Trends of Adverse Drug Reaction Reports in a Hospitalized Psychiatric Population: Exploring Prescriber Discontinuations as Potential Unreported Adverse Drug Events.

The review of adverse drug reactions (ADRs) is a safety mandate required by numerous organizations in the medication safety community. For adverse reactions to be properly reviewed, they must first be reported as potential events. There are notable challenges to ensure adequate and accurate reporting of ADRs that could be overcome if obstacles were better understood and addressed in a manner that is not punitive or threatening. Even reports of seemingly benign side effects might be valuable when considering the deleterious impact on medication adherence, notably in a psychiatric population. Our study examines the potential underreporting of adverse drug reactions that have been likely dismissed as expected side effects of medications. We underscore that there is a significant difference in what has been reported formally as an ADR and what should be reported based on the ability to identify prescribing changes that might be initiated in response to an ADR.

The Role of Serum Lithium Concentration on Pill Burden in Psychiatric Populations.

Objective: Current research validates the use of lithium as a first-line agent in bipolar disorder, yet it remains underutilized. This might, in part, be the result of lithium's risk of toxicity. A lower serum lithium concentration would decrease the risk of toxicity. This study examined whether lithium serum concentrations are associated with an additional medication burden resulting from psychiatric polypharmacy. Methods: The retrospective data of adult inpatients receiving lithium who had at least one serum lithium concentration recorded were extracted from the computerized patient record system, bar code medication administration, and mental health automated health record system. Results: 38 patient charts were reviewed and a total of 192 individual serum lithium concentrations were analyzed. There was no statistically significant difference (increase or decrease) in the number of psychiatric medications prescribed or the number of scheduled psychiatric medication doses administered. There was a statistically significant increase in the number of psychiatric medications prescribed over the Food and Drug Administration (FDA) recommended maximum daily dose (MDD) following a serum lithium concentration record. Individuals with a serum lithium concentration below 0.6mEq/L were more likely to be prescribed medications over the MDD. Conclusion: Serum lithium concentrations did not increase or decrease the overall psychiatric pill burden. The number of psychiatric medications an individual is prescribed remained the same regardless of their serum lithium concentration. Overall pill burden did not change with the serum lithium concentration; however, lower serum lithium concentrations might necessitate prescribing of psychiatric medications in doses exceeding the MDD.

Impact of Ramadan fasting on medical and psychiatric health.

Ramadan is a religious month dedicated to prayer, fasting and feasting. Recently, there has been an increased interest among healthcare providers regarding possible health-related complications as a consequence of religious fasting such as that seen during Ramadan. In , a 34-year-old female patient with a diagnosis of schizoaffective disorder, depressive type, was admitted for inpatient hospitalization to an inpatient psychiatric hospital in Buffalo, New York. The earliest date of initial diagnosis is unclear; however, the patient reports an increase in symptoms during her early twenties. Upon admission, the patient was continued on haloperidol, lithium and fluphenazine decanoate which had been initiated prior to this admission. Medication administration and meal times were adjusted to accommodate her observance of Ramadan. Despite efforts to mitigate the potential impact, the patient complained of dizziness and weakness following initiation and titration of clozapine. Due to psychiatric exacerbation, inpatient hospitalization and continuous monitoring, clozapine titration occurred quickly. Upon admission, the patient's blood pressure was 137/85 mmHg, which decreased to a low of 87/58 mmHg as her clozapine dose was increased, leaving the patient requesting bedrest due to significant dizziness and weakness. On the 21st day of Ramadan, the patient broke her fast due to substantial adverse effects. Five days after breaking her fast, the patient's blood pressure increased and returned to baseline. Individuals participating in Ramadan tend to have disrupted sleep cycles, including nocturnal sleep reduction and broken sleep patterns, which can impact overall health. Additional health-related complications that have been reported include dehydration and changes in blood glucose, blood pressure, lipid panel, body weight and exacerbation of psychiatric symptoms. These adverse effects can result in serious complications in fasting individuals with acute medical and psychiatric illness. Clozapine was initiated and rapidly titrated during the patient's observance of Ramadan. She exhibited signs and symptoms of hypotension, which were also subjectively reported by the patient. The significant drop in blood pressure while fasting, and rapid increase once the fast was broken, confirm that medication changes implemented during religious fasting, such as that seen during Ramadan, can increase a patient's risk of serious adverse effects.