Abstract
Objectives: Antipsychotics are commonly initiated in the hospital for agitation and delirium and may be inappropriately continued upon floor transfer and at discharge. We sought to evaluate the magnitude of this issue within our health care system. Methods: We conducted a multicenter, retrospective cohort study within a 22-hospital health care system to evaluate the proportion of patients without identifiable psychiatric illness who received newly initiated inpatient antipsychotics and were then continued on an antipsychotic at hospital discharge. Results: Of 23 049 patients who received at least 1 in-hospital dose of haloperidol, olanzapine, quetiapine, risperidone, or ziprasidone, 8297 patients were included in the final analysis after applying exclusion for identifiable psychiatric illness or previous antipsychotic use. Ultimately, 334 patients (4%) were discharged with a new antipsychotic prescription. Patients receiving antipsychotics at discharge were more likely as an inpatient to receive quetiapine (77.2% vs 35.9%; odds ratio [OR]: 6.1, 95% confidence interval [CI]: 4.7-8.0; P < .001) and less likely to receive haloperidol (15% vs 47%; OR: 0.2, 95% CI: 0.14-0.27; P < .001) or olanzapine (16.2% vs 20.9%; OR: 0.73, 95% CI: 0.53-0.98; P < .04). Conclusions: Antipsychotics may be inappropriately continued in non-psychiatric patients at hospital discharge. Strategies to limit potentially unnecessary antipsychotics upon discharge should be evaluated.
Keywords: antipsychotics, transitions of care, discharge medications, quetiapine
Introduction
Antipsychotics are utilized for a variety of acute inpatient indications including the treatment and prevention of delirium, agitation, and insomnia.1,2 Length of treatment for these indications is highly dependent on patient-specific factors such as clinical response, toxicities, adverse drug events, drug-drug interactions, and overall clinical course.3,4 Unfortunately, discrepancies in medication reconciliation occur frequently, and as a result, patients may inappropriately remain on antipsychotics upon transfer from an intensive care unit (ICU) to a lower acuity floor or upon discharge from any hospital unit.4-10
Complications of both short- and long-term antipsychotic use include acute kidney injury, pneumonia, hypotension, serotonin syndrome, extrapyramidal symptoms, neuroleptic malignant syndrome, QTc prolongation, anticholinergic effects, and increased risk of out-of-hospital cardiac arrest.3,11,12 Antipsychotics also carry a boxed warning for increased mortality in elderly patients with dementia. An estimated 15 272 annual emergency department visits are attributed to adverse drug events related to atypical antipsychotic use.13 This equates to 11.7 emergency department visits per 10 000 outpatient prescriptions, which is greater than sedatives and anxiolytics (3.6 visits), stimulants (2.9 visits), and antidepressants (2.4 visits) combined.13 In the absence of an ongoing indication for an antipsychotic, it is imperative to discontinue these medications when the acute indication has lapsed.
We aimed to elucidate the magnitude of the issue of continuing potentially inappropriate antipsychotics at hospital discharge in a large, multihospital health care system. The primary objective of this study was to determine the proportion of patients, without an identifiable psychiatric illness and without former antipsychotic use, who received an inpatient antipsychotic and were discharged with a potentially inappropriate antipsychotic prescription.
Methods
A retrospective review of electronic medical records was performed of patients at least 18 years of age who were admitted to any of 22 hospitals within the Intermountain Healthcare system (Utah and southern Idaho) from January 1, 2010, through December 31, 2013. Data were obtained from the Intermountain Healthcare Enterprise Data Warehouse (EDW), an electronic data repository containing all inpatient and outpatient records including medication administration, prescriptions, laboratory, imaging, and other medical information. Patients had to receive at least 1 dose of haloperidol, olanzapine, quetiapine, risperidone, or ziprasidone during their hospital stay. This included administration in both ICU and non-ICU floors. To isolate only potentially inappropriate antipsychotic continuation at hospital discharge, patients were excluded if they had an identifiable psychiatric illness present upon admission, documented during the index hospitalization, or upon discharge (except for delirium, which was not considered a chronic psychiatric illness). These included psychiatric diagnoses with a possible indication for chronic antipsychotic therapy which were identified using selected International Classification of Diseases, Ninth Revision (ICD-9) codes (see Appendix). Whether an antipsychotic prescription at discharge was truly inappropriate given a lack of indication could not definitely be identified, however. Previous antipsychotic utilization, previous admission to a psychiatric unit, or an antipsychotic on the admission medication history were additional exclusion criteria. Previous antipsychotic utilization was obtained from the EDW, and included historical medication administration records from any previous hospitalization at any of the 22 Intermountain Healthcare hospitals or an electronic prescription documented within the electronic medical record at any time prior to the study period.
Data collection included baseline demographics, inpatient antipsychotic(s) received, hospital and ICU lengths of stay (LOS), mortality, and receipt of an electronic antipsychotic prescription at hospital discharge. Electronic antipsychotic prescriptions at discharge were obtained from the electronic RX Module, an e-prescribing functionality of the electronic medical record, which also allows for prescription printing. The primary outcome was the proportion of patients without an identifiable psychiatric illness or previous antipsychotic utilization who received an antipsychotic at hospital discharge after at least 1 inpatient dose. Secondary, descriptive outcomes included hospital and ICU LOS and 30-day readmission. The Institutional Review Board approved the study protocol with a waiver of informed consent.
Results
Primary Outcome
Over the 4-year study period, 23 049 patients received at least 1 dose of haloperidol, olanzapine, quetiapine, risperidone, or ziprasidone as an inpatient. Of those, 8297 patients remained after applying exclusion criteria (Figure 1). In the study cohort (n = 8297), the majority of patients received either haloperidol (45.7%) or quetiapine (37.5%) while inpatient (Table 1). Ultimately, 334 patients (4%) were discharged with an electronic, outpatient antipsychotic prescription. The majority of patients discharged with an outpatient antipsychotic prescription (n = 334) received only 1 antipsychotic during their admission (91.3%), though 29 patients (8.7%) received multiple antipsychotics. On average, patients receiving antipsychotic prescriptions at discharge received 6.5 doses of an inpatient antipsychotic versus 5.1 doses in patients discharged without an antipsychotic prescription. Patients receiving antipsychotic prescriptions at discharge were more likely to receive quetiapine (77.2% vs 35.9%; odds ratio [OR]: 6.1, 95% confidence interval [CI]: 4.7-8.0; P < .001), and less likely to receive haloperidol (15% vs 47%; OR: 0.2, 95% CI: 0.14-0.27; P < .001) or olanzapine (16.2% vs 20.9%; OR: 0.73, 95% CI: 0.53-0.98; P = .04) as an inpatient (Table 1).
Figure 1.
Patient Selection.
Note. Patients were sequentially excluded in a stepwise manner for the listed criteria and were only counted within the first exclusion criteria met. ICD-9 = International Classification of Diseases, Ninth Revision.
Table 1.
Inpatient Antipsychotics Used and Odds of Being Discharged With an Antipsychotic Prescription.
| Antipsychotic medications,a n (%) | Study cohort (n = 8297) | Discharged with antipsychotic prescription (n = 334) | Discharged without antipsychotic prescription (n = 7963) | OR, 95% CI; P valueb |
|---|---|---|---|---|
| Quetiapine | 3115 (37.5) | 258 (77.2) | 2857 (35.9) | 6.07, 4.66-7.98; <.001 |
| Olanzapine | 1719 (20.7) | 54 (16.2) | 1665 (20.9) | 0.73, 0.53-0.98; .04 |
| Haloperidol | 3792 (45.7) | 50 (15) | 3742 (47) | 0.20, 0.14-0.27; <.001 |
| Risperidone | 544 (6.6) | 20 (6) | 524 (6.6) | 0.90, 0.54-1.44; .74 |
| Ziprasidone | 332 (4) | 12 (3.6) | 320 (4) | 0.89, 0.45-1.60; .89 |
Note. OR = odds ratio; CI = confidence interval.
Patients who received multiple antipsychotics were counted for each medication they received.
Odds ratios are comparing the relative likelihood of being discharged with versus without antipsychotic prescriptions when receiving a particular inpatient antipsychotic.
Secondary, Descriptive Outcomes
Patients discharged with an antipsychotic prescription (n = 334) were predominantly Caucasian (62%), male (58.4%), with a median age of 37 years (interquartile range [IQR]: 25-62 years), and a median 10 (IQR: 7-15) chronic and acute diagnoses. The median (IQR) hospital and ICU LOS for the discharge versus the overall study cohort were 3.7 (2.3-5.1) versus 4.1 (2.2-9.2) and 3.6 (1.7-5.7) versus 4.9 (2.1-10.3) days, respectively. Of the 334 patients discharged with an antipsychotic prescription, 139 patients (41.6%) were readmitted within 30 days, compared with 3421 patients (41.2%) in the overall study cohort.
Discussion
One in 25 patients without an identifiable antecedent or incidental psychiatric illness was discharged with an antipsychotic prescription after receiving an inpatient antipsychotic within our health system. Although 4% is relatively low in comparison with prior studies,6-9 this may be due to the inclusion of patients who were treated in both ICU and non-ICU floors, the inclusion of those who were prescribed an antipsychotic for acute indications other than delirium, and the thorough exclusion criteria for psychiatric illnesses. Nonetheless, the number of patients receiving potentially inappropriate medications at discharge warrants further consideration.
In our study, inpatient quetiapine was more likely to be used in patients discharged home with an antipsychotic prescription. This does not necessarily mean that patients receiving inpatient quetiapine were then discharged with a prescription for quetiapine, as they could have been sent home with a prescription for another antipsychotic. Quetiapine tends to be used for indications such as insomnia more commonly than other antipsychotics. Perhaps because of the more frequent use of quetiapine in patients with insomnia, an indication with uncertain benefit,14,15 providers are more inclined to discharge patients home with a prescription for this particular antipsychotic. However, an analysis of this perceived correlation was not conducted in our study.
Similar studies have been recently conducted. A retrospective review of 80 adult ICU patients at a single center evaluated prescribing patterns of newly initiated atypical antipsychotics utilized for ICU delirium. Of the 59 patients (73.8%) who survived to discharge, 28 (47.5%) had an antipsychotic continued when transferred from the ICU, and 20 (33.9%) had an antipsychotic continued at discharge.8 Another retrospective review evaluated the rate of antipsychotic continuation during transitions of care from a medical ICU. Of 87 patients included, 23 (26%) were continued on antipsychotic therapy after being transferred out of the ICU, and 9 (10.3%) were discharged with an antipsychotic prescription.6 The most recent study, a retrospective cohort of 39 248 ICU admissions, found 8% of antipsychotic utilization was newly initiated within the ICU, and 21% continued therapy at discharge.9 Similar to our study, quetiapine use was more frequent in those discharged on an antipsychotic (OR: 3.2, 95% CI: 2.5-4.0; P < .0001).9 In one study, patients discharged on a newly prescribed antipsychotic had a high rate of hospital readmission (41%), antipsychotic continuation (65%), and 1-year mortality (29%).10 However, the indication for and the appropriateness of the antipsychotics were not evaluated and may play a role in the patients’ underlying diseases.
Many factors likely play a role in drug continuation, including care discontinuity and lack of communication in transitions of care between critical- and acute-care floors and also at the time of discharge.5,6 Preventing inappropriate antipsychotic continuation would likely decrease the myriad adverse effects associated with antipsychotic use, as well as emergency department visits due to these adverse effects.3,13 To prevent inappropriate prescribing or continuation of antipsychotics, available evidence supports the use of medication reconciliation interventions when focusing on patients at high risk for adverse events.16 One pre-/post-antipsychotic tapering bundle study showed a reduction in antipsychotic continuation at ICU discharge (27.9% vs 17.7% in the pre- and post-bundle groups, respectively;P < .05). The reduction in antipsychotic continuation also held true at hospital discharge (OR: 0.4, 95% CI: 0.18-0.89).17 Additional methods for addressing this issue and areas of future study include automatic discontinuation protocols, pharmacist counseling and intervention, and intensive discharge medication reconciliation. The last approach is currently being studied and will evaluate the impact of electronic medication reconciliation on the incidence of adverse drug events in a cluster-randomized trial (NCT01179867).
On the other hand, antipsychotics continued upon transfer from an ICU to a hospital floor, or at hospital discharge, could be appropriate. For instance, ongoing agitated delirium or suspected, but not clinically diagnosed psychiatric illnesses may be appropriate reasons, in some situations, to continue antipsychotics during transitions of care. The appropriateness of this practice, however, needs further evaluation and is beyond the scope of our study.
Strengths of our study include the large patient population (8297 vs 146 patients combined in 2 former studies6,8) and the inclusion of both ICU and non-ICU patients. Data from 22 hospitals within the health system included large academic medical centers, smaller community hospitals, and urban and rural facilities, thereby enabling an evaluation of many patients and practice types. Thorough exclusion criteria were utilized to focus only on patients without identifiable psychiatric illnesses, a practice not employed in former studies.
The primary limitation of our study is that patients were only evaluated if the prescription they received was electronically documented within the electronic medical record used at our health system. If a handwritten prescription was given to a patient at discharge, they would not have been identified. We may have therefore underestimated the proportion of patients inappropriately discharged on an antipsychotic. Secondly, we did not search for and exclude patients with Tourette syndrome, a potential indication for certain antipsychotic medications. In addition, patients may have had psychiatric illness documented outside the health system which was not accessible. Last, our study was meant to report the incidence of potentially inappropriate antipsychotic continuation at hospital discharge and not necessarily the outcomes associated with this practice. Future studies should further elucidate the clinical and financial impact of inappropriate antipsychotic continuation at discharge and thoroughly evaluate methods of reducing inappropriate medication continuation.
Conclusion
Within a large, integrated health care system, 1 in 25 patients receiving an inpatient antipsychotic without an identified psychiatric illness was discharged with an antipsychotic prescription. Strategies to limit the number of potentially inappropriate antipsychotic prescriptions at hospital discharge should be evaluated to reduce the undue adverse effect burden and emergency department visits associated with antipsychotic use.
Appendix
International Classification of Diseases, Ninth Revision (ICD-9) Codes Used in Exclusion
Schizophrenia
| ICD-9 Code | ICD-9 Code Description |
|---|---|
| 295.00 | SIMPLE TYPE SCHIZOPHRENIA UNSPECIFIED STATE |
| 295.01 | SIMPLE TYPE SCHIZOPHRENIA SUBCHRONIC STATE |
| 295.02 | SIMPLE TYPE SCHIZOPHRENIA CHRONIC STATE |
| 295.03 | SIMPLE TYPE SCHIZOPHRENIA SUBCHRONIC STATE WITH ACUTE EXACERBATION |
| 295.04 | SIMPLE TYPE SCHIZOPHRENIA CHRONIC STATE WITH ACUTE EXACERBATION |
| 295.05 | SIMPLE TYPE SCHIZOPHRENIA IN REMISSION |
| 295.10 | DISORGANIZED TYPE SCHIZOPHRENIA UNSPECIFIED STATE |
| 295.11 | DISORGANIZED TYPE SCHIZOPHRENIA SUBCHRONIC STATE |
| 295.12 | DISORGANIZED TYPE SCHIZOPHRENIA CHRONIC STATE |
| 295.13 | DISORGANIZED TYPE SCHIZOPHRENIA SUBCHRONIC STATE WITH ACUTE EXACERBATION |
| 295.14 | DISORGANIZED TYPE SCHIZOPHRENIA CHRONIC STATE WITH ACUTE EXACERBATION |
| 295.15 | DISORGANIZED TYPE SCHIZOPHRENIA IN REMISSION |
| 295.20 | CATATONIC TYPE SCHIZOPHRENIA UNSPECIFIED STATE |
| 295.21 | CATATONIC TYPE SCHIZOPHRENIA SUBCHRONIC STATE |
| 295.22 | CATATONIC TYPE SCHIZOPHRENIA CHRONIC STATE |
| 295.23 | CATATONIC TYPE SCHIZOPHRENIA SUBCHRONIC STATE WITH ACUTE EXACERBATION |
| 295.24 | CATATONIC TYPE SCHIZOPHRENIA CHRONIC STATE WITH ACUTE EXACERBATION |
| 295.25 | CATATONIC TYPE SCHIZOPHRENIA IN REMISSION |
| 295.30 | PARANOID TYPE SCHIZOPHRENIA UNSPECIFIED STATE |
| 295.31 | PARANOID TYPE SCHIZOPHRENIA SUBCHRONIC STATE |
| 295.32 | PARANOID TYPE SCHIZOPHRENIA CHRONIC STATE |
| 295.33 | PARANOID TYPE SCHIZOPHRENIA SUBCHRONIC STATE WITH ACUTE EXACERBATION |
| 295.34 | PARANOID TYPE SCHIZOPHRENIA CHRONIC STATE WITH ACUTE EXACERBATION |
| 295.35 | PARANOID TYPE SCHIZOPHRENIA IN REMISSION |
| 295.50 | LATENT SCHIZOPHRENIA UNSPECIFIED STATE |
| 295.51 | LATENT SCHIZOPHRENIA SUBCHRONIC STATE |
| 295.52 | LATENT SCHIZOPHRENIA CHRONIC STATE |
| 295.53 | LATENT SCHIZOPHRENIA SUBCHRONIC STATE WITH ACUTE EXACERBATION |
| 295.54 | LATENT SCHIZOPHRENIA CHRONIC STATE WITH ACUTE EXACERBATION |
| 295.55 | LATENT SCHIZOPHRENIA IN REMISSION |
| 295.80 | OTHER SPECIFIED TYPES OF SCHIZOPHRENIA UNSPECIFIED STATE |
| 295.81 | OTHER SPECIFIED TYPES OF SCHIZOPHRENIA SUBCHRONIC STATE |
| 295.82 | OTHER SPECIFIED TYPES OF SCHIZOPHRENIA CHRONIC STATE |
| 295.83 | OTHER SPECIFIED TYPES OF SCHIZOPHRENIA SUBCHRONIC STATE WITH ACUTE EXACERBATION |
| 295.84 | OTHER SPECIFIED TYPES OF SCHIZOPHRENIA CHRONIC STATE WITH ACUTE EXACERBATION |
| 295.85 | OTHER SPECIFIED TYPES OF SCHIZOPHRENIA IN REMISSION |
| 295.90 | UNSPECIFIED TYPE SCHIZOPHRENIA UNSPECIFIED STATE |
| 295.91 | UNSPECIFIED TYPE SCHIZOPHRENIA SUBCHRONIC STATE |
| 295.92 | UNSPECIFIED TYPE SCHIZOPHRENIA CHRONIC STATE |
| 295.93 | UNSPECIFIED TYPE SCHIZOPHRENIA SUBCHRONIC STATE WITH ACUTE EXACERBATION |
| 295.94 | UNSPECIFIED TYPE SCHIZOPHRENIA CHRONIC STATE WITH ACUTE EXACERBATION |
| 295.95 | UNSPECIFIED TYPE SCHIZOPHRENIA IN REMISSION |
Bipolar Disorder
| ICD-9 Code | ICD-9 Code Description |
|---|---|
| 296.00 | BIPOLAR I DISORDER, SINGLE MANIC EPISODE, UNSPECIFIED |
| 296.01 | BIPOLAR I DISORDER, SINGLE MANIC EPISODE, MILD |
| 296.02 | BIPOLAR I DISORDER, SINGLE MANIC EPISODE, MODERATE |
| 296.03 | BIPOLAR I DISORDER, SINGLE MANIC EPISODE, SEVERE, WITHOUT MENTION OF PSYCHOTIC BEHAVIOR |
| 296.04 | BIPOLAR I DISORDER, SINGLE MANIC EPISODE, SEVERE, SPECIFIED AS WITH PSYCHOTIC BEHAVIOR |
| 296.05 | BIPOLAR I DISORDER, SINGLE MANIC EPISODE, IN PARTIAL OR UNSPECIFIED REMISSION |
| 296.06 | BIPOLAR I DISORDER, SINGLE MANIC EPISODE, IN FULL REMISSION |
| 296.40 | BIPOLAR I DISORDER, MOST RECENT EPISODE (OR CURRENT) MANIC, UNSPECIFIED |
| 296.41 | BIPOLAR I DISORDER, MOST RECENT EPISODE (OR CURRENT) MANIC, MILD |
| 296.42 | BIPOLAR I DISORDER, MOST RECENT EPISODE (OR CURRENT) MANIC, MODERATE |
| 296.43 | BIPOLAR I DISORDER, MOST RECENT EPISODE (OR CURRENT) MANIC, SEVERE, WITHOUT MENTION OF PSYCHOTIC BEHAVIOR |
| 296.44 | BIPOLAR I DISORDER, MOST RECENT EPISODE (OR CURRENT) MANIC, SEVERE, SPECIFIED AS WITH PSYCHOTIC BEHAVIOR |
| 296.45 | BIPOLAR I DISORDER, MOST RECENT EPISODE (OR CURRENT) MANIC, IN PARTIAL OR UNSPECIFIED REMISSION |
| 296.46 | BIPOLAR I DISORDER, MOST RECENT EPISODE (OR CURRENT) MANIC, IN FULL REMISSION |
| 296.50 | BIPOLAR I DISORDER, MOST RECENT EPISODE (OR CURRENT) DEPRESSED, UNSPECIFIED |
| 296.51 | BIPOLAR I DISORDER, MOST RECENT EPISODE (OR CURRENT) DEPRESSED, MILD |
| 296.52 | BIPOLAR I DISORDER, MOST RECENT EPISODE (OR CURRENT) DEPRESSED, MODERATE |
| 296.53 | BIPOLAR I DISORDER, MOST RECENT EPISODE (OR CURRENT) DEPRESSED, SEVERE, WITHOUT MENTION OF PSYCHOTIC BEHAVIOR |
| 296.54 | BIPOLAR I DISORDER, MOST RECENT EPISODE (OR CURRENT) DEPRESSED, SEVERE, SPECIFIED AS WITH PSYCHOTIC BEHAVIOR |
| 296.55 | BIPOLAR I DISORDER, MOST RECENT EPISODE (OR CURRENT) DEPRESSED, IN PARTIAL OR UNSPECIFIED REMISSION |
| 296.56 | BIPOLAR I DISORDER, MOST RECENT EPISODE (OR CURRENT) DEPRESSED, IN FULL REMISSION |
| 296.60 | BIPOLAR I DISORDER, MOST RECENT EPISODE (OR CURRENT) MIXED, UNSPECIFIED |
| 296.61 | BIPOLAR I DISORDER, MOST RECENT EPISODE (OR CURRENT) MIXED, MILD |
| 296.62 | BIPOLAR I DISORDER, MOST RECENT EPISODE (OR CURRENT) MIXED, MODERATE |
| 296.63 | BIPOLAR I DISORDER, MOST RECENT EPISODE (OR CURRENT) MIXED, SEVERE, WITHOUT MENTION OF PSYCHOTIC BEHAVIOR |
| 296.64 | BIPOLAR I DISORDER, MOST RECENT EPISODE (OR CURRENT) MIXED, SEVERE, SPECIFIED AS WITH PSYCHOTIC BEHAVIOR |
| 296.65 | BIPOLAR I DISORDER, MOST RECENT EPISODE (OR CURRENT) MIXED, IN PARTIAL OR UNSPECIFIED REMISSION |
| 296.66 | BIPOLAR I DISORDER, MOST RECENT EPISODE (OR CURRENT) MIXED, IN FULL REMISSION |
| 296.7 | BIPOLAR I DISORDER, MOST RECENT EPISODE (OR CURRENT) UNSPECIFIED |
| 296.80 | BIPOLAR DISORDER, UNSPECIFIED |
| 296.89 | OTHER AND UNSPECIFIED BIPOLAR DISORDERS, OTHER |
Autistic Disorder—Irritability
| ICD-9 Code | ICD-9 Code Description |
|---|---|
| 299.00 | AUTISTIC DISORDER, CURRENT OR ACTIVE STATE |
| 299.01 | AUTISTIC DISORDER, RESIDUAL STATE |
Major Depressive Disorder
| ICD-9 Code | ICD-9 Code Description |
|---|---|
| 290.13 | PRESENILE DEMENTIA WITH DEPRESSIVE FEATURES |
| 290.21 | SENILE DEMENTIA WITH DEPRESSIVE FEATURES |
| 296.20 | MAJOR DEPRESSIVE AFFECTIVE DISORDER SINGLE EPISODE UNSPECIFIED DEGREE |
| 296.21 | MAJOR DEPRESSIVE AFFECTIVE DISORDER SINGLE EPISODE MILD DEGREE |
| 296.22 | MAJOR DEPRESSIVE AFFECTIVE DISORDER SINGLE EPISODE MODERATE DEGREE |
| 296.23 | MAJOR DEPRESSIVE AFFECTIVE DISORDER SINGLE EPISODE SEVERE DEGREE WITHOUT PSYCHOTIC BEHAVIOR |
| 296.24 | MAJOR DEPRESSIVE AFFECTIVE DISORDER SINGLE EPISODE SEVERE DEGREE SPECIFIED AS WITH PSYCHOTIC BEHAVIOR |
| 296.25 | MAJOR DEPRESSIVE AFFECTIVE DISORDER SINGLE EPISODE IN PARTIAL OR UNSPECIFIED REMISSION |
| 296.26 | MAJOR DEPRESSIVE AFFECTIVE DISORDER SINGLE EPISODE IN FULL REMISSION |
| 296.30 | MAJOR DEPRESSIVE AFFECTIVE DISORDER RECURRENT EPISODE UNSPECIFIED DEGREE |
| 296.31 | MAJOR DEPRESSIVE AFFECTIVE DISORDER RECURRENT EPISODE MILD DEGREE |
| 296.32 | MAJOR DEPRESSIVE AFFECTIVE DISORDER RECURRENT EPISODE MODERATE DEGREE |
| 296.33 | MAJOR DEPRESSIVE AFFECTIVE DISORDER RECURRENT EPISODE SEVERE DEGREE WITHOUT PSYCHOTIC BEHAVIOR |
| 296.34 | MAJOR DEPRESSIVE AFFECTIVE DISORDER RECURRENT EPISODE SEVERE DEGREE SPECIFIED AS WITH PSYCHOTIC BEHAVIOR |
| 296.35 | MAJOR DEPRESSIVE AFFECTIVE DISORDER RECURRENT EPISODE IN PARTIAL OR UNSPECIFIED REMISSION |
| 296.36 | MAJOR DEPRESSIVE AFFECTIVE DISORDER RECURRENT EPISODE IN FULL REMISSION |
| 296.82 | ATYPICAL DEPRESSIVE DISORDER |
| 298.0 | DEPRESSIVE TYPE PSYCHOSIS |
| 301.12 | CHRONIC DEPRESSIVE PERSONALITY DISORDER |
| 309.1 | ADJUSTMENT REACTION WITH PROLONGED DEPRESSIVE REACTION |
| 311 | DEPRESSIVE DISORDER NOT ELSEWHERE CLASSIFIED |
Schizoaffective Disorder
| ICD-9 Code | ICD-9 Code Description |
|---|---|
| 295.70 | SCHIZOAFFECTIVE DISORDER, UNSPECIFIED |
| 295.71 | SCHIZOAFFECTIVE DISORDER, SUBCHRONIC |
| 295.72 | SCHIZOAFFECTIVE DISORDER, CHRONIC |
| 295.73 | SCHIZOAFFECTIVE DISORDER, SUBCHRONIC WITH ACUTE EXACERBATION |
| 295.74 | SCHIZOAFFECTIVE DISORDER, CHRONIC WITH ACUTE EXACERBATION |
| 295.75 | SCHIZOAFFECTIVE DISORDER, IN REMISSION |
Footnotes
Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.
References
- 1. Barr J, Fraser GL, Puntillo K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013;41(1):263-306. [DOI] [PubMed] [Google Scholar]
- 2. Anderson SL, Vande Griend JP. Quetiapine for insomnia: A review of the literature. Am J Health Syst Pharm. 2014;71(5):394-402. [DOI] [PubMed] [Google Scholar]
- 3. Hale GM, Kane-Gill SL, Groetzinger L, Smithburger PL. An evaluation of adverse drug reactions associated with antipsychotic use for the treatment of delirium in the intensive care unit. J Pharm Pract. 2016;29:355-360. [DOI] [PubMed] [Google Scholar]
- 4. Rowe AS, Hamilton LA, Curtis RA, et al. Risk factors for discharge on a new antipsychotic medication after admission to an intensive care unit. J Crit Care. 2015;30(6):1283-1286. doi: 10.1016/j.jcrc.2015.08.009. [DOI] [PubMed] [Google Scholar]
- 5. Pippins JR, Gandhi TK, Hamann C, et al. Classifying and predicting errors of inpatient medication reconciliation. J Gen Intern Med. 2008;23(9):1414-1422. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6. Flurie RW, Gonzales JP, Tata AL, Millstein LS, Gulati M. Hospital delirium treatment: continuation of antipsychotic therapy from the intensive care unit to discharge. Am J Health Syst Pharm. 2015;72(23)(suppl 3):S133-S139. [DOI] [PubMed] [Google Scholar]
- 7. Farrokh S, Castle AC, Heavner M, Pisani MA. Continuation rate of atypical antipsychotics after discharge when initiated in the intensive care unit. J Pharm Pract. 2017;30:342-346. [DOI] [PubMed] [Google Scholar]
- 8. Jasiak KD, Middleton EA, Camamo JM, Erstad BL, Snyder LS, Huckleberry YC. Evaluation of discontinuation of atypical antipsychotics prescribed for ICU delirium. J Pharm Pract. 2013;26(3):253-256. [DOI] [PubMed] [Google Scholar]
- 9. Marshall J, Herzig SJ, Howell MD, et al. Antipsychotic utilization in the intensive care unit and in transitions of care. J Crit Care. 2016;33:119-124. doi: 10.1016/j.jcrc.2015.12.017. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10. Loh KP, Ramdass S, Garb JL, et al. Long-term outcomes of elders discharged on antipsychotics. J Hosp Med. 2016;11(8):550-555. doi: 10.1002/jhm.2585. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11. Weeke P, Jensen A, Folke F, et al. Antipsychotics and associated risk of out-of-hospital cardiac arrest. Clin Pharmacol Ther. 2014;96(4):490-497. [DOI] [PubMed] [Google Scholar]
- 12. Hwang YJ, Dixon SN, Reiss JP, et al. Atypical antipsychotic drugs and the risk for acute kidney injury and other adverse outcomes in older adults: a population-based cohort study. Ann Intern Med. 2014;161(4):242-248. [DOI] [PubMed] [Google Scholar]
- 13. Hampton LM, Daubresse M, Chang HY, Alexander GC, Budnitz DS. Emergency department visits by adults for psychiatric medication adverse events. JAMA Psychiatry. 2014;71(9):1006-1014. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14. Karsten J, Hagenauw LA, Kamphuis J, Lancel M. Low doses of mirtazapine or quetiapine for transient insomnia: a randomised, double-blind, cross-over, placebo-controlled trial. J Psychopharmacol. 2017;31(3):327-337. doi: 10.1177/0269881116681399. [DOI] [PubMed] [Google Scholar]
- 15. Thompson W, Quay TAW, Rojas-Fernandez C, Farrell B, Bjerre LM. Atypical antipsychotics for insomnia: a systematic review. Sleep Med. 2016;22:13-17. doi: 10.1016/j.sleep.2016.04.003. [DOI] [PubMed] [Google Scholar]
- 16. Mueller SK, Sponsler KC, Kripalani S, Schnipper JL. Hospital-based medication reconciliation practices: a systematic review. Arch Intern Med. 2012;172(14):1057-1069. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17. D’Angelo RG, Rincavage M, Tata AL, et al. Impact of an antipsychotic discontinuation bundle during transitions of care in critically ill patients. J Intensive Care Med. 2016;1:885066616686741. doi: 10.1177/0885066616686741. [DOI] [PubMed] [Google Scholar]