Antipsychotic drug treatment of schizophrenia in later life: Results from the European cross-sectional AMSP study.

OBJECTIVES: To investigate the relationship between patient age and the selection and dosage of antipsychotic drugs (APDs) for treatment of schizophrenia. We describe age effects for multiple individual APDs, thus allowing comparisons between drugs. METHODS: Prescription data of 32,062 inpatients with schizophrenia from 2000 to 2017 were obtained from the Drug Safety Program in Psychiatry (AMSP) database. APD selection and dosage were related to patient age with sex as an influencing variable. Moreover, a systematic search of current guideline recommendations on APD treatment in patients with schizophrenia aged ≥65 years was performed. RESULTS: Eighty percentof elderly patients (≥65 years) received a second-generation APD, most commonly risperidone. The dosage of APDs increased with age until about age 40 years, then decreased slowly at first and more steeply beyond age 55 years. The influence of age as well as sex on dosage partly differed between the individual drugs. Only one of eight schizophrenia guidelines systematically addressed specific aspects of pharmacotherapy in older adults. CONCLUSIONS: In clinical routine, age has a significant impact on selection and dosing of APDs. Information on optimising pharmacotherapy in older adults with schizophrenia from clinical trials is needed. Guidelines should be improved regarding APD therapy specifically for older adults.

[DNVF-Discussion paper - Specificities, Challenges and Aims of Mental Health Service Research in Germany]. / DNVF-Diskussionspapier ­ Besonderheiten, Herausforderungen und Ziele der Versorgungsforschung im Feld der seelischen Gesundheit.

Research in mental health services in Germany is of increasing relevance. To this end, the recently founded "Mental Health Working Group" as part of the German Network of Health Services Research (DNVF) has written a discussion paper presenting key specifics, challenges, and goals of health service research in the field of mental health. Some research-relevant specifics in the area of mental health care, pragmatic challenges of research organization, ethical problems, and particular research topics in this field are presented and discussed critically.

[Psychopharmaceutical Medication in Brandenburgian Nursing Homes - An Exploratory Study]. / Psychopharmakamedikation in brandenburgischen Pflegeheimen ­ eine explorative Studie.

OBJECTIVE: Psychopharmaceuticals are often prescribed in nursing homes for elderly. Together with the general polypharmacy, the risk for adverse drug reactions and interactions is increased. METHODS: Medication data of 398 nursing home residents were analyzed. Guided interviews and focus groups were carried out with nurses, prescribing physicians and relatives. RESULTS: About 70 % of the residents received psychotropic drugs often with sedative properties. High work load, sociodemographic development and shortage of psychiatrists and neurologists had an influence on the prescription rates. CONCLUSION: Nurses and physicians need to be aware of possible adverse drug effects and interactions of psychotropics. The overall amount of psychopharmaceuticals prescribed in nursing homes should be reduced.