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Pharmacy World and Science

, Volume 18, Issue 1, pp 42–47 | Cite as

Psychotropic drug use in a group of Dutch nursing home patients with dementia: many users, long-term use, but low doses

  • R. T. C. M. Koopmans
  • M. A. J. H. Willekens-Bogaers
  • J. M. van Rossum
  • H. J. M. van den Hoogen
  • C. van Weel
  • Y. A. Hekster
Practice/Case Reports

Abstract

The aim of this study was to describe the use of psychotropic drugs in a psychogeriatric nursing home, “Joachim en Anna”, in Nijmegen, the Netherlands. To this end the medical records of 890 nursing home patients with dementia, admitted between 1980 and 1989, were analysed retrospectively. Each time pattern of psychotropic drug use was registered. Drugs were coded by means of the Anatomical Therapeutic Chemical classification system. The daily dose was expressed as the ratio of the mean prescribed daily dose and the defined daily dose. Side-effects and changes in prescription patterns throughout the years patients were admitted were analysed. A total of 3,090 time patterns of exposure to psychotropics were registered. Neuroleptics, benzodiazepines, and antidepressants accounted for 58, 32, and 9% of the time patterns, respectively. For almost every drug prescription the prescribed daily dose was lower than the defined daily dose. More than 75% of these nursing home patients had at least one prescription for a psychotropic drug during institutionalization. One or more side-effects were observed in 50% of the patients who used a neuroleptic. The total number of patients receiving psychotropics did not change throughout the study. Psychotropics were prescribed for long-term use, but in a low dose. Side-effects were frequently observed while the correct individual dose was being determined.

Keywords

Adverse effects Dementia Drug utilization Nursing homes Pharmacoepidemiology Psychotropic drugs 

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References

  1. 1.
    American Psychiatric Association (APA). Diagnostic and statistical manual of mental disorders. 3rd ed. Revised. Washington: American Psychiatric Association, 1987.Google Scholar
  2. 2.
    Cummings JL, Benson DF. Dementia. A clinical approach. 2nd ed. Stoneham: Butterworth, 1992.Google Scholar
  3. 3.
    Wragg RE, Jeste DV. Neuroleptics and alternative treatments. Management of behavioral symptoms and psychosis in Alzheimer's disease and related conditions. Psychiatric Clin North Am 1988;11:195–213.Google Scholar
  4. 4.
    Niekerk BV, Erckens B. Geneesmiddelengebruik in de psychogeriatrie [Drug usage in psychogeriatrics]. Med Contact 1988;12:369–73.Google Scholar
  5. 5.
    Razenberg TPA. Neuroleptica- en laxantiagebruik in een psychogeriatrisch verpleeghuis [Use of neuroleptics and laxatives in a psychogeriatric nursing home]. Med Contact 1987;10:304–6.Google Scholar
  6. 6.
    Willekens-Bogaers MAJH, Smits GWJM. Neuroleptica in de psychogeriatrie. Evaluatie van een behandelvoorstel [Neuroleptic drugs in psychogeriatry. An evaluation of a treatment schedule]. Tijdschr Gerontol Geriatr 1990;21:99–107.Google Scholar
  7. 7.
    Gillissen R; van den Brink G. Het gebruik van psychofarmaca in een verpleeghuis. Een oriënterend onderzoek [The usage of psychotropics in a nursing home. A pilot study]. Med Contact 1982;38:1196–8.Google Scholar
  8. 8.
    Schols JMGA. Slaapproblemen en slaapmiddelengebruik in een verpleeghuis. Een inventariserend onderzoek [Sleeping problems and the use of hypnotics in a nursing home. A survey]. Tijdschr Gerontol Geriatr 1991;22:139–42.Google Scholar
  9. 9.
    Galasko D, Corey-Bloom J, Thal LJ. Monitoring progression in Alzheimer's disease. J Am Geriatr Soc 1991;39:932–41.Google Scholar
  10. 10.
    Mendez MF, Martin RJ, Smyth KA, Whitehouse PJ Psychiatric symptoms associated with Alzheimer's disease. J Neuropsychiatry Clin Neurosci 1990;2:29–33.Google Scholar
  11. 11.
    Ancill RJ, Embury GD, Macewan GW, Kennedy JS. The use and misuse of psychotropic prescribing for elderly psychiatric patients. Can J Psychiatry 1988;33:585–9.Google Scholar
  12. 12.
    Devanand DP, Sackeim HA, Mayeux R. Psychosis, behavioral disturbance, and the use of neuroleptics in dementia. Compr Psychiatry 1988;4:387–401.Google Scholar
  13. 13.
    Taft LB, Barkin RL. Drug abuse? Use and misuse of psychotropic drugs in Alzheimer's care. J Gerontol Nurs 1990;16:4–10.Google Scholar
  14. 14.
    Wragg RE, Jeste DV. Neuroleptics and alternative treatments. Management of behavioral symptoms and psychosis in Alzheimer's disease and related conditions. Psychiatr Clin North Am 1988;11:195–213.Google Scholar
  15. 15.
    Reisberg B, Borenstein J, Salob SP, Ferris SH, Franssen E, Ageorgota S. Behavioral symptoms in Alzheimer's disease: phenomenology and treatment. J Clin Psychiatry 1987;48:9–15.Google Scholar
  16. 16.
    Sunderland T, Silver MA. Neuroleptics in the treatment of dementia. Int J Geriatr Psychiatry 1987;3:79–88.Google Scholar
  17. 17.
    Risse SC, Lampe THH, Cubberley L. Very low-dose neuroleptic treatment in two patients with agitation associated with Alzheimer's disease. J Clin Psychiatry 1987;48:207–8.Google Scholar
  18. 18.
    Reisberg B, Borrenstein J, Franssen E, Shulman E, Steinberg G, Ferris SH. Remediable behavioral symptomatology in Alzheimer's disease. Hosp Community Psychiatry 1986;37:1199–201.Google Scholar
  19. 19.
    Risse SC, Barnes R. Pharmacologic treatment of agitation associated with dementia. J Am Geriatr Soc 1986;34:368–76.Google Scholar
  20. 20.
    Willekens-Bogaers MAJH, Vollaard EJ. Neuroleptica in de psychogeriatrie. Een voorstel voor een rationeler voorschrijfbeleid [Neuroleptic drugs in psychogeriatry. A proposal for a more rational prescribing policy]. Tijdschr Gerontol Geriatr 1985;16:179–89.Google Scholar
  21. 21.
    Koopmans RTCM, van Hell ME, de Jongh F, Froeling PGAM, van den Hoogen HJM, van Weel C. Het beloop van de ziekte van Alzheimer bij een groep verpleeghuispatiënten: epidemiologie, (bijkomende) morbiditeit en sterfte [The course of Alzheimer's disease in a nursing home population: epidemiologic aspects, (co)morbidity and mortality]. Ned Tijdschr Geneeskd 1991;135:845–9.Google Scholar
  22. 22.
    Koopmans RTCM, Ekkerink JLP, Sirre LGNJ, Verkuylen MMJD, van den Hoogen HJM, van Weel C. Verpleeghuispatiënten met een multi-infarctdementie; een ander beloop dan de ziekte van Alzheimer [Multi-infarct dementia in nursing home patients; more comorbidity and shorter life expectancy than in Alzheimer's disease]. Ned Tijdschr Geneesk 1992;136:2223–7.Google Scholar
  23. 23.
    Leufkens HG, Urquhart J. Variability in patterns of drug usage. J Pharm Pharmacol 1994;46:433–7.Google Scholar
  24. 24.
    van Staa TP, Abenhaim L, Leufkens HG. A study of the effects of exposure misclassification due to the time-window design in pharmacoepidemiologic studies. J Clin Epidemiol 1994;47:183–9.Google Scholar
  25. 25.
    Leufkens HG, Urquhart J. Automated record linkage and other approaches the pharmacoepidemiology in the Netherlands. Pharmacoepidemiology. 2nd ed. 1994;231–44.Google Scholar
  26. 26.
    Nordic Council on Medicines. Guidelines for ATC classification. Oslo: WHO Collaborating Center for Drugs Statistics Methodology, 1990.Google Scholar
  27. 27.
    Nordic Council on Medicines. Guidelines for defined daily dose. Oslo: WHO Collaborating Center for Drugs Statistics Methodology, 1991.Google Scholar
  28. 28.
    Classification Committee of Wonca. ICHPPC-2-defined. 3rd ed. New York: Oxford University Press, 1986.Google Scholar
  29. 29.
    Mattheus DE, Farewell VT. Using and understanding statistics. 2nd ed. Basel: Karger, 1988.Google Scholar
  30. 30.
    Wingard LB, Brody TM, Larner J, Schwartz A. Gerontological pharmacology. In: Wingard LB, Brody TM, Larner J, Schwartz A, editors. Human pharmacology. Molecular-to-clinical. London: Wolfe Publishing Ltd, 1991:851–6.Google Scholar
  31. 31.
    Schneider LS, Pollock VE, Lyness SA. A meta-analysis of controlled trials of neuroleptic treatment in dementia. J Am Geriatr Soc 1990;38:553–63.Google Scholar
  32. 32.
    Salzman C. Treatment of agitation, anxiety and depression in dementia. Psychopharmacol Bull 1988;24:39–42.Google Scholar
  33. 33.
    Koopmans RTCM, de Vaan HHC, van den Hoogen HJM, Gribnau FWJ, Hekster YA, van Weel C. Afhame van genees-middelengebruik na opname in een psychogeriatrish verpleeghuis: stoppen is mogelijk [Reduction of drug intake atter admission to a psychogeriatric nursing home: discontinuation is possible]. Ned Tijdschr Geneeskd 1993;137:1049–54.Google Scholar
  34. 34.
    Koopmans RTCM, de Vaan HHC, van den Hoogen HJM, Gribnau FWJ, Hekster YA, van Weel C. Veranderingen in geneesmiddelengebruik tijdens verblijf in een psychogeriatrisch verpleeghuis [Changes in drug intake during institutionalization in a Dutch psychogeriatric nursing home]. Ned Tijdschr Geneeskd 1994;138:1122–6.Google Scholar
  35. 35.
    Chouinard G, Jones B, Remington G, et al. A Canadian multicenter placebo-controlled study of fixed doses of risperidone and haloperidol in the treatment of chronic schizophrenic patients. J Clin Psychopharmacol 1993;13:25–40.Google Scholar
  36. 36.
    Borison RL, Pathirala AP, Diamond BI, Meibach RC. Risperidone: clinical safety and efficacy in schizophrenia. Psychopharmacol Bull. 1992;28:213–8.Google Scholar

Copyright information

© Kluwer Academic Publishers 1996

Authors and Affiliations

  • R. T. C. M. Koopmans
    • 1
  • M. A. J. H. Willekens-Bogaers
    • 1
  • J. M. van Rossum
    • 1
  • H. J. M. van den Hoogen
    • 2
  • C. van Weel
    • 2
  • Y. A. Hekster
    • 3
  1. 1.“Joachim en Anna” Nursing HomeNijmegenthe Netherlands
  2. 2.Department of General Practice and Social MedicineUniversity of NijmegenNijmegenThe Netherlands
  3. 3.Department of Clinical PharmacyUniversity Hospital Nijmegen St RadboudNijmegenThe Netherlands

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