title: Side effects related to potentially inappropriate medications in elderly psychiatric patients under everyday pharmacotherapy.
abstract: OBJECTIVE
  Potentially inappropriate medication (PIM) is suggested to give rise to adverse drug events. To study this suggestion for elderly psychiatric patients, an observational analysis related prescription of PRISCUS PIMs and drug-induced side effects in old aged (≥65 years) psychiatric inpatients and outpatients under conditions of everyday pharmacotherapy.
  
  
  METHODS
  Request forms from a therapeutic drug monitoring (TDM) survey and medical files were screened for medication to identify PIMs of the PRISCUS list and assessed using the Udvalg for Kliniske Undersøgelser (UKU) side effect rating scale.
  
  
  RESULTS
  From 914 TDM request forms, data were available for 168 patients (64.3 % female). Patients (mean ± SD age 73.0 ± 5.5 years) received by mean 6.4 ± 3.9 drugs per day. More than half of them (53.0 %, n = 89) had at least one PIM, inpatients 0.9 ± 0.8 and outpatients 0.5 ± 0.7. Predominant PIMs were hypnotic drugs (69 %) in inpatients and antipsychotic drugs (35.6 %) in outpatients. The number of PIMs correlated with the total number of drugs administered per day (Spearman correlation coefficient 0.225, p < 0.01, CI 95 %). Side effects were documented for 106 patients (63 %). Severity of side effects did not correlate significantly (p > 0.05) with number of PIMs. However, only 6 of 77 patients who took no PRISCUS PIMs but 2 of 3 patients who took 3 PRISCUS PIMs exhibited severe side effects.
  
  
  CONCLUSIONS
  Though the prevalence for PIMs and side effects was high in old aged psychiatric inpatients and outpatients, PIMs could not be identified as major determinants of overall unwanted side effects. Nevertheless, prescription of PIMs should be minimized, especially of hypnotic drugs, to improve safety.
authors.affiliation: Department of Psychiatry and Psychotherapy, University Medical Center, Mainz, Germany, gudrun.hefner@unimedizin-mainz.de.
authors.forename: Gudrun
authors.initials: G
authors.lastname: Hefner
authors.forename: Viktoria
authors.initials: V
authors.lastname: Stieffenhofer
authors.forename: Susanne
authors.initials: S
authors.lastname: Gabriel
authors.forename: Gerlind
authors.initials: G
authors.lastname: Palmer
authors.forename: Kay-Maria
authors.initials: KM
authors.lastname: Müller
authors.forename: Joachim
authors.initials: J
authors.lastname: Röschke
authors.forename: Christoph
authors.initials: C
authors.lastname: Hiemke
mesh_terms: D000368:Aged; D014150:Antipsychotic Agents / Q000009:adverse effects; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology*; D005260:Female; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D010045:Outpatients / Q000706:statistics & numerical data
chemical_list: D014150:Antipsychotic Agents; D006993:Hypnotics and Sedatives