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Original Investigation |

Emergency Department Visits by Adults for Psychiatric Medication Adverse Events

Lee M. Hampton, MD, MSc1; Matthew Daubresse, MHS2,3; Hsien-Yen Chang, PhD2,4; G. Caleb Alexander, MD, MS2,3,5; Daniel S. Budnitz, MD, MPH1
[+] Author Affiliations
1Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
2Center for Drug Safety and Effectiveness, The Johns Hopkins University, Baltimore, Maryland
3Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
4Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
5Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
JAMA Psychiatry. 2014;71(9):1006-1014. doi:10.1001/jamapsychiatry.2014.436.
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Importance  In 2011, an estimated 26.8 million US adults used prescription medications for mental illness.

Objective  To estimate the numbers and rates of adverse drug event (ADE) emergency department (ED) visits involving psychiatric medications among US adults between January 1, 2009, and December 31, 2011.

Design and Setting  Descriptive analyses of active, nationally representative surveillance of ADE ED visits using the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance system and of drug prescribing during outpatient visits using the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey.

Participants  Medical records from national probability samples of ED and outpatient visits by adults 19 years or older were reviewed and analyzed.

Exposures  Antidepressants, antipsychotics, lithium salts, sedatives and anxiolytics, and stimulants.

Main Outcomes and Measures  National estimates of ADE ED visits resulting from therapeutic psychiatric medication use and of psychiatric medication ADE ED visits per 10 000 outpatient visits at which psychiatric medications were prescribed.

Results  From 2009 through 2011, there were an estimated 89 094 (95% CI, 68 641-109 548) psychiatric medication ADE ED visits annually, with 19.3% (95% CI, 16.3%-22.2%) resulting in hospitalization and 49.4% (95% CI, 46.5%-52.4%) involving patients aged 19 to 44 years. Sedatives and anxiolytics, antidepressants, antipsychotics, lithium salts, and stimulants were implicated in an estimated 30 707 (95% CI, 23 406-38 008), 25 377 (95% CI, 19 051-31 704), 21 578 (95% CI, 16 599-26 557), 3620 (95% CI, 2311-4928), and 2779 (95% CI, 1764-3794) respective ADE ED visits annually. Antipsychotics and lithium salts were implicated in 11.7 (95% CI, 10.1-13.2) and 16.4 (95% CI, 13.0-19.9) ADE ED visits per 10 000 outpatient prescription visits, respectively, compared with 3.6 (95% CI, 3.2-4.1) for sedatives and anxiolytics, 2.9 (95% CI, 2.3-3.5) for stimulants, and 2.4 (95% CI, 2.1-2.7) for antidepressants. The commonly used sedative zolpidem tartrate was implicated in 11.5% (95% CI, 9.5%-13.4%) of all adult psychiatric medication ADE ED visits and in 21.0% (95% CI, 16.3%-25.7%) of visits involving adults 65 years or older, in both cases significantly more than any other psychiatric medication.

Conclusions and Relevance  Psychiatric medications are implicated in many ADEs treated in US EDs. Efforts to reduce ADEs should include adults of all ages but might prioritize medications causing high numbers and rates of ED visits.

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Submit a Comment
Psychiatric patients complex folly psychopharmacy
Posted on August 6, 2014
Zucker Hillside
Conflict of Interest: None Declared
Most patients who present at psychiatric hospitals go to psychiatric hospitals due to \"medication management\" a euphemism for adverse effects due to complex psycho-pharmacology. Where do they show up in this study? Almost always these patients are blamed for the presentation by blaming the patient. The psychiatrist will note the illness often bipolar or schizophrenia and just assume that the illness is getting worse and the adverse effects are not taken into consideration at all. Talk about not being able to tell from the forest and the trees. So drugs are jiggled around and the patient is released only to show up once more at a psychiatric ER hospital- only to be seen again by an inexperienced hardly supervised resident who has little experience. Blaming the psychiatric patient is standard course as the merry go round continues and the band plays on.
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