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P.3.c.004 Anticholinergic prescribing patterns in patients receiving treatment with antipsychotic medication
S460
P.3.c. Psychotic disorders and antipsychotics − Antipsychotics (clinical)
became worse in haloperidol group (PSQI = −3.0±1.5) than in the quetiapine group (PSQI = −0.7±0.3) (P < 0.05). PANSS and CGI scores improved similarly for both agents (P>0.05), but quetiapine improved CDSS-evaluated depressive syndrome to a greater degree (P < 0.05) and was associated with less side effects than haloperidol evaluated by TESS (P < 0.01). Conclusions: Objective (PSG) and subjective parameters (ESS and PSQI) demonstrated that quetiapine fumarate improved sleep quality in schizophrenic patients without causing daytime sleepiness. Quetiapine was also as clinically effective as haloperidol, although it had a greater beneficial effect on depressive syndrome and fewer side effects. Disclosure statement: This paper is financially supported by an grant of Investigator Sponsored Study-AstraZeneca, (Study Code: D1443L00011); References [1] Bona OL, Stanerb L, Hoffmanna G, et al. The first-night effect may last more than one night. J Psychiatr Res. 2001; 35: 165–172. [2] Iber C, Ancoli-Israel S, Cheeson A, and Quan SF for the academy of Sleep Medicine. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications, 1st ed. Westchester, Illinois: American Academy of Sleep Medicine, 2007.
P.3.c.004 Anticholinergic prescribing patterns in patients receiving treatment with antipsychotic medication F. Oosthuizen1 ° , K. du Toit2 , A.N. Khumalo2 , N.N.P. Shinga2 , T. Pillai2 , K. Pillay2 , S. Kanhai2 , T.S. Nhlapo2 . 1 University of KwaZulu-Natal, Pharmacology, Durban, South Africa; 2 University of KwaZulu-Natal, Pharmacy, Durban, South Africa Purpose of the study: Extrapyramidal side effects are relatively common in patients receiving typical antipsychotic medication. These side effects are caused by a dopaminergic-cholinergic imbalance resulting in a variety of symptoms such as tardive dyskinesia, Parkinsonism, akathasia and acute distonia. Blockade of cholinergic activity by anticholinergic drugs results in restoring a normal dopaminergic-cholinergic balance and therefore extrapyramidal effects are minimized. Despite the fact that anticholinergic drugs are frequently used during antipsychotic therapy to counteract the extrapyramidal adverse effects experienced, there seems to be no definite guidelines in the prescribing of anticholinergic medication as an adjunct to antipsychotic drug treatment. The aim of this study was to determine antipsychotic/anticholinergic prescribing patterns in two types of public health care facilities in South Africa. Methods: This was a retrospective, uncontrolled study. Data was collected at the psychiatric unit of a tertiary hospital, as well as a community health centre (primary health care facility). Patient medical charts for one randomly chosen month were reviewed, and relevant data was extracted using a data collection sheet. Only outpatients, receiving treatment with antipsychotic medication, were included in this study. Patients with pre-existing movement disorders were excluded from this study. Results: Typical antipsychotics were most often prescribed at both primary and tertiary levels; this included haloperidol (26.6%) at tertiary level, and chlorpromazine (30.7%) at primary level. While no distinct differences were observed in the types of antipsychotic medication prescribed, it was noticeable that patients at primary level were seldom receiving treatment with a single
antipsychotic − 46% of patients at primary level were treated with a combination of antipsychotic drugs compared to only 11.1% at tertiary level. Anticholinergic medication was more often prescribed at primary level (76.7%), than at tertiary level (32.2%). Orphenadrine was the only anticholinergic prescribed at tertiary level (15%), while both orphenadrine (15%) and biperidine (60%) were prescribed at primary level. At tertiary level, anticholinergic medication was most often prescribed to patients receiving treatment with a single antipsychotic drug (25.6%). At the primary level, anticholinergic medication was most often prescribed to patients being treated with a combination of two antipsychotic drugs (40%). Conclusions: This study found that no clear guidelines exist for the co-prescribing of anticholinergic and antipsychotic medication in South Africa as distinct differences in prescribing patterns of antipsychotic/anticholinergic co-prescribing were observed at different levels of the healthcare system − anticholinergic medication was used more often at primary level, when compared to tertiary level. There might be several reasons for the higher use of anticholinergics at primary level: 1) combination antipsychotics were used more often which might cause a higher incidence of extrapyramidal side effects, and 2) anticholinergic medication might be used as “prophylaxis” against extrapyramidal symptoms at primary level. The use of anticholinergic medication on a prophylactic basis will increase cost of treatment, impact on medication adherence and also increase the possible incidence of adverse effects. Guidelines should therefore be devised to guide the concomitant prescribing of anticholinergic/antipsychotic medication. P.3.c.005 Association of antipsychotic polypharmacy with health service cost − a Danish register-based cost-minimisation analysis L. Baandrup1 ° , J. Sørensen2 , H. Lublin1 , M. Nordentoft3 , B. Glenthøj1 . 1 University of Copenhagen Psychiatric Center Glostrup, Center for Neuropsychiatric Schizophrenia Research, Glostrup, Denmark; 2 University of Southern Denmark, Centre for Applied Health Services Research and Technology Assessment, Odense, Denmark; 3 University of Copenhagen, Psychiatric Center Bispebjerg, Copenhagen NV, Denmark Objective: Schizophrenia represents a large economic burden on society due to the early age of onset of disease, the chronic course, frequent and long hospital stays and temporary or permanent inability to work [1]. Antipsychotic polypharmacy (concomitant treatment with more than one antipsychotic drug) is increasingly used in the treatment of schizophrenia, despite the lack of evidence of superior efficacy compared with antipsychotic monotherapy [2]. Previous studies have documented that antipsychotic polypharmacy is more costly than antipsychotic monotherapy, but most studies included only the cost of drugs and not associated use of health care services [3]. The objective of this study was to investigate the association of antipsychotic polypharmacy in schizophrenia with costs of primary and secondary health service use. Method: Cost-minimisation analysis under the assumption that antipsychotic polypharmacy and monotherapy have equivalent benefits. Resource utilisation and costs were operationalised using central Danish registers to measure consumption of health services for a two year period (2007–2008). We included patients attached to one of two Danish psychiatric referral centres at January 1, 2008
P.3.c. Psychotic disorders and antipsychotics − Antipsychotics (clinical)
became worse in haloperidol group (PSQI = −3.0±1.5) than in the quetiapine group (PSQI = −0.7±0.3) (P < 0.05). PANSS and CGI scores improved similarly for both agents (P>0.05), but quetiapine improved CDSS-evaluated depressive syndrome to a greater degree (P < 0.05) and was associated with less side effects than haloperidol evaluated by TESS (P < 0.01). Conclusions: Objective (PSG) and subjective parameters (ESS and PSQI) demonstrated that quetiapine fumarate improved sleep quality in schizophrenic patients without causing daytime sleepiness. Quetiapine was also as clinically effective as haloperidol, although it had a greater beneficial effect on depressive syndrome and fewer side effects. Disclosure statement: This paper is financially supported by an grant of Investigator Sponsored Study-AstraZeneca, (Study Code: D1443L00011); References [1] Bona OL, Stanerb L, Hoffmanna G, et al. The first-night effect may last more than one night. J Psychiatr Res. 2001; 35: 165–172. [2] Iber C, Ancoli-Israel S, Cheeson A, and Quan SF for the academy of Sleep Medicine. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications, 1st ed. Westchester, Illinois: American Academy of Sleep Medicine, 2007.
P.3.c.004 Anticholinergic prescribing patterns in patients receiving treatment with antipsychotic medication F. Oosthuizen1 ° , K. du Toit2 , A.N. Khumalo2 , N.N.P. Shinga2 , T. Pillai2 , K. Pillay2 , S. Kanhai2 , T.S. Nhlapo2 . 1 University of KwaZulu-Natal, Pharmacology, Durban, South Africa; 2 University of KwaZulu-Natal, Pharmacy, Durban, South Africa Purpose of the study: Extrapyramidal side effects are relatively common in patients receiving typical antipsychotic medication. These side effects are caused by a dopaminergic-cholinergic imbalance resulting in a variety of symptoms such as tardive dyskinesia, Parkinsonism, akathasia and acute distonia. Blockade of cholinergic activity by anticholinergic drugs results in restoring a normal dopaminergic-cholinergic balance and therefore extrapyramidal effects are minimized. Despite the fact that anticholinergic drugs are frequently used during antipsychotic therapy to counteract the extrapyramidal adverse effects experienced, there seems to be no definite guidelines in the prescribing of anticholinergic medication as an adjunct to antipsychotic drug treatment. The aim of this study was to determine antipsychotic/anticholinergic prescribing patterns in two types of public health care facilities in South Africa. Methods: This was a retrospective, uncontrolled study. Data was collected at the psychiatric unit of a tertiary hospital, as well as a community health centre (primary health care facility). Patient medical charts for one randomly chosen month were reviewed, and relevant data was extracted using a data collection sheet. Only outpatients, receiving treatment with antipsychotic medication, were included in this study. Patients with pre-existing movement disorders were excluded from this study. Results: Typical antipsychotics were most often prescribed at both primary and tertiary levels; this included haloperidol (26.6%) at tertiary level, and chlorpromazine (30.7%) at primary level. While no distinct differences were observed in the types of antipsychotic medication prescribed, it was noticeable that patients at primary level were seldom receiving treatment with a single
antipsychotic − 46% of patients at primary level were treated with a combination of antipsychotic drugs compared to only 11.1% at tertiary level. Anticholinergic medication was more often prescribed at primary level (76.7%), than at tertiary level (32.2%). Orphenadrine was the only anticholinergic prescribed at tertiary level (15%), while both orphenadrine (15%) and biperidine (60%) were prescribed at primary level. At tertiary level, anticholinergic medication was most often prescribed to patients receiving treatment with a single antipsychotic drug (25.6%). At the primary level, anticholinergic medication was most often prescribed to patients being treated with a combination of two antipsychotic drugs (40%). Conclusions: This study found that no clear guidelines exist for the co-prescribing of anticholinergic and antipsychotic medication in South Africa as distinct differences in prescribing patterns of antipsychotic/anticholinergic co-prescribing were observed at different levels of the healthcare system − anticholinergic medication was used more often at primary level, when compared to tertiary level. There might be several reasons for the higher use of anticholinergics at primary level: 1) combination antipsychotics were used more often which might cause a higher incidence of extrapyramidal side effects, and 2) anticholinergic medication might be used as “prophylaxis” against extrapyramidal symptoms at primary level. The use of anticholinergic medication on a prophylactic basis will increase cost of treatment, impact on medication adherence and also increase the possible incidence of adverse effects. Guidelines should therefore be devised to guide the concomitant prescribing of anticholinergic/antipsychotic medication. P.3.c.005 Association of antipsychotic polypharmacy with health service cost − a Danish register-based cost-minimisation analysis L. Baandrup1 ° , J. Sørensen2 , H. Lublin1 , M. Nordentoft3 , B. Glenthøj1 . 1 University of Copenhagen Psychiatric Center Glostrup, Center for Neuropsychiatric Schizophrenia Research, Glostrup, Denmark; 2 University of Southern Denmark, Centre for Applied Health Services Research and Technology Assessment, Odense, Denmark; 3 University of Copenhagen, Psychiatric Center Bispebjerg, Copenhagen NV, Denmark Objective: Schizophrenia represents a large economic burden on society due to the early age of onset of disease, the chronic course, frequent and long hospital stays and temporary or permanent inability to work [1]. Antipsychotic polypharmacy (concomitant treatment with more than one antipsychotic drug) is increasingly used in the treatment of schizophrenia, despite the lack of evidence of superior efficacy compared with antipsychotic monotherapy [2]. Previous studies have documented that antipsychotic polypharmacy is more costly than antipsychotic monotherapy, but most studies included only the cost of drugs and not associated use of health care services [3]. The objective of this study was to investigate the association of antipsychotic polypharmacy in schizophrenia with costs of primary and secondary health service use. Method: Cost-minimisation analysis under the assumption that antipsychotic polypharmacy and monotherapy have equivalent benefits. Resource utilisation and costs were operationalised using central Danish registers to measure consumption of health services for a two year period (2007–2008). We included patients attached to one of two Danish psychiatric referral centres at January 1, 2008