Drug-Related Problems in Hospitalized Patients with Schizophrenia: A Systematic Review of Prevalence and Intervention
Article Sidebar
Main Article Content
Page: 644-656
Abstract
Schizophrenia is a severe mental disorder with increasing prevalence. Treatment for schizophrenia is chronic and often leads to Drug-Related Problems (DRPs), especially in hospitalized schizophrenia patients. This systematic review aims to map the prevalence and most common types of DRPs and evaluate the impact of clinical pharmacist involvement in addressing DRPs. A literature search was conducted across six electronic databases (Scopus, PubMed, ScienceDirect, Web of Science, ProQuest, and Springer Nature) for publications published between January 2009 and December 2024. Eleven studies met the inclusion criteria, consisting of nine cross-sectional studies and two quasi-experimental studies, with a total of over 61,000 hospitalized schizophrenia patients. The prevalence of DRPs has been reported to range from 52.8% to 100%, depending on the study design and the DRP identification method. Studies using structured medication reviews reported a higher DRP burden, at 0.75–2.5 DRPs per patient. The most frequently identified types of DRPs include polypharmacy, drug interactions, inappropriate medication selection, and dosing problems (overdose and underdose). QTc prolongation was reported in 2.5–8.26% of patients. Clinical pharmacist involvement was reported in three studies, with physician acceptance of recommendations ranging from 49 to 50%. DRPs are a common problem in hospitalized patients with schizophrenia, and clinical pharmacist involvement has the potential to improve the rationality and safety of drug therapy.
Downloads
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
References
Ramani, A., Dian Eka Sari, J., Diana Rachmayanti, R., Ardhana Riswari, A., Prayoga, D., & Lailiyah, ul. (2024). What Family Determinants Are Associated With the Duration of Hallucinatory Disorders in the City of Surabaya, East Java, Indonesia? Malaysian Journal of Medicine and Health Sciences, 20(SUPP9), 22–26. https://doi.org/10.47836/mjmhs20.s9.4
Messias, E. L., Chen, C.-Y., & Eaton, W. W. (2007). Epidemiology of Schizophrenia: Review of Findings and Myths. Psychiatric Clinics of North America, 30(3), 323–338. https://doi.org/10.1016/j.psc.2007.04.007 DOI: https://doi.org/10.1016/j.psc.2007.04.007
Institute of Health Metrics and Evaluation (IHME). (2019). Global Health Data Exchange (GHDx). IHME. https://vizhub.healthdata.org/gbd-results/?params=gbd-api-2019-permalink/27a7644e8ad28e739382d31e77589dd7
World Health Organization. (2022, January 10). Schizophrenia. WHO. https://www.who.int/news-room/fact-sheets/detail/schizophrenia
Laursen, T. M., Nordentoft, M., & Mortensen, P. B. (2014). Excess Early Mortality in Schizophrenia. Annual Review of Clinical Psychology, 10(1), 425–448. https://doi.org/10.1146/annurev-clinpsy-032813-153657 DOI: https://doi.org/10.1146/annurev-clinpsy-032813-153657
Larco, J. P., & Jeste, D. V. (1994). Physical comorbidity and polypharmacy in older psychiatric patients. Biological Psychiatry, 36(3), 146–152. https://doi.org/10.1016/0006-3223(94)91220-3 DOI: https://doi.org/10.1016/0006-3223(94)91220-3
Mann, E., Frühwald, T., Haastert, B., Sauermann, R., Hinteregger, M., Hölzl, D., Keuerleber, S., Scheuringer, M., & Meyer, G. (2014). O2.16: Potentially inappropriate medication in older persons in Austria: a nationwide prevalence study. European Geriatric Medicine, 5, S60. https://doi.org/10.1016/S1878-7649(14)70121-4 DOI: https://doi.org/10.1016/S1878-7649(14)70121-4
Richardson, T. E., O’Reilly, C. L., & Chen, T. F. (2014). Drug-Related Problems and the clinical role of pharmacists in inpatient mental health: an insight into practice in Australia. International Journal of Clinical Pharmacy, 36(5), 1077–1086. https://doi.org/10.1007/s11096-014-9997-7 DOI: https://doi.org/10.1007/s11096-014-9997-7
Bereda, G. (2022). Annals of Psychiatry and Mental Health. Cite this article: Bereda G. Drug Therapy Problems in Schizophrenic Patients. Ann Psychiatry Ment Health, 10(1), 1174.
Chaiyakunapruk, N., Chong, H. Y., Teoh, S. L., Wu, D. B.-C., Kotirum, S., & Chiou, C.-F. (2016). Global economic burden of schizophrenia: a systematic review. Neuropsychiatric Disease and Treatment, 357. https://doi.org/10.2147/NDT.S96649 DOI: https://doi.org/10.2147/NDT.S96649
De Luca, V., Tharmalingam, S., Müller, D. J., Wong, G., de Bartolomeis, A., & Kennedy, J. L. (2006). Gene–gene interaction between MAOA and COMT in suicidal behavior: Analysis in schizophrenia. Brain Research, 1097(1), 26–30. https://doi.org/10.1016/j.brainres.2006.04.053 DOI: https://doi.org/10.1016/j.brainres.2006.04.053
Wien, K., Reißner, P., Hefner, G., Thern, J., & Borgwardt, S. (2024). Prevalence and solving strategies of Drug-Related Problems in adult psychiatric inpatients - a systematic review. Frontiers in Psychiatry, 15. https://doi.org/10.3389/fpsyt.2024.1460098 DOI: https://doi.org/10.3389/fpsyt.2024.1460098
Utami, V. W., Farmasi, S., Aini, S. R., & Puspitasari, C. E. (2022). Pharmaceutical Journal of Indonesia Profil Drug-Related Problems (DRPs) pada Pasien Skizofrenia di Instalasi Rawat Inap Rumah Sakit Jiwa Mutiara Sukma Provinsi NTB Tahun 2020. Pharmaceutical Journal of Indonesia, 8(1), 87–94. http://.pji.ub.ac.id DOI: https://doi.org/10.21776/ub.pji.2022.008.01.9
Bačar Bole, C., Nagode, K., Pišlar, M., Mrhar, A., Grabnar, I., & Vovk, T. (2023). Potential Drug-Drug Interactions among Patients with Schizophrenia Spectrum Disorders: Prevalence, Association with Risk Factors, and Replicate Analysis in 2021. Medicina (Lithuania), 59(2). https://doi.org/10.3390/medicina59020284 DOI: https://doi.org/10.3390/medicina59020284
Ocaña-Zurita, M. C., Juárez-Rojop, I. E., Genis, A., Tovilla-Zárate, C. A., González-Castro, T. B., Lilia López-Narváez, M., de la O, M. E., & Nicolini, H. (2016). Potential drug–drug interaction in Mexican patients with schizophrenia. International Journal of Psychiatry in Clinical Practice, 20(4), 249–253. https://doi.org/10.1080/13651501.2016.1213854 DOI: https://doi.org/10.1080/13651501.2016.1213854
Kibsdal, K. P., Andersen, S., Gazerani, P., & Plet, H. (2020). Rates and correlates of pharmacotherapy-related problems among psychiatric inpatients: a representative Danish study. Therapeutic Advances in Psychopharmacology, 10. https://doi.org/10.1177/2045125320957120 DOI: https://doi.org/10.1177/2045125320957120
Temtem, G., Woldu, M., Berha, A., Shibeshi, W., Teferra, S., & Engidawork, E. (2023). Drug therapy problems in patients with schizophrenia: A cross-sectional study. Clinical Medicine Insights: Psychiatry, 14. https://doi.org/10.1177/11795573231222147 DOI: https://doi.org/10.1177/11795573231222147
Cao, H., Zhou, Y., Li, T., Yao, C., Yang, W., Kong, S., Wang, Y., Yu, B., Jiao, Q., Sun, Y., Jia, X., Wang, Y., Wang, Z., Zhang, X., & Li, J. (2021). The Prevalence, Risk Factors, and Clinical Correlates of QTc Prolongation in Chinese Hospitalized Patients With Chronic Schizophrenia. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.704045 DOI: https://doi.org/10.3389/fpsyt.2021.704045
Yang, F. De, Wang, X. Q., Liu, X. P., Zhao, K. X., Fu, W. H., Hao, X. R., Zhang, X. L., Huang, G. S., Qu, S. C., Bai, J. S., Huang, X. F., Kosten, T. R., & Zhang, X. Y. (2011). Sex difference in QTc prolongation in chronic institutionalized patients with schizophrenia on long-term treatment with typical and atypical antipsychotics. Psychopharmacology, 216(1), 9–16. https://doi.org/10.1007/s00213-011-2188-5 DOI: https://doi.org/10.1007/s00213-011-2188-5
Ramos-Ríos, R., Arrojo-Romero, M., Paz-Silva, E., Carballal-Calvo, F., Bouzón-Barreiro, J. L., Seoane-Prado, J., Codesido-Barcala, R., Crespí-Armenteros, A., Fernández-Pérez, R., López-Moríñigo, J. D., Tortajada-Bonaselt, I., Díaz, F. J., & de León, J. (2010). QTc interval in a sample of long-term schizophrenia inpatients. Schizophrenia Research, 116(1), 35–43. https://doi.org/10.1016/j.schres.2009.09.041 DOI: https://doi.org/10.1016/j.schres.2009.09.041
Ozeki, Y., Fujii, K., Kurimoto, N., Yamada, N., Okawa, M., Aoki, T., Takahashi, J., Ishida, N., Horie, M., & Kunugi, H. (2010). QTc prolongation and antipsychotic medications in a sample of 1017 patients with schizophrenia. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 34(2), 401–405. https://doi.org/10.1016/j.pnpbp.2010.01.008 DOI: https://doi.org/10.1016/j.pnpbp.2010.01.008
Ilickovic, I. M., Jankovic, S. M., Tomcuk, A., & Djedovic, J. (2016). Pharmaceutical care in a long-stay psychiatric hospital. European Journal of Hospital Pharmacy, 23(3), 177–181. https://doi.org/10.1136/ejhpharm-2015-000718 DOI: https://doi.org/10.1136/ejhpharm-2015-000718
Grohmann, R., Engel, R. R., Möller, H. J., Rüther, E., Van Der Velden, J. W., & Stübner, S. (2014). Flupentixol use and adverse reactions in comparison with other common first- and second-generation antipsychotics: Data from the AMSP study. European Archives of Psychiatry and Clinical Neuroscience, 264(2), 131–141. https://doi.org/10.1007/s00406-013-0419-y DOI: https://doi.org/10.1007/s00406-013-0419-y
Hashimoto, Y., & Tensho, M. (2016). Effect of pharmacist intervention on physician prescribing in patients with chronic schizophrenia: A descriptive pre/post study. BMC Health Services Research, 16(1). https://doi.org/10.1186/s12913-016-1408-4 DOI: https://doi.org/10.1186/s12913-016-1408-4
American Psychiatric Association (APA), 2021. The American Psychiatric Association practice guideline for the treatment of patients with schizophrenia. American Psychiatric Association. DOI: https://doi.org/10.1176/appi.books.9780890424841
Jusuf, H., Madania, M., Ramadhani, F.N., Papeo, D.R.P., Kalasi, M., 2024. Gambaran Penggunaan Obat Antipsikotik pada Pasien Skizofrenia di Puskesmas Kota Gorontalo. Journal Syifa Sciences and Clinical Research, 6(1) DOI: https://doi.org/10.37311/jsscr.v6i1.23849
Tiihonen, J., Taipale, H., Mehtälä, J., Vattulainen, P., Correll, C.U., Tanskanen, A., 2019. Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia. JAMA Psychiatry, 76(5), 499. DOI: https://doi.org/10.1001/jamapsychiatry.2018.4320