title: Reducing psychotropic pharmacotherapy in patients with severe mental illness: a cluster-randomized controlled intervention study.
abstract: BACKGROUND
  Many patients with mental illness receive psychotropic medicine in high dosages and from more than one drug. One of the consequences of this practice is obesity, which is a contributing factor to increased physical morbidity and premature death.
  
  
  METHODS
  Our study was a cluster-randomized intervention study involving 6 facilities and 174 patients diagnosed with severe mental illnesses (73% schizophrenia). The intervention period was 12 months and consisted of teaching sessions with the staff and evaluating the patients' intake of psychotropic medication. At index, 44% met criteria for obesity and 76% met criteria for overweight. Waist circumferences were 108 cm for men and 108 cm for women. Olanzapine, clozapine and quetiapine were the most common prescribed antipsychotics. Mean values of daily doses of antipsychotic were 2.5.
  
  
  RESULTS
  The intervention showed no significant differences between the intervention and control group regarding psychotropic treatment. At follow up, independent of intervention, patients receiving antipsychotic polypharmacy had a larger waist circumference compared with patients receiving antipsychotic monotherapy of 9.8 cm (1.5-18.1) (p = 0.028).
  
  
  CONCLUSIONS
  We found both a high prevalence of obesity and that the patients received treatment with antipsychotic polypharmaceutics in high dosages. Active awareness did not change practice and we must think of other ways to restrict treatment with psychotropics in this group of patients.
authors.affiliation: Aarhus University Hospital - Randers Lokal Psychiatry, Dronningborg Boulevard 15, Randers, 8900, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Hjorth
authors.affiliation: Klinik fur Psyckiatrie und Psychotherapie, Ulm University, Gunzburg, Germany.
authors.forename: Reinhold
authors.initials: R
authors.lastname: Kilian
authors.affiliation: Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aalborg, Denmark.
authors.forename: Helle Østermark
authors.initials: HØ
authors.lastname: Sørensen
authors.affiliation: Region of North Jutland - Visborggaard, Visborg, Denmark.
authors.forename: Susan Engelbrechsen
authors.initials: SE
authors.lastname: Eriksen
authors.affiliation: Institut for folkevidenskab, Copenhagen University - Forskningsenheden for Almen Praksis og Afdelingen for Almen Medicin, Copenhagen, Denmark.
authors.forename: Annette Sofie
authors.initials: AS
authors.lastname: Davidsen
authors.affiliation: Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aalborg, Denmark.
authors.forename: Signe Olrik Wallenstein
authors.initials: SO
authors.lastname: Jensen
authors.affiliation: Aarhus University Hospital, Risskov - M, Aarhus, Denmark.
authors.forename: Povl
authors.initials: P
authors.lastname: Munk-Jørgensen
keywords: cluster randomized intervention; mental illness; obesity; psychotropic polypharmacy