Atherton Jennifer, Abdrabbo Maryam, Kassab Hagar
Department of Pharmacy, St. Joseph's University Medical Center, Paterson, NJ, USA.
Department of Pharmacy, Yale New Haven Hospital, New Haven, CT, USA.
J Pharm Technol. 2023 Aug;39(4):199-204. doi: 10.1177/87551225231182286. Epub 2023 Jun 30.
Abrupt discontinuation of home psychotropic medications is common among critically ill patients but may precipitate clinically significant withdrawal. To determine the percent of patients with interruptions in home psychotropic medications upon intensive care unit (ICU) admission and to identify outcomes associated with these interruptions. This was an institutional review board-approved, single-center, retrospective study of critically ill patients with a history of mental illness taking an antipsychotic or antidepressant medication. The primary outcome was the percent of patients with interruption in at least one home psychotropic medication for ≥24 hours upon ICU admission. Secondary outcomes included time to psychotropic re-initiation, percent of home psychotropic medications restarted in the ICU, ICU length of stay (LOS), delirium, withdrawal-related complications, need for acute antipsychotics or benzodiazepines, and reasons for psychotropic interruption. Among 183 patients, 93 (50.8%) had interruptions in home psychotropic therapy for ≥24 hours upon ICU admission. Mean time to reinitiation of at least one psychotropic agent was 1.4 days, and 16.4% of patients did not have any home psychotropics restarted. Patients with psychotropic interruption had a longer ICU LOS ( = 0.01) and greater incidence of ICU delirium ( < 0.01). Withdrawal-related complications were similar between groups. Acute antipsychotic use was greater in patients with psychotropic interruption ( < 0.01). Acute benzodiazepine use was not different between groups ( = 0.87). Most patients did not have a documented reason for therapy interruption. Unless contraindicated, clinicians should attempt to restart home psychotropic medications as soon as possible in critically ill patients.
在重症患者中，突然停用家庭精神药物的情况很常见，但这可能会引发具有临床意义的戒断反应。为了确定重症监护病房（ICU）入院时家庭精神药物中断的患者比例，并确定与这些中断相关的结局。这是一项经机构审查委员会批准的单中心回顾性研究，研究对象为有精神疾病史且正在服用抗精神病药或抗抑郁药的重症患者。主要结局是ICU入院时至少一种家庭精神药物中断≥24小时的患者比例。次要结局包括精神药物重新开始使用的时间、在ICU重新开始使用的家庭精神药物的比例、ICU住院时间（LOS）、谵妄、戒断相关并发症、使用急性抗精神病药或苯二氮卓类药物的需求以及精神药物中断的原因。在183例患者中，93例（50.8%）在ICU入院时家庭精神治疗中断≥24小时。重新开始使用至少一种精神药物的平均时间为1.4天，16.4%的患者没有重新开始使用任何家庭精神药物。精神药物中断的患者ICU住院时间更长（P = 0.01），ICU谵妄的发生率更高（P < 0.01）。两组之间戒断相关并发症相似。精神药物中断的患者急性抗精神病药的使用更多（P < 0.01）。两组之间急性苯二氮卓类药物的使用没有差异（P = 0.87）。大多数患者没有记录在案的治疗中断原因。除非有禁忌证，临床医生应在重症患者中尽快尝试重新开始使用家庭精神药物。
