Objective: In response to the increasing cost of psychopharmacological medication, the Department of Geriatric Psychiatry at Frederiksberg Hospital, Copenhagen, is seeking to derive a policy, which will ensure psychiatric patients receive appropriate treatment, while controlling the overall cost of treatment.
Design: Naturalistic study. Part of larger prospective study. Registration of the current practice and how they influence on the future prescription of psychotropic drugs.
Materials and Methods: All hospitalized patients (47) at the given day, were categorized by diagnosis on admission.The patient's current medication, prescribed for treatment of psychiatric and somatic illnesses, was recorded. The use and reason for prescription of additional or replacement psychotropic medication during the period of treatment in the department, as well as non-medication therapies, were recorded. Outcome and cost of treatment discussed.
Results: 12 of the patients had a current medical condition that could explain the patient's symptoms, and 7 of these patients were already taking medication that would influence the choice of psychotropic drug. Prior to hospital admission, patients with Affective Disorders (22 patients ) were treated with SSRI; in 9 cases followed by nortriptilyn, mitrazapine, mianserine and eenlaflaxins and lithium (one case). In 6 cases patients with psychotic features, the antidepressant had been augmented by one antipsychotic, such as olazapine or risperidone. In some cases, a combination of dDisorders, the prescribed medication has been a SSRI (5 cases), olanzapine (4),risperidone (4). Lithium in one cases. As expected, inpatients withsSchizophrenia (6 patients), the treatment for half of them had recently been changed to a newer antipsychotic and in 5 cases augmented with antidepressants. During hospitalization 4 patients with diagnosis affective of medication was increased, augmented by other anidepresants in 4, or with olanzapine in 3 cases. However, 8 of 22 patients recovered only when they were treated with ECT. In patients with organic disorders, doses for current medication was increased, but in more than one third of patients medication for concomitant somatic illness was prescribe, and ECT was used in one cases. In patients with schizophreni, current medication was increased in 5 patients, decreased in one or augmented by anxiolytic in 3. Two patiens were only counselled.
Conclusion: Pharmacological treatment of the same psychiatric condition and symptoms varied from patient to patient without any explanation. The coste of such treatment varied as well. Some of the pharmacological treatment, as increase of the current medication, could be given to the paients at home and they do not need hospitalization. Augmentation by other medication was very common. That suggests a need for the future study on a more systematic approach to pharmacological management of elderly psychiatric patients. Is it possible to give the same pharmacological treatment to the patient with the same psychiatric symptoms and get the same outcome.
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