Physician-led medication reviews may prevent overprescription in psychiatric patients with diabetes

Implementation of physician-led medication reviews through interdisciplinary dialogue can reduce the number of prescribed drugs and potentially inappropriate prescriptions (PIPs) in psychiatric outpatients with coexisting diabetes, a study has shown.

“It reduces the number of prescribed antipsychotics, reduces nonsignificant drug interactions, and improves psychopharmacological prescription patterns,” the researchers said.

Fifty-two patients from an endocrinologist‒psychiatrist outpatient clinic in Slagelse Region, Zealand, Denmark, were included in this study. Participants were assigned to an intervention group, where pharmacological treatment was discussed at an interdisciplinary treatment conference based on a medication review done by a specialist in clinical pharmacology, or to standard care (control group).

Furthermore, participants went through psychometric testing, side effect screening, clinical interviews, and had their regimens and biochemical test results extracted from electronic health records at baseline and at 6 months of follow-up.

Of the patients, 48 completed the study, with an average time to follow-up of 7 months. The intervention group showed a median reduction of 1 drug and 1 PIP as opposed to a median increase of 2 drugs and 2 PIPs in the control group. [Br J Clin Pharmacol 2025;91:2543-2554]

In addition, a reduction was noted in the use of both somatic and psychiatric drugs. Moreover, no differences were seen in clinical outcomes.

“Crucially, rather than conducting medication reviews by solely reviewing drug regimens, interdisciplinary dialogue may address the often complex and conflicting reality clinicians face when treating multimorbid psychiatric patients,” the researchers said.

“Interdisciplinary dialogue may improve the applicability of medication reviews particularly in a psychiatric setting,” they added.

Quetiapine

A subanalysis revealed a decrease in the use of quetiapine in the intervention group, potentially indicating improved prescription patterns.

Low-dose quetiapine is used off-label for anxiolytic or hypnotic purposes. However, it has been shown to contribute to an increased risk of cardiovascular events and greater mortality compared with Z-drug hypnotics. [World Psychiatry 2022;21:444-451]

Furthermore, treatment with quetiapine may result in the development of dyslipidaemia and weight gain. Thus, its use in a diabetic population is disadvantageous.  [Lancet Psychiatry 2020;7:64-77]

Deprescribing

“Finding no effect on adherence or any … outcomes, we infer that deprescribing in a psychiatric context is achievable without compromising patients' clinical appearance,” according to the researchers.

“While short-term deprescribing is achievable, sustained deprescribing may be challenging,” they added.

A Danish trial that explored the effects of adding consultation to geriatric outpatients showed improved quality of life, lower mortality, and reduced average number of drugs by 2 at 4 months in the intervention group. At 13 months, however, an average reduction of only 1.3 drugs persisted. [Brit J Clin Pharma 2022;88:3360-3369]

“These results emphasize the need for long follow-up periods when investigating the true effects of deprescribing initiatives in practice. Patients' condition may deteriorate, or other medical specialists may prescribe drugs leading to renewed polypharmacy,” the researchers said.

“Sustained deprescribing especially in psychiatry may require continuous interdisciplinary dialogue to accommodate both patients', relatives' and the physician's needs,” they added.