Polypharmacy in Pregnant Women with Severe Mental Illness
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PREGNANCY AND PSYCHOTROPIC MEDICATION Kathleen S. Peindl1, PhD, Paolo Mannelli, MD1, Ashwin Patker, MD1, Prakash Masand1, MD, Meera Narasimhan, MD2 1Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina; 2University of South Carolina School of Medicine, Department of Neuropsychiatry, Columbia South Carolina
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ABSTRACT Objective: The aim of this study is to describe the patterns of medication use across pregnancy in a low SES group of women with severe mental illness. Method: Data from the years 2002-2004 and the South Carolina Medicaid system, which included 5,000 patients with a psychiatric diagnosis of bipolar, schizoaffective or schizophrenia was examined. The study was approved by South Carolina School of Medicine IRB. Among the 5,000 patients, 115 women were pregnant Information on diagnosis, age, dates prescription were filled, type , dose and quantity of medication was extracted from the records. Results: There was data on 75 women of which 56 women had nine months worth of data; 10 women miscarried and 9 women delivered prematurely. The mean age was 26. The mean number of medications was 3 (range 0-10). 26.8% of the women filled prescriptions for 6-10 medications. No dosing changes occurred over the pregnancies. The most frequently prescribed medications for these women were opiates and antimicrobial medications. Almost no women were sustained on medications for their psychiatric illness.
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Conclusions: Prescriptions for psychotropic medication during pregnancy requires clinical vigilance given the implications on the well being of the fetus. The increased medical comorbidities as well as prescription medication along with psychiatric illness may increase the risk for early delivery or miscarriage. An integrated care model that consists of OB/GYN and psychiatrists or other primary care physicians needs to be implemented.
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Methods Data on pregnancy information was collected from a South Carolina Medicaid database for the years 2002-2004. All IC-9 codes, prescription medications that were filled, dose and quantity and time were variables gathered. The database contained information on patients with Bipolar, Schizoaffective and Schizophrenia diagnoses. Pregnancies were identified by ICD-9 Codes. Information from months that women were pregnant gave three groups. Women with 9 months of information (full-term and delivery), miscarriage and pre-mature (<37 weeks gestation). Data on 40% of the women was excluded because only 1-2 months of data were available.
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Results Mean age for the total cohort was 26 (11-45) years. Fifty-six (75%) women were full term, 10 (13%) had a miscarriage and 9 (12%) had a pre-term delivery There was no consistent treatment for mental illness during pregnancy 66% of the women were taking opiate analgesics during pregnancy 100% of the women were taking antimicrobials during pregnancy and 45% were on sleep aid medications All women were taking a combination of medications that may lead to drug-drug interactions Most of the women had a co-occurring disorder
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Psychiatric Diagnoses of low SES Pregnant Women
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Median Number of Medications by Pregnancy Status
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Treatment for Psychiatric Illness during Pregnancy
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Results 90% of the women who miscarried had a co-occurring alcohol dependency diagnosis There were no dose changes over the course of pregnancy for changing pregnancy metabolism There were no blood levels obtained to gather information of medication levels
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Conclusions Prescriptions for psychotropic medication during pregnancy requires clinical vigilance given the implications for the wellbeing of the fetus and mother. Pregnant women with severe psychiatric diagnoses also have a high rate of co-occurring disorders that also need management More communication about the number and types of medication that women are prescribed during pregnancy needs to be addressed with an option of having clinical management teams for these women.
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References Trixler M, Gati A, Fekete S et al. Use of antipsychotics in the management of schizophrenia during pregnancy. Drugs 2005;65:1193-1206. Yonkers, KA, Wisner KL, Stowe, Z et al. Management of bipolar disorder during pregnancy and the postpartum period. Am J Psychiatry 2004; 161:608-620. Alshuler AA, Hendrick V. Pregnancy and psychotropic medication: Changes in blood levels. J Clin Psychopharmacol 1996; 16:78-80.
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PowerPoint Slide Presentation on this paper describes the diganoses and number and types of medications used for women with psychiatric illness during pregnancy. Many women were not medicated for psychiatric illness over the total pregnancy and many were taking multiple medications
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