Study, Aug/23: Impact of Abrupt Interruption of Home Psychotropic Medications at ICU Admission

[[La...]]

 

Impact of Abrupt Interruption of Home Psychotropic Medications at ICU Admission

https://pubmed.ncbi.nlm.nih.gov/37529150/

 

Abstract

Background: Abrupt discontinuation of home psychotropic medications is common among critically ill patients but may precipitate clinically significant withdrawal.

Objective: To determine the percent of patients with interruptions in home psychotropic medications upon intensive care unit (ICU) admission and to identify outcomes associated with these interruptions.

Methods: This was an institutional review board-approved, single-center, retrospective study of critically ill patients with a history of mental illness taking an antipsychotic or antidepressant medication. The primary outcome was the percent of patients with interruption in at least one home psychotropic medication for ≥24 hours upon ICU admission. Secondary outcomes included time to psychotropic re-initiation, percent of home psychotropic medications restarted in the ICU, ICU length of stay (LOS), delirium, withdrawal-related complications, need for acute antipsychotics or benzodiazepines, and reasons for psychotropic interruption.

Results: Among 183 patients, 93 (50.8%) had interruptions in home psychotropic therapy for ≥24 hours upon ICU admission. Mean time to reinitiation of at least one psychotropic agent was 1.4 days, and 16.4% of patients did not have any home psychotropics restarted. Patients with psychotropic interruption had a longer ICU LOS (P = 0.01) and greater incidence of ICU delirium (P < 0.01). Withdrawal-related complications were similar between groups. Acute antipsychotic use was greater in patients with psychotropic interruption (P < 0.01). Acute benzodiazepine use was not different between groups (P = 0.87). Most patients did not have a documented reason for therapy interruption.

Conclusion and Relevance: Unless contraindicated, clinicians should attempt to restart home psychotropic medications as soon as possible in critically ill patients.

Full Paper:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10387813/ 

 

 

[[Li...]]

Thank you for bringing this to our attention, @[La...].  I’ve read about several members who have suffered this fate.

[[Kr...]]

Yeah, I don’t and will not talk about it but it happened to me. 
Traumatic.

[[La...]]

I understand why it could happen, but of course, the repercussions can be serious. It's good to see that it's being studied.