Polypharmacy in a 75-year-old patient with schizoaffective disorder.
A 75-year-old white female with schizoaffective disorder was admitted to an inpatient psychiatry unit for uncooperativeness in refusing to take scheduled medications. She complained of anticholinergic adverse effects and had abnormal involuntary movements in the oral/buccal region. The patient had been prescribed six psychotropic medications (i.e., thiothixene, lithium, divalproex sodium, amitriptyline, benztropine, and trazodone effects. The treatment team determined that the patient was noncompliant and experienced the effects of polypharmacy. She had been prescribed two mood stabilizers and suffered from anticholinergic adverse effects and the movement disorder tardive dyskinesia (TD). Four medications were discontinued: thiothixene, amitriptyline, lithium, and benztropine. Quetiapine, a second-generation antipsychotic, was recommended, with a daily titration schedule to reach a target dose of 600 mg per day in divided doses. This agent has less propensity to cause movement disorders compared with first-generation antipsychotics. All medications with additive anticholinergic properties also were discontinued. Lithium was stopped secondary to subtherapeutic levels and potential drug interactions. The pharmacist educated the inpatient team on the additive anticholinergic effects of each medication, reduced the total number of medications prescribed, and assisted in appropriate conversion to quetiapine to reduce TD symptoms.
Department o Pharmacy, Virginia Commonwealth University Health-Systems, Richmond, Virginia, USA. ebreden@vcu.edu
Ericka L
EL
Breden
Cynthia K
CK
Kirkwood
D000368:Aged; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D018680:Cholinergic Antagonists / Q000009:adverse effects; D003987:Dibenzothiazepines / Q000008:administration & dosage / Q000627:therapeutic use*; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D004409:Dyskinesia, Drug-Induced / Q000209:etiology*; D005260:Female; D006801:Humans; D009459:Neuroleptic Malignant Syndrome; D019338:Polypharmacy; D011618:Psychotic Disorders / Q000188:drug therapy*; D000069348:Quetiapine Fumarate; D016312:Treatment Refusal
D014150:Antipsychotic Agents; D018680:Cholinergic Antagonists; D003987:Dibenzothiazepines; D000069348:Quetiapine Fumarate