Transcript Stoss, Y.A., Miesner, M.T.,Druery, R.C, Dula, C.S. (2011, March).

What Are We On? Investigating Anxiety and Mood Disorders
and Multiple Drug Prescriptions in Primary Care
Yasmin A. Stoss, Michael T. Miesner, Ryne Druery & Chris S. Dula
APPLIED PSYCHOLOGY LABORATORY
East Tennessee State University
http://www.etsu.edu/apl/
Johnson City, Tennessee
INTRODUCTION
RESULTS
DISCUSSION
 Though newer Serotonin Re-uptake Inhibitors (SSRIs) may be safer
when used alone, there are data suggesting they are more dangerous
when combined with other medications (polytherapy), due to their
pharmacodynamic and pharmacokinetic properties (Settle, 1992).
Data was analyzed using Analysis of Variance (ANOVA). Chart notation of
anxiety was not significantly related to prescription quantity, F(1,96) = 3.487
with p = .065. Chart notions of mood disorders did differ significantly as a
function of prescription quantity, F(1,96)= 8.771, p=.004.
 Anxiety was not found to be significantly related to prescription
quantity. This was unexpected and is interesting considering the
overlap between anxiety and mood disorders in treatment.
 Previous studies depict the common use of polytherapy despite lack
of greater effectiveness. The data partially supports H2, as it relates to
polytherapy of two drug classes.. However monotherapy in this
instance is more common. The most common combinations found in
this study were first SSRIs and Anticonvulsants and second SSRIs
and Antipsychotics.
 A growing number of options for treating mood disorders seems to
encourage prescription of multiple mood-altering and psychotropic
agents. However, polytherapy has not been shown to be associated
with superior clinical improvement or shorter hospitalization but was
associated with higher body weight (Centorrino, et. al., 2007).
 Use of antidepressants in the treatment of bipolar depression was
found to be highly prevalent and sustained, despite limited evidence
of efficacy or safety in this context (Baldessarini, et. al., 2007).
 It is critical to continue efficacy research in medicinal treatments of
mood and other mental disorders, but it is likewise vital to better
understand physician prescription patterns.
16
14
12
Number of Patient s
 Polytherapy involving antipsychotic drugs continues to increase
despite limited empirical evidence for greater effectiveness and
findings suggesting safety concerns (Centorrino, et. al., 2007).
Frequency of Treatment with Polytherapy
LIMITATIONS
10
 Data were collected only from one primary care site.
 There was no way to verify that the medical charts were complete in
Mood
regards to patients’ full medical histories. Thus, some patients may
Anxiety
have had relevant but unnoted diagnoses from previous physicians.
8
6
 The scope of this project limited the gathering the diagnostic types of
affective disorders as well as the severity of the potential disorders,
due to the nature of the medical chart review procedures.
4
2
 One of the problems in detecting a mental health disorder in primary
care is the ability for a patient to effectively communicate with their
PCP. This may be in part to many patients having trouble overcoming
the negative stigma associated with seeking mental health treatment.
0
0
HYPOTHESES
2
3
4
5
Number of Prescriptions
 H1: Patients with chart notations or diagnoses of mood and or
anxiety will not have been prescribed significantly more mental
health drugs in combination (Polytherapy) than other affective
disorders.
 H2: A diagnosis of either a mood or anxiety disorder may lead to a
increased number of multiple drug prescriptions.(e.g. SSRI’s, TCA’s,
Antipsychotics, Benzodiazepines, or Anticonvulsants).
1
IMPLICATIONS & FUTURE DIRECTIONS
 Future studies might seek to further test the efficacy of polytherapy
for mood and anxiety diagnosed patients versus monotherapy and
other forms of treatment.
Most Common drugs prescribed in combination
7
6
 Ongoing research seeks to determine how accurate physicians are at
detecting and treating affective disorders in primary care.
5
METHOD
 Participants : 100 medical charts were reviewed at a rural family
medicine clinic. Patients were between 18 and 90 years old with a
mean age of 49.84, SD= 17.79.
 Method: Data was collected by 8 undergraduates trained to review
charts in an integrated primary care practice. Data were recorded
pertaining to the number of drugs a patient was prescribed, the types
of drugs prescribed, and the relation of drug prescription to mental
health conditions noted in patient’s charts. Data was matched up with
the categories for mental illness types to see if any relation presented
itself between the existence of a particular kind of mental disorder
and the number of types of drugs a patient was prescribed.
 Physicians in the primary care setting might be educated on affective
disorders and how to refer possibly afflicted patients to mental health
Anxiety
care professionals, in addition to providing relevant medications.
4
Mood
3
REFERENCES
2
Centorrino, F., Cincotta, S. L., Talamo, A., Fogarty, K. V., Guzzetta, F., Saadeh,
M. G., et al. (2008). Hospital use of antipsychotic drugs: Polytherapy. Psychiatry:
Interpersonal and Biological Processes, 49, 65–69.
1
0
SSRIs and TCA
SSRIs and
Antipsychotics
SSRIs and
anticonvulsants
SSRIs and
Benzodioazapenes
CONTACT: Yasmin A. Stoss, [email protected] or Chris S. Dula, [email protected]
Prairie, E., Cor-, N., Hanover, E., & Diego, S. (2008). Psychotropic Medications
for Patients With Bipolar Disorder in the United States: Polytherapy and
Adherence. October, 59 (10).
Settle, E. C. (1992). Antidepressant side effects: Issues and options [Monograph].
Journal of Clinical Psychiatry, 10, 48–61.