Polypharmacy in antipsychotic pharmacological treatment among patients with dual diagnosis in Denmark

Abstract

Introduction

Antipsychotic polypharmacy is prevalent, however literature on antipsychotic polypharmacy during treatment among patients with dual diagnosis is largely non-existent. This study aims to investigating the extent of antipsychotic polypharmacy dual diagnosis patients during hospitalisations.

Methods

Utilizing cohort data from an integrated dual diagnosis in-patient facility from patients hospitalized between 1 March 2012, to 31 December 2016, we compared the mean antipsychotic medication administered at admission and discharge and examined covariate associations with logistic regressions.

Results

The study identified 907 hospital admissions, of which 641 were the first for each patient during the period. At admission, 74.1% received antipsychotics; polypharmacy spanned psychiatric disorders. categories. Patients with affective or personality spectrum disorders were less likely to have antipsychotic polypharmacy upon admission compared to those with psychosis spectrum disorders. 2013–2016 admissions presented less polypharmacy than 2012. Mean antipsychotic numbers remained unchanged for >30-day hospitalizations. Patients admitted without antipsychotic polypharmacy with an affective spectrum disorder or aged 41–50 or over 51 years old were less likely to be discharged with antipsychotic polypharmacy when compared to patients with psychosis spectrum disorder or aged 18–30 years old.

Conclusion

Approximately three-quarters of admitted patients were treated with antipsychotic medication. Antipsychotic polypharmacy was observed across all psychiatric disorder categories, indicating potential off-label use. Addressing antipsychotic polypharmacy during treatment is challenging, even for specialised facilities. Rational antipsychotic prescribing, deprescribing protocols, and further prescription pattern research are needed.

Keywords:

• Dual diagnosis
• co-occurring disorders
• polypharmacy
• antipsychotics
• Denmark
• treatment
• integrated care

Ethical statement

The data were collected according to approvals received from the Danish Patient Safety Authority (3-3013-2017/1) and the Danish Data Protection Agency (RHP-2017-019).

Authors’ contribution

LBJ, SM, and SWD were involved in conceptualisation. LBJ and SM were involved in data curation and formal analysis. LBJ and SM were involved in the original draft while SWD provided critical feedback, and medical expertise. All authors were involved in review and editing of the manuscript.

Disclosure statement

The authors declare no relevant conflicts of interest.

Data availability statement

The datasets generated and analysed in this study are not publicly available due to privacy and confidentiality restrictions and restrictions imposed by the data provider.

Additional information

Funding

This project was funded by the Psychiatric Center Sct. Hans, the Muusfeldt Foundation [Grant number 2017-871] and Helsefonden [Grant number 19-A-0042].