Lonchampt Sophie, Gerber Fabienne, Aubry Jean-Michel, Desmeules Jules, Kosel Markus, Besson Marie
Psychopharmacology Unit, Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Intensive Care, Pharmacology and Emergency, Geneva University Hospitals, Geneva, Switzerland.
Unit for Treatment and Assessment of In and Out Patients With Learning Disabilities and Autism Spectrum Disorders, Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland.
Front Psychiatry. 2021 Jun 25;12:614825. doi: 10.3389/fpsyt.2021.614825. eCollection 2021.
Polypharmacy and inappropriate prescription are frequent in vulnerable and multi-morbid populations. Adults with intellectual disability (ID) are at risk of being polymedicated because they often present with multiple comorbidities and challenging behaviors. The objective of this study was thus to evaluate the prevalence of potentially inappropriate medications (PIM) and polypharmacy in a hospital unit dedicated to adults with ID. A 10-month prospective observational study took place at a hospital unit specializing in the care of adults with ID in Geneva, Switzerland. Once a week, health and prescription data were collected and screened for PIM according to preset definitions. Fourteen patients consented to participate, leading to 20 hospitalization events assessed during the study. Hospitalizations lasted 12.8 weeks on average. ID severities ranged from mild to profound, all degrees of severity being equally represented. One hundred percent of the patients were polymedicated (defined as five drugs or more prescribed simultaneously). A mean number of 9.4 drugs were prescribed per week, including 5.3 psychotropic drugs. The number of prescribed drugs remained stable throughout the hospitalizations. Antipsychotics were the most prescribed drug class (19% of all prescribed drugs), followed by benzodiazepines (13%) and laxatives (12%). A total of 114 PIM were recorded with an average of 5.7 PIM per hospitalization. This study showed that polypharmacy and inappropriate prescription are very common in adults with ID, even though the literature and expert positions advocate for deprescription in these patients. Specific prescribing and deprescribing guidelines are needed for that specific population.
多重用药和不适当处方在弱势群体和患有多种疾病的人群中很常见。成年智力残疾者有接受多种药物治疗的风险，因为他们经常患有多种合并症且行为具有挑战性。因此，本研究的目的是评估在一个专门收治成年智力残疾者的医院科室中，潜在不适当用药（PIM）和多重用药的发生率。在瑞士日内瓦一家专门照料成年智力残疾者的医院科室进行了一项为期10个月的前瞻性观察研究。每周收集一次健康和处方数据，并根据预设定义筛查PIM。14名患者同意参与，研究期间共评估了20次住院事件。住院时间平均为12.8周。智力残疾严重程度从轻度到重度不等，各严重程度的患者人数均衡。100%的患者接受了多重用药（定义为同时开具五种或更多药物）。每周平均开具9.4种药物，其中包括5.3种精神药物。在整个住院期间，开具药物的数量保持稳定。抗精神病药物是开具最多的药物类别（占所有开具药物的19%），其次是苯二氮䓬类药物（13%）和泻药（12%）。共记录到114例PIM，每次住院平均有5.7例PIM。本研究表明，多重用药和不适当处方在成年智力残疾者中非常普遍，尽管文献和专家观点主张对这些患者进行减药。针对该特定人群需要制定具体的处方和减药指南。
