Thursday, July 21, 2016

Antipsychotics for Sleep: When Did This Become a Thing?



by: Eric Widera (@ewidera)

Sleep.   It’s sometimes hard enough to get enough at home with all the distractions of daily life.   It’s only made more difficult in the hospital setting.

We’ve seen a lot of interventions to help with this that generally consist of pills, because as compared to changing the environment or culture of the hospital, as it’s an easy intervention.  However, most of these have little to no evidence that they work.

The latest one that I just saw in the hospital was prescriptions for quetiapine, an antipsychotic, for sleep.   I thought to myself, well that’s odd.   Hopefully this won’t become a thing.   I’m sad to say, just like Pok√©mon Go, it has.

A study came out last week in JAMA IM titled “Off-label Use of Quetiapine in Medical Inpatients and Postdischarge.”   The authors prospectively enrolled all inpatients 60 years or older between December of 2013 and April of 2015 from a teaching hospital in Quebec, Canada.

One of the authors then looked at all of the medical records for quetiapine prescriptions, dosing, and indication.    If they didn't have a comorbid psychiatric condition (eg, schizophrenia, major depressive, or bipolar affective disorder) or evidence of delirium it was assumed that they were receiving night time dosing of quetiapine for sleep.

What they found was shocking.   One out of every ten patients (13.0%) received quetiapine during hospitalization, 64.0% of which received the medication at bedtime for sleep.  That’s 8% of hospitalized patients getting quetiapine for sleep.   Most of these individuals were newly initiated on this antipsychotic in the hospital.   Sadly, 1 in 7 patients who first received quetiapine for sleep in the hospital was discharged home with at least a 1-month prescription.

Seriously.  Antipsychotics for sleep.  Really, is this the best we can do to help with sleep in the hospital?  If you want to read a good case of why this is just bad practice, take a look at the Teachable Moment case from that same JAMA IM issue.

Is this a thing at your hospital too?








4 comments:

Jordan Fallis said...

It's ridiculous that these are being prescribed for sleep. They deplete critical nutrients too, yet no one ever discusses it: http://www.optimallivingdynamics.com/blog/7-important-nutrients-depleted-by-psychiatric-drugs-antidepressants-antipsychotics-stimulants-benzodiazepines-induced-guide-vitamins-medications

Helen Chen, MD said...

In post-acute, skilled nursing settings, we are required to consent patients/healthcare proxies whenever we prescribe psychoactive medications and specifically antipsychotics. We have also noticed a small rise in patients being discharged to us on antipsychotics for insomnia, often without their clear understanding or consent. For so many reasons, not a good practice. As attendings and geriatrics consultants we should be taking a stand and educating trainees about the dangers of this approach.

Rodney KSiegel said...

I agree with @Fallis: "It's ridiculous that these are being prescribed for sleep"

Laurie said...

I don't think it's ridiculous. Just take more time for it.