Improving drug safety and tolerability in psychiatric clinical practice

✍ Scribed by Dr Peter M. Haddad; Dr Serdar M. Dursun

• Publisher: John Wiley and Sons
• Year: 2007
• Tongue: English
• Weight: 65 KB
• Volume: 23
• Category: Article
• ISSN: 0885-6222
• DOI: 10.1002/hup.919

✦ Synopsis

Improving drug safety and tolerability in psychiatric clinical practice y Psychiatric drugs, like all drugs, are associated with a range of adverse effects. Sometimes these are trivial but when severe they can impair quality of life, lead to poor adherence with medication, cause physical morbidity and in extreme cases be fatal. These potential problems need to be balanced against the benefits of medication. Drugs are a key part of the treatment of most major psychiatric disorders. Randomised controlled trials have incontrovertibly demonstrated the efficacy of antidepressants in the acute, continuation and maintenance phase of depressive illness (Anderson et al., 2000;Carney et al., 2001) and the efficacy of antipsychotics in the acute (Davis et al., 2003) and long term treatment of schizophrenia (Leucht et al., 2003). A strong evidence base supports the use of antipsychotics in mania and increasing data support the use of specific atypical drugs in other phases of bipolar disorder (National Institute of Clinical Excellence, 2006). Clozapine has unique efficacy in treatment resistant schizophrenia (Wahlbeck et al., 2000). This supplement highlights some key areas in psychiatric drug safety and tolerability. For a comprehensive review of other adverse effects of psychiatric drugs readers are referred to a recent text book (Haddad et al., 2004).

The paper by Mackin (2007) comprehensively reviews the cardiac side effects of psychiatric drugs including orthostatic hypotension, syncope, myocarditis, cardiomyopathy and QTc prolongation and its relationship to arrhythmic risk. Mackin highlights that patients with severe mental illness (SMI) are a 'high risk' population with regard to cardiovascular morbidity and mortality. This partly reflects traditional risk factors, such as diets high in saturated fat and lack of exercise, but psychotropic drugs may also contribute by causing