Impact of Deprescribing on Polypharmacy, Adverse Drug Reactions, and Quality of Life in Patients on Antipsychotic Medications: A Prospective Observational Study
Keywords:
Deprescribing, Polypharmacy, Psychiatric care, Adverse drug reactions (ADRs), Quality of life (QoL), Cognitive functioningAbstract
Introduction: Polypharmacy in psychiatric care often results in adverse drug reactions, treatment challenges and poor patient outcomes. The idea of deprescribing or lowering or ending use of unnecessary medicines, is now seen as a helpful approach to these challenges. We still know little about how psychiatric patients are affected by polypharmacy and how beneficial the deprescribing is. Thus this study focussed to find out if a structured deprescribing approach could help reduce polypharmacy, ADRs, treatment burden, psychiatric symptoms and cognitive function in psychiatric patients.
Methods: The study was conducted at a tertiary care psychiatric hospital in Ongole, Andhra Pradesh. A total of 205 people over 18 years old with psychiatric disorders and polypharmacy were enrolled for the study which was conducted from June 2022 to December 2023. Medications were slowly reduced according to both clinical recommendations and patient consent. To assess the results, psychiatric symptom severity (PANSS), quality of life (WHOQOL-BREF), cognitive function (MoCA), adverse drug reactions (ADRs) and treatment burden (TBQ) were measured. Assessments were made before deprescribing and after that. Statistical tests used in the study were paired t-tests, Chi-square tests and regression models.
Results: Post-deprescribing, a 3.2% decrease in polypharmacy (p=0.057) was observed with fewer ADRs (58.6% less, p<0.001) and improvements in psychiatric symptoms (14.9% decrease, p<0.01), QoL (16.8% more, p<0.001) and cognitive function (18.8% more, p<0.05). All areas of the TBQ showed a significant decrease in treatment burden (p<0.05), along with greater satisfaction and better medication adherence by patients.
Conclusion: Deprescription of drugs in psychiatric patients led to fewer side effects, less polypharmacy and less difficulty with medications, together with improvements in mood, quality of life and cognitive abilities. The results suggest that deprescribing in routine therapeutic practice in psychiatry can make medication management safer and more effective.
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