Abstract：
OBJECTIVE: In 2019, a regional survey of potentially inappropriate prescriptions (PIP) of psychotropic drugs in elderly psychiatric inpatients was carried out highlighting their inappropriate use in this population. The aim of this study was to assess the clinical relevance - defined as the provision of an appropriate and necessary treatment, chosen from other alternatives as being the most likely to produce the expected results for a given patient - of these prescriptions considered inappropriate according to current established criteria.
METHODS: Patients aged over 75, or 64 to 75 and polypathological with at least one PIP of psychotropic drugs or drugs with a high anticholinergic burden, identified by an audit grid established on the basis of STOPP/STARTv2 criteria and the Laroche list on the prescription at 48h of hospitalization, were included. The weighing of the inappropriateness nature of the prescription (resistance to treatment, period of crisis, comorbidities…) was established by a pharmacist-psychiatrist pair on the entire computerized record of the current episode. The clinical relevance of the PIP and the overall prescription was rated as 0 (irrelevant), 1 (partially relevant) or 2 (relevant).
RESULTS: Thirty-four patients were included. One hundred and twenty-five PIP of psychotropic drugs were noted: 50.4% concerned benzodiazepines and non-benzodiazepines anxiolytics (BZD/Z), 25.6% neuroleptics (NL), 12% antidepressants (ATD) and 12% drugs with a high anticholinergic burden. On one hand, 49.2% of PIP of BZD/Z, 50% of PIP of NL and 20% of PIP of ATD were considered irrelevant. On the other hand, 49.2% of PIP of BZD/Z, 31.3% of PIP of NL and 13.3% of PIP of ATD were considered partially relevant. Furthermore, 1.6% of PIP of BZD/Z, 18.8% of PIP of NL and 66.7% of PIP of ATD were considered relevant. For PIPs of drugs with a high anticholinergic burden, 80% were deemed irrelevant, 13.3% partially relevant and 6.7% relevant. In all, of the 34 drug prescriptions studied, three (8.8%) were considered irrelevant, 11 (32.4%) partially relevant and 20 (58.8%) clinically relevant.
CONCLUSIONS: This study highlighted the clinical relevance of more than half the prescriptions considered inappropriate according to current PPI criteria in the elderly. It underlines the interest of a new PPI detection tool for elderly patients with psychiatric disorders.
METHODS: Patients aged over 75, or 64 to 75 and polypathological with at least one PIP of psychotropic drugs or drugs with a high anticholinergic burden, identified by an audit grid established on the basis of STOPP/STARTv2 criteria and the Laroche list on the prescription at 48h of hospitalization, were included. The weighing of the inappropriateness nature of the prescription (resistance to treatment, period of crisis, comorbidities…) was established by a pharmacist-psychiatrist pair on the entire computerized record of the current episode. The clinical relevance of the PIP and the overall prescription was rated as 0 (irrelevant), 1 (partially relevant) or 2 (relevant).
RESULTS: Thirty-four patients were included. One hundred and twenty-five PIP of psychotropic drugs were noted: 50.4% concerned benzodiazepines and non-benzodiazepines anxiolytics (BZD/Z), 25.6% neuroleptics (NL), 12% antidepressants (ATD) and 12% drugs with a high anticholinergic burden. On one hand, 49.2% of PIP of BZD/Z, 50% of PIP of NL and 20% of PIP of ATD were considered irrelevant. On the other hand, 49.2% of PIP of BZD/Z, 31.3% of PIP of NL and 13.3% of PIP of ATD were considered partially relevant. Furthermore, 1.6% of PIP of BZD/Z, 18.8% of PIP of NL and 66.7% of PIP of ATD were considered relevant. For PIPs of drugs with a high anticholinergic burden, 80% were deemed irrelevant, 13.3% partially relevant and 6.7% relevant. In all, of the 34 drug prescriptions studied, three (8.8%) were considered irrelevant, 11 (32.4%) partially relevant and 20 (58.8%) clinically relevant.
CONCLUSIONS: This study highlighted the clinical relevance of more than half the prescriptions considered inappropriate according to current PPI criteria in the elderly. It underlines the interest of a new PPI detection tool for elderly patients with psychiatric disorders.
摘要：
目的：2019年，对老年精神病住院患者的精神药物潜在不适当处方（PIP）进行了区域调查，强调了其在该人群中的不适当使用。这项研究的目的是评估临床相关性-定义为提供适当和必要的治疗，从其他替代方案中选择为最有可能产生给定患者的预期结果-根据当前既定标准，这些处方被认为是不合适的。
方法：年龄在75岁或64至75岁以上且患有至少一种PIP的精神药物或具有高抗胆碱能负担的药物的患者，由根据STOPP/STARTv2标准和住院48小时处方上的Laroche清单建立的审核网格确定，包括在内。处方不适当性质的权衡(对治疗的抵抗力，危机时期,合并症...）是由药剂师-精神病医生对当前情节的整个计算机化记录建立的。PIP和总体处方的临床相关性被评为0（无关），1（部分相关）或2（相关）。
结果：纳入34例患者。注意到125种精神药物的PIP：50.4％涉及苯二氮卓类药物和非苯二氮卓类药物抗焦虑药（BZD/Z），25.6%抗精神病药(NL),12％的抗抑郁药（ATD）和12％的药物具有高抗胆碱能负担。一方面,BZD/Z的PIP的49.2%，50%的NL的PIP和20%的ATD的PIP被认为是不相关的。另一方面,BZD/Z的PIP的49.2%，NL的31.3％的PIP和ATD的13.3％的PIP被认为是部分相关的。此外，1.6%的BZD/Z的PIP，18.8%的NLPIP和66.7%的ATDPIP被认为是相关的。对于具有高抗胆碱能负担的药物的PIP，80%被认为无关紧要，13.3%部分相关，6.7%相关。总之,在研究的34种药物处方中，三人(8.8%)被认为无关紧要，11（32.4%）部分相关，20（58.8%）临床相关。
结论：这项研究强调了根据目前的PPI标准，超过一半的处方被认为不适合老年人的临床相关性。它强调了一种新的PPI检测工具对患有精神疾病的老年患者的兴趣。
方法：年龄在75岁或64至75岁以上且患有至少一种PIP的精神药物或具有高抗胆碱能负担的药物的患者，由根据STOPP/STARTv2标准和住院48小时处方上的Laroche清单建立的审核网格确定，包括在内。处方不适当性质的权衡(对治疗的抵抗力，危机时期,合并症...）是由药剂师-精神病医生对当前情节的整个计算机化记录建立的。PIP和总体处方的临床相关性被评为0（无关），1（部分相关）或2（相关）。
结果：纳入34例患者。注意到125种精神药物的PIP：50.4％涉及苯二氮卓类药物和非苯二氮卓类药物抗焦虑药（BZD/Z），25.6%抗精神病药(NL),12％的抗抑郁药（ATD）和12％的药物具有高抗胆碱能负担。一方面,BZD/Z的PIP的49.2%，50%的NL的PIP和20%的ATD的PIP被认为是不相关的。另一方面,BZD/Z的PIP的49.2%，NL的31.3％的PIP和ATD的13.3％的PIP被认为是部分相关的。此外，1.6%的BZD/Z的PIP，18.8%的NLPIP和66.7%的ATDPIP被认为是相关的。对于具有高抗胆碱能负担的药物的PIP，80%被认为无关紧要，13.3%部分相关，6.7%相关。总之,在研究的34种药物处方中，三人(8.8%)被认为无关紧要，11（32.4%）部分相关，20（58.8%）临床相关。
结论：这项研究强调了根据目前的PPI标准，超过一半的处方被认为不适合老年人的临床相关性。它强调了一种新的PPI检测工具对患有精神疾病的老年患者的兴趣。
