prescribing and deprescribing practices or perceptions in acute care. Protocols, editorials, opinion pieces, systematic or scoping reviews were excluded. Sahlberg M, Holm E, Gislason GH, Kober L, Torp-Pedersen C, Andersson C. Association of selected antipsychotic agents with major adverse cardiovascular events and noncardiovascular mortality in elderly persons. In some cases, medications can be used 'off-license', which means it has not been formally . Updated 2018 Nov 30. 179 N 1200 E. #101. Considering heterogeneous quantitative data from included studies, we grouped studies according to outcomes and setting (i.e., intensive care, inpatient, emergency department) and summarized data as counts with proportions. Conference abstracts were included if they met all inclusion criteria even if full articles related to the conference abstracts were not found. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. The TDF is a theoretical framework of 14 behavior and behavior change domains with associated constructs that identifies pertinent factors that influence the behavior patterns of healthcare professionals [39, 40]. What is psychosis? Rebound psychosis may also occur. The TDF is a theoretical framework of 14 behavior and behavior change domains with associated constructs that identifies pertinent factors that influence the behavior patterns of healthcare professionals [39, 40]. Levine AR, Lemieux SM, DAquino D, Tenney A, Pisani M, Ali S. Risk factors for continuation of atypical antipsychotics at hospital discharge in two intensive care unit cohorts. Qualitative thematic analysis was performed to understand the reported priority factors that influence healthcare professional antipsychoticprescribing practices. Deprescribing strategies were infrequently described in the literature. Levine AR, Lemieux SM, DAquino D, Tenney A, Pisani M, Ali S. Risk factors for continuation of atypical antipsychotics at hospital discharge in two intensive care unit cohorts. Shen WW. Int J Geriatr Psychiatry. In-hospital clinical environments provide a safe and monitored setting to facilitate the necessary steps required to initiate a deprescribing care plan and warrants further evaluation. Of 4528 studies screened, we included 80 studies. Antipsychotics for treatment of delirium in hospitalised nonICU patients. 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