title: Adverse drug reactions in hospitalized psychiatric patients.
abstract: BACKGROUND
  Reducing adverse drug reactions (ADRs) is a critical element in providing safe medication use to hospitalized patients. There is an abundance of literature describing ADRs and preventable ADRs (pADRs) in hospitalized patients; however, little has been published specific to psychiatric inpatients. Further knowledge of the most common pADRs in hospitalized psychiatric patients will allow targeted patient safety initiatives to be developed.
  
  
  OBJECTIVE
  To determine the most frequent ADRs and pADRs in a psychiatric hospital, with emphasis on identifying factors for prevention.
  
  
  METHODS
  Three years of ADRs at a psychiatric hospital were analyzed and evaluated according to type of medication, preventability, severity, and factors associated with preventability.
  
  
  RESULTS
  From July 1, 2006, to June 30, 2009, 93 ADRs were reported; 19 (20.4%) were classified as preventable. Psychiatric medications accounted for 45 (48.4%) of the ADRs and nonpsychiatric medications were associated with 48 (51.6%). Cardiovascular agents (n = 17) and antiepileptics (n = 17) were responsible for most ADRs. Of the 19 pADRs, lithium was the drug reported most frequently, followed by phenytoin and anxiolytics. Nine (47%) of the pADRs were severe and required a medical transfer for management; 3 of the 9 were lithium toxicity. The most common preventability factor involved drug interactions. A pharmacy intervention involving staff education to reduce lithium pADRs is presented.
  
  
  CONCLUSIONS
  Awareness of the most frequent drug classes associated with ADRs and pADRs in a psychiatric hospital allows opportunity for education, medication management system changes, and improved patient safety. Lithium, followed by phenytoin and anxiolytics, were the most common drugs associated with pADRs. A drug-drug interaction was the most frequent factor associated with pADRs.
authors.affiliation: Department of Pharmacy, Springfield Hospital Center, Sykesville, MD 21784, USA. mithomas@dhmh.state.md.us
authors.forename: Michele
authors.initials: M
authors.lastname: Thomas
authors.forename: Angela A
authors.initials: AA
authors.lastname: Boggs
authors.forename: Bethany
authors.initials: B
authors.lastname: DiPaula
authors.forename: Shahida
authors.initials: S
authors.lastname: Siddiqi
mesh_terms: D016907:Adverse Drug Reaction Reporting Systems / Q000706:statistics & numerical data; D000927:Anticonvulsants / Q000009:adverse effects*; D014150:Antipsychotic Agents / Q000009:adverse effects*; D002317:Cardiovascular Agents / Q000009:adverse effects*; D004347:Drug Interactions; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D006760:Hospitalization; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data; D006801:Humans; D008396:Maryland; D001523:Mental Disorders / Q000188:drug therapy*; D011336:Probability; D012189:Retrospective Studies
chemical_list: D000927:Anticonvulsants; D014150:Antipsychotic Agents; D002317:Cardiovascular Agents