Adverse Drug Reactions Associated with Polypharmacy, Risk Assessment Tools, and Deprescribing Strategies in Elderly Psychiatric Patients: Systematic Review
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Abstract
Objective: To review the definition of polypharmacy, tools used to assess the risk of adverse drug reactions, and guidelines for reducing the use of potentially severe adverse drug reactions in elderly psychiatric patients.
Materials and methods: A literature review was conducted using Thai and English documents from PubMed and Google Scholar between 2010 and 2025, employing keywords such as polypharmacy OR psychotropic polypharmacy, potentially inappropriate medication and elderly, deprescription, anticholinergic burden, drug burden index, and sedative load. A total of 3,660 entries were found from which 30 entries were selected for systematic review.
Results: Tools for assessing the risk of adverse drug reactions include tools for identifying inappropriate medications, such as Beer’s criteria and STOPP/START criteria. Tools for assessing the level of risk include anticholinergic burden, sedative load, and drug burden index. The process of reducing medication prescriptions includes medication list assessment, adverse reaction risk assessment, assessment of the feasibility of discontinuing or reducing medication, prioritization, implementation, and follow-up after discontinuation or reduction of medication.
Conclusion: Psychotropic polypharmacy is defined as the use of two or more psychiatric medications to treat a single symptom. Elderly psychiatric patients are likely to receive multiple medications, especially those with anticholinergic or central nervous system depressant effects. Using tools to identify inappropriate medication lists and tools to assess the risk of adverse drug reactions can reduce the risk of serious adverse drug reactions.
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บทความหลังผ่านการปรับแก้จากกองบรรณาธิการแล้ว เป็นลิขสิทธ์ของวารสารจิตเวชวิทยาสาร โรงพยาบาลสวนปรุง กรมสุขภาพจิต กระทรวงสาธารณสุข ห้ามเผยแพร่เพื่อประโยชน์ทางการค้าโดยไม่ได้รับอนุญาต แต่อนุญาตให้เผยแพร่บทความดังกล่าวเพื่อประโยชน์ทางการศึกษาแก่ประชาชนทั่วไป ทั้งนี้กองบรรณาธิการไม่จำเป็นต้องเห็นด้วยกับบทความหรือข้อคิดเห็นใดๆ ที่ปรากฏในวารสารสวนปรุง
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