Schulze Westhoff Martin, Bannasch Sophie, Heck Johannes, Bleich Stefan, Schröder Sebastian, Groh Adrian
Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany.
Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany.
Ther Adv Psychopharmacol. 2025 May 16;15:20451253251339373. doi: 10.1177/20451253251339373. eCollection 2025.
Psychiatric emergencies include agitation, substance-related (e.g., withdrawal) symptoms, and suicidal as well as self-harming behavior and require interdisciplinary management. Drug treatment of geriatric patients in emergency situations may be complicated by adverse drug reactions (ADRs).
This study aimed to investigate prescriptions of potentially inappropriate medications (PIMs) and potential drug-drug interactions (DDIs) in the context of geriatric psychiatric emergencies in the emergency department (ED).
Retrospective single-center study.
The medication lists of 87 consecutively acquired geriatric patient cases receiving pharmacological treatment between January 2018 and December 2022 in a psychiatric emergency department were analyzed. Herein, utilizing the PRISCUS 2.0 list and the Fit fOR The Aged (FORTA) classification, prescriptions of PIMs were assessed, and DDIs were classified with the aid of the drug interaction program AiDKlinik® (Arzneimittel-Informations-Dienste, Dosing GmbH, Heidelberg, Germany).
A total of 94 drugs were administered during treatment in the ED. The total number of drugs per patient was on average 5.9 1 (median: 5; interquartile range: 4) hereafter. 77.7% of the newly prescribed drugs were PIMs according to the PRISCUS 2.0 list, while 18.1% were designated as therapeutic alternatives to PIMs. 70.2% and 22.3% of the newly recommended drugs were FORTA category C and D drugs, respectively. An average of 0.8 (median: 0; interquartile range: 1) potential DDIs existed before psychiatric ED treatment, and 0.9 (median: 0; interquartile range: 2) potential DDIs thereafter ( = 0.002). Coercive measures-such as administration of medication against the patient's will-were rarely required in the study population.
The majority of all drug prescriptions for the treatment of geriatric psychiatric emergencies were categorized as PIMs according to the PRISCUS 2.0 list and the FORTA classification. However, it should be noted that these PIM classification systems were not specifically designed for geriatric psychiatric settings. The number of potential DDIs was significantly higher after drug administration in the ED than before, which should prompt the monitoring of certain clinical parameters in the further course of treatment.
精神科急症包括躁动、物质相关（如戒断）症状、自杀及自伤行为，需要多学科管理。老年患者在急诊情况下的药物治疗可能因药物不良反应（ADR）而变得复杂。
本研究旨在调查急诊科（ED）老年精神科急症中潜在不适当药物（PIM）的处方及潜在药物相互作用（DDI）。
回顾性单中心研究。
分析了2018年1月至2022年12月期间在一家精神科急诊科连续收治的87例接受药物治疗的老年患者的用药清单。在此，利用PRISCUS 2.0清单和适合老年人（FORTA）分类评估PIM的处方，并借助药物相互作用程序AiDKlinik®（德国海德堡剂量有限公司药物信息服务部）对DDI进行分类。
在ED治疗期间共使用了94种药物。此后每位患者的药物总数平均为5.91种（中位数：5；四分位间距：4）。根据PRISCUS 2.0清单，77.7%的新处方药物为PIM，而18.1%被指定为PIM的治疗替代药物。新推荐药物中分别有70.2%和22.3%属于FORTA C类和D类药物。在精神科ED治疗前平均存在0.8种（中位数：0；四分位间距：1）潜在DDI，治疗后为0.9种（中位数：0；四分位间距：2）（P = 0.002）。在研究人群中很少需要采取强制措施，如违背患者意愿给药。
根据PRISCUS 2.0清单和FORTA分类，治疗老年精神科急症的所有药物处方中大多数被归类为PIM。然而，应注意这些PIM分类系统并非专门为老年精神科环境设计。在ED给药后潜在DDI的数量显著高于给药前，这应促使在后续治疗过程中监测某些临床参数。
