# Drug utilization in geriatric psychiatric patients in the emergency department—a cohort study under real-world conditions

## TL;DR

This study examines drug prescriptions for elderly psychiatric patients in emergency departments, finding that most medications are potentially inappropriate.

## Contribution

The study provides empirical evidence on the prevalence of potentially inappropriate medications and drug interactions in geriatric psychiatric emergency care.

## Key findings

- 77.7% of newly prescribed drugs were classified as potentially inappropriate medications (PIMs) according to PRISCUS 2.0.
- The number of potential drug–drug interactions increased significantly after treatment in the emergency department.
- FORTA classification showed that 70.2% of new prescriptions were in high-risk categories C or D.

## Abstract

Psychiatric emergencies include agitation, substance-related (e.g., withdrawal) symptoms, and suicidal as well as self-harming behavior and require interdisciplinary management. Drug treatment of geriatric patients in emergency situations may be complicated by adverse drug reactions (ADRs).

This study aimed to investigate prescriptions of potentially inappropriate medications (PIMs) and potential drug–drug interactions (DDIs) in the context of geriatric psychiatric emergencies in the emergency department (ED).

Retrospective single-center study.

The medication lists of 87 consecutively acquired geriatric patient cases receiving pharmacological treatment between January 2018 and December 2022 in a psychiatric emergency department were analyzed. Herein, utilizing the PRISCUS 2.0 list and the Fit fOR The Aged (FORTA) classification, prescriptions of PIMs were assessed, and DDIs were classified with the aid of the drug interaction program AiDKlinik® (Arzneimittel-Informations-Dienste, Dosing GmbH, Heidelberg, Germany).

A total of 94 drugs were administered during treatment in the ED. The total number of drugs per patient was on average 5.9 1 (median: 5; interquartile range: 4) hereafter. 77.7% of the newly prescribed drugs were PIMs according to the PRISCUS 2.0 list, while 18.1% were designated as therapeutic alternatives to PIMs. 70.2% and 22.3% of the newly recommended drugs were FORTA category C and D drugs, respectively. An average of 0.8 (median: 0; interquartile range: 1) potential DDIs existed before psychiatric ED treatment, and 0.9 (median: 0; interquartile range: 2) potential DDIs thereafter (p = 0.002). Coercive measures—such as administration of medication against the patient’s will—were rarely required in the study population.

The majority of all drug prescriptions for the treatment of geriatric psychiatric emergencies were categorized as PIMs according to the PRISCUS 2.0 list and the FORTA classification. However, it should be noted that these PIM classification systems were not specifically designed for geriatric psychiatric settings. The number of potential DDIs was significantly higher after drug administration in the ED than before, which should prompt the monitoring of certain clinical parameters in the further course of treatment.