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P.3.d.017 Psychotropic medication use profile and adequacy in elderly institutionalised population
P.3.e. Psychotic disorders and antipsychotics − Others (clinical) P.3.d.017 Psychotropic medication use profile and adequacy in elderly institutionalised population B. Pascual Arce1 ° , M.C. Perez Navarro1 , L. Garcia Sanchez1 , N. Muro Perea1 , A. Sicras Mainar2 , M. Blanca Tamayo3 . 1 Badalona Serveis Assistencials SA, Dept. of Pharmacy, Badalona. Barcelona, Spain; 2 Badalona Serveis Assistencials SA, Planning Department, Badalona. Barcelona, Spain; 3 Badalona Serveis Assistencials SA, Psychiatry Service, Badalona. Barcelona, Spain Purpose of study: Concern has been expressed regarding the extensive use of psychotropic drugs in elderly population. The most common disorders of late life include depression, dementia, schizophrenia, insomnia and anxiety. Evidence base supports the efficacy of geriatric mental health interventions, but successful psychotropic pharmacotherapy in the elderly requires careful consideration of medications to balance the therapeutic effects and side effect profiles of these agents. Psychotropic medication can lead to physical and nervous system side effects, and falls, which may result in hip fractures. Our objective is to evaluate the utilization of psychotropic medication in our institutionalized population. Patients and Methods: We performed a retrospective crosssectional study. Clinical records and treatment charts of the 210 residents in a long-term care centre were reviewed. Details on prescription of psychotropic drugs were recorded of residents aged 65 years to analyze the prescription of ansiolytics and hypnotics (AH), antidepressants (AD) and antipsychotics (AP). Main measures were sociodemographic data, main diagnosis and psychotropic drug prescriptions. We used official treatment recommendation guide edited to assess the accuracy of prescriptions and detect selected major interactions of psychodrugs and duplicities. Results: 171 patients were included: mean age: 80.76±7.42 years, 66.7% female. 45.6% of patients belonged to a geriatric convalescence unit, 22.8% to a long stay unit and 31.6% others (psychogeriatric unit, palliative care, and neurorehabilitation). 26 (15%) residents had malignant pathology, 62 (36%) cardiovascular disease, 46 (27%) dementia or other neurological illness, 12 (7%) respiratory pathology and 25 (15%) other diagnosis. Principal entrance diagnosis was bone fractures (22%) and ictus (21%). Psychotropic drug prescriptions were recorded in 117 (68.4%) patients: 58.1% used AH drugs, 55.5% AD and 30.8% AP. Citalopram, lorazepam and risperidone were the most prescribed drugs (34, 26 and 18 patients respectively). Main daily doses used were 20 mg, for citalopram and 1 mg for lorazepam and risperidone.. Long-acting benzodiazepines (diazepam and clorazepate) represented only 5.8% of the benzodiazepine prescription. The follow associations were found: 4 patients had 2 benzodiazepines (BZ), 3 patients had 2 antidepressants (serotonin selective reuptake inhibitors (SSRI) + trazodone), 2 patients had 2 antipsychotics (haloperidol + risperidone/quetiapine) and 5 patients had 3 or more psychotropic drugs. Few major interactions were detected (7): SSRI plus amiodarone (1), SSRI plus ciprofloxacin (1), SSRI plus tramadol (2) and TCA plus drugs that prolongue QT interval prolongation (3). Prescription of BZ and other hypnotic drugs were appropriated based on the treatment guide (11.1% inapropriated) but the length of treatment was longer than recommended. We weren’t able to assess quality of prescriptions of AD and AP because indication was not clearly registered in the treatment charts.
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Conclusions: High prescription of psychotropic dugs in elderly patients (68.4%) was found. Elderly patients receiving psychotropic drug therapy must be monitored carefully: treatment failure due to undermedication and drug toxicity due to overmedication may have severe consequences.. Evidence from the literature and the present study suggests that psychotropic drug use is inappropriate with no recommended associations and excessive length of treatments.
P.3.e. Psychotic disorders and antipsychotics − Others (clinical) P.3.e.001 Facial emotion recognition deficit in schizophrenia: a replication study in Korean subjects S.J. Lee1 ° , H.D. Rim1 , Y.W. Park2 , J.J. Lee1 , S.M. Jang1 , 1 Kyungpook National J.M. Woo1 , H.Y. Jo1 , K.U. Lee3 . University, Department of Psychiatry, Dae-gu, South-Korea; 2 Daegu Fatima Hospital, Department of Psychiatry, Dae-gu, South-Korea; 3 Uijeongbu St. Mary’s Hosptial, Department of Psychiatry, Uijeongbu, South-Korea Objective: Although schizophrenia appears quite similar across a range of cultures, cross-cultural variability has been noted. Correspondingly, there have been a few cross-cultural comparisons of facial emotion recognition in schizophrenia and normal controls. However, the majority of studies have focused on Caucasian samples using only Caucasian faces as stimuli and culture or ethnicity specific data on facial emotion recognition, especially in schizophrenia, are still scarce. Hence, we investigated the deficit in the recognition of facial emotions in a sample of medicated stable Korean patients with schizophrenia using Korean facial emotion pictures and examined whether the possible impairments would corroborate previous findings. Specifically, neutral faces were included to see if patients with schizophrenia misidentified neutral cues as unpleasant or threatening relative to normal controls. Methods: Fifty-five patients with schizophrenia and 62 healthy control subjects completed the Facial Affect Identification Test (FAIT). In this test, subjects were asked to choose one of six emotions and neutral emotion while viewing the images. A total of 44 facial images displaying happy, sad, fear, anger, surprise, disgust, or neutral expressions were then presented: seven faces are for surprise and disgust, and 6 faces for the other emotions and neutral expression. Hence, the maximum score is either 6 or 7 according to the numbers of facial images in each emotion. The order of stimuli was randomized. Choices were displayed on the screen along with the stimuli, and subjects responded by pressing the touch screen. Results: Korean patients with schizophrenia showed impairments in recognition of sad, fearful, and angry faces [F(1,114) = 6.26, p = 0.014; F(1,114) = 6.18, p = 0.014; F(1,114) = 9.28, p = 0.003, respectively] but they were equally accurate as controls in recognition of happy emotions. Higher total and three subscale scores of Positive and Negative Syndrome Scale (PANSS) correlated with poorer performance on both angry and neutral faces. The correct responses on the happy stimuli were negatively correlated with negative scores of PANSS. We found that patients and healthy subjects differed in the distribution of errors for angry, surprise, disgusted and neutral expressions. In general, while responses in healthy participants were driven to the one prominent emotion, those in patients were relatively divergent. Patients
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Conclusions: High prescription of psychotropic dugs in elderly patients (68.4%) was found. Elderly patients receiving psychotropic drug therapy must be monitored carefully: treatment failure due to undermedication and drug toxicity due to overmedication may have severe consequences.. Evidence from the literature and the present study suggests that psychotropic drug use is inappropriate with no recommended associations and excessive length of treatments.
P.3.e. Psychotic disorders and antipsychotics − Others (clinical) P.3.e.001 Facial emotion recognition deficit in schizophrenia: a replication study in Korean subjects S.J. Lee1 ° , H.D. Rim1 , Y.W. Park2 , J.J. Lee1 , S.M. Jang1 , 1 Kyungpook National J.M. Woo1 , H.Y. Jo1 , K.U. Lee3 . University, Department of Psychiatry, Dae-gu, South-Korea; 2 Daegu Fatima Hospital, Department of Psychiatry, Dae-gu, South-Korea; 3 Uijeongbu St. Mary’s Hosptial, Department of Psychiatry, Uijeongbu, South-Korea Objective: Although schizophrenia appears quite similar across a range of cultures, cross-cultural variability has been noted. Correspondingly, there have been a few cross-cultural comparisons of facial emotion recognition in schizophrenia and normal controls. However, the majority of studies have focused on Caucasian samples using only Caucasian faces as stimuli and culture or ethnicity specific data on facial emotion recognition, especially in schizophrenia, are still scarce. Hence, we investigated the deficit in the recognition of facial emotions in a sample of medicated stable Korean patients with schizophrenia using Korean facial emotion pictures and examined whether the possible impairments would corroborate previous findings. Specifically, neutral faces were included to see if patients with schizophrenia misidentified neutral cues as unpleasant or threatening relative to normal controls. Methods: Fifty-five patients with schizophrenia and 62 healthy control subjects completed the Facial Affect Identification Test (FAIT). In this test, subjects were asked to choose one of six emotions and neutral emotion while viewing the images. A total of 44 facial images displaying happy, sad, fear, anger, surprise, disgust, or neutral expressions were then presented: seven faces are for surprise and disgust, and 6 faces for the other emotions and neutral expression. Hence, the maximum score is either 6 or 7 according to the numbers of facial images in each emotion. The order of stimuli was randomized. Choices were displayed on the screen along with the stimuli, and subjects responded by pressing the touch screen. Results: Korean patients with schizophrenia showed impairments in recognition of sad, fearful, and angry faces [F(1,114) = 6.26, p = 0.014; F(1,114) = 6.18, p = 0.014; F(1,114) = 9.28, p = 0.003, respectively] but they were equally accurate as controls in recognition of happy emotions. Higher total and three subscale scores of Positive and Negative Syndrome Scale (PANSS) correlated with poorer performance on both angry and neutral faces. The correct responses on the happy stimuli were negatively correlated with negative scores of PANSS. We found that patients and healthy subjects differed in the distribution of errors for angry, surprise, disgusted and neutral expressions. In general, while responses in healthy participants were driven to the one prominent emotion, those in patients were relatively divergent. Patients