Adverse drug reactions: a retrospective review of hospitalized patients at a state psychiatric hospital.
BACKGROUND
There is a paucity of information regarding adverse drug reactions (ADRs) in psychiatric patients. Information on common and preventable ADRs (pADRs) in psychiatric patients will allow for targeted improvement projects.


OBJECTIVE
To characterize reported ADRs and pharmacist interventions to prevent ADRs in an extended-care state psychiatric hospital.


METHODS
Four years of ADR reports were assessed for probability, reaction severity, pharmacological class of medication involved, preventability, change in therapy, and transfers to a medical facility. The pharmacist intervention database was queried for interventions classified as "prevention of ADR." The interventions were assessed for type of medication and recommendation acceptance.


RESULTS
Medication classes responsible for ADRs included mood stabilizers (30%), typical antipsychotics (25%), atypical antipsychotics (25%), and antidepressants (8%). Nine percent resulted in transfer to a medical facility. Of all ADRs, 34.4% were pADRs; mood stabilizers (41%) and atypical antipsychotics (27%) were the most common pADRs. The most common causes of pADRs were supratherapeutic serum concentrations, drug-drug interactions, and history of reaction. There were 87 pharmacist interventions that were classified as "prevention of ADR," and the acceptance rate of pharmacists' recommendations was 96.5%. Mood stabilizers (20%), atypical antipsychotics (17%), and typical antipsychotics (11%) were commonly associated with prevented ADRs. Lithium accounted for 13.8% of prevented ADRs; these ADRs were most often due to a drug-drug interaction with a nonsteroidal anti-inflammatory drug.


CONCLUSIONS
ADRs were most commonly associated with mood stabilizers and antipsychotics, and pADRs were common. There is an opportunity to provide education to medical staff on therapeutic drug monitoring and drug-drug interactions for these classes, particularly lithium.
Clinical Pharmacist, Center for Behavioral Medicine, Kansas City, Missouri;
Courtney A
CA
Iuppa
Associate Professor, University of Missouri-Kansas City, School of Pharmacy;
Leigh Anne
LA
Nelson
Clinical Pharmacy Manager, Center for Behavioral Medicine, Kansas City, Missouri;
Ellie
E
Elliott
Professor, University of Missouri-Kansas City, Missouri. Corresponding author: Leigh Anne Nelson, PharmD, BCPP, Division of Pharmacy Practice and Administration, University of Missouri-Kansas City, 2464 Charlotte Street, 4250 Health Sciences Building, Kansas City, MO 64108; phone: 816-512-7487; fax: 816-512-7478; e-mail: nelsonla@umkc.edu.
Roger W
RW
Sommi
adverse drug reactions; drug interactions; drug safety; preventable adverse drug reactions; psychiatry; psychotropic drugs