Is higher psychotropic medication burden associated with involuntary treatment under the Mental Health Act? A four-year Australian cohort study

Journal article

Wheeler, Amanda J., Hu, Jie, Profitt, Caitlin, McMillan, Sara S. and Theodoros, Theo. (2020). Is higher psychotropic medication burden associated with involuntary treatment under the Mental Health Act? A four-year Australian cohort study. BMC Psychiatry. 20(1), p. 294. https://doi.org/10.1186/s12888-020-02661-6
AuthorsWheeler, Amanda J., Hu, Jie, Profitt, Caitlin, McMillan, Sara S. and Theodoros, Theo
Abstract

Background
Involuntary treatment for individuals who lack sufficient capacity to make informed decisions regarding treatment has been associated with increased rates of injectable antipsychotics, antipsychotic polytherapy, and/or high doses. However, little is known about non-antipsychotic psychotropic prescription, or psychotropic medication burden as a more encompassing approach for people treated involuntarily. The aim of this study was to examine the relationship between Mental Health Act (MHA) status and psychotropic polypharmacy and/or high-dose medication prescribing practices in an Australian inpatient mental health unit.

Methods
A retrospective cohort study of 800 adults discharged from a large metropolitan Queensland mental health unit was undertaken. Data was collected for 200 individuals, discharged on at least one psychotropic medicine, at four time periods; Cohort 1 (on or before 31st January 2014), Cohort 2 (2015), Cohort 3 (2016) and Cohort 4 (2017). The number of prescribed medicines and total daily doses were recorded and reviewed for alignment with current clinical guidelines. Participant demographics and clinical characteristics were compared by individual MHA status using chi-square test for categorical variables and analysis of variance for continuous variables. Associations between MHA status and prescribing practices (psychotropic polypharmacy and/or high-dose prescribing) were assessed using bivariate and multivariate binomial logistic regression models. Age, gender, birth country, year of admission, admissions in previous 12 months, primary diagnosis, ECT/clozapine treatment, and other psychotropic medications were adjusted as covariates.

Results
Regression analysis found that compared to their voluntary counterparts, individuals treated involuntarily were 2.7 times more likely to be prescribed an antipsychotic at discharge, 8.8 times more likely to be prescribed more than one antipsychotic at discharge and 1.65 times more likely to be prescribed high-dose antipsychotic treatment at discharge. The adjusted model also found that they were half as likely to be prescribed an antidepressant at discharge.

Conclusion
Implicit review of justifications for increased psychotropic medication burden (antipsychotic polypharmacy and high-doses) in those treated involuntarily is required to ensure clinical outcomes and overall quality of life are improved in this vulnerable group. Clearly documented medication histories, reconciliation at discharge and directions for medication management after discharge are necessary to ensure quality use of medicines.

Keywordspsychotropics; medication; involuntary treatment; antipsychotic; polypharmacy
Year2020
JournalBMC Psychiatry
Journal citation20 (1), p. 294
PublisherBiomed Central Ltd
ISSN1471-244X
Digital Object Identifier (DOI)https://doi.org/10.1186/s12888-020-02661-6
Scopus EID2-s2.0-85086425539
Open accessPublished as ‘gold’ (paid) open access
Research or scholarlyResearch
Page range1-10
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online11 Jun 2020
Publication process dates
Accepted11 May 2020
Deposited07 Jul 2021
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Using Global Positioning Systems (GPS) and temperature data to generate time-activity classifications for estimating personal exposure in air monitoring studies: An automated method
Nethery, Elizabeth, Mallach, Gary, Rainham, Daniel, Goldberg, Mark S. and Wheeler, Amanda. (2014). Using Global Positioning Systems (GPS) and temperature data to generate time-activity classifications for estimating personal exposure in air monitoring studies: An automated method. Environmental Health: A Global Access Science Source. 13(1), pp. 1 - 11. https://doi.org/10.1186/1476-069X-13-33
Quantifying the contribution of ambient and indoor-generated fine particles to indoor air in residential environments
MacNeill, Morgan, Kearney, J., Wallace, Lance, Gibson, M., Heroux, M. E., Kuchta, J., Guernsey, J. R. and Wheeler, Amanda. (2014). Quantifying the contribution of ambient and indoor-generated fine particles to indoor air in residential environments. Indoor Air: international journal of indoor air quality and climate. 24(4), pp. 362 - 375. https://doi.org/10.1111/ina.12084
Comparison of questionnaire responses with biomarkers of tobacco smoke exposure in a Canadian birth cohort at three months of age
McLean, Kathleen, Lanphear, Bruce P., Wheeler, Amanda, Brook, Jeff, Scott, James, Allen, Ryan, Brauer, Michael, Sears, Malcolm, Subbarao, Padmaja, Turvey, Stuart, Becker, Allan, Mandhane, Piush and Takaro, Tim. (2014). Comparison of questionnaire responses with biomarkers of tobacco smoke exposure in a Canadian birth cohort at three months of age. In R. Warrington (Ed.). Canadian Society of Allergy and Clinical Immunology Annual Scientific Meeting 2013. United Kingdom: BioMed Central. pp. 1 - 2 https://doi.org/10.1186/1710-1492-10-S1-A60
Consumer health organisations for chronic conditions : Why do some people access them and others don't?
Sav, Adem, McMillan, Sara, Kelly, Fiona, Whitty, Jennifer, Kendall, Elizabeth, King, Michelle and Wheeler, Amanda. (2014). Consumer health organisations for chronic conditions : Why do some people access them and others don't? Primary Health Care Research and Development. 15(4), pp. 418 - 429. https://doi.org/10.1017/S1463423614000036
Chronic Conditions, financial burden and pharmaceutical pricing : Insights from Australian Consumers
Whitty, Jennifer, Sav, Adem, Kelly, Fiona, King, Michelle, McMillan, Sara, Kendall, Elizabeth and Wheeler, Amanda. (2014). Chronic Conditions, financial burden and pharmaceutical pricing : Insights from Australian Consumers. Australian Health Review. 38(5), pp. 589 - 595. https://doi.org/10.1071/AH13190
Predictors of indoor BTEX concentrations in Canadian residences
Wheeler, Amanda J., Wong, Suzy L., Khoury, Cheryl and Zhu, Jiping. (2013). Predictors of indoor BTEX concentrations in Canadian residences. Health Reports. 24(5), pp. 11-17.
Long-term exposure to traffic-related air pollution and cardiovascular mortality
Chen, Hong, Goldberg, Mark S., Burnett, Richard T., Jerrett, Michael, Wheeler, Amanda J. and Villeneuve, Paul J.. (2013). Long-term exposure to traffic-related air pollution and cardiovascular mortality. Epidemiology. 24(1), pp. 35-43. https://doi.org/10.1097/EDE.0b013e318276c005
Identifying the sources driving observed PM2.5 temporal variability over Halifax, Nova Scotia, during BORTAS-B
Gibson, M. D., Pierce, J. R., Waugh, D., Kuchta, J. S., Chisholm, L., Duck, T. J., Hopper, J. T., Beauchamp, S., King, G. H., Franklin, J. E., Leaitch, W. R., Wheeler, A. J., Li, Z., Gagnon, G. A. and Palmer, P. I.. (2013). Identifying the sources driving observed PM2.5 temporal variability over Halifax, Nova Scotia, during BORTAS-B. Atmospheric Chemistry and Physics. 13(14), pp. 7199-7213. https://doi.org/10.5194/acp-13-7199-2013
Fine and ultrafine particle decay rates in multiple homes
Wallace, Lance, Kindzierski, Warren, Kearney, Jill, MacNeill, Morgan, Héroux, Marie-Ève and Wheeler, Amanda J.. (2013). Fine and ultrafine particle decay rates in multiple homes. Environmental Science and Technology. 47(22), pp. 12929-12937. https://doi.org/10.1021/es402580t
Development of temporally refined land-use regression models predicting daily household-level air pollution in a panel study of lung function among asthmatic children
Johnson, Markey, MacNeill, Morgan, Grgicak-Mannion, Alice, Nethery, Elizabeth, Xu, Xiaohong, Dales, Robert, Rasmussen, Pat and Wheeler, Amanda. (2013). Development of temporally refined land-use regression models predicting daily household-level air pollution in a panel study of lung function among asthmatic children. Journal of Exposure Science and Environmental Epidemiology. 23, pp. 259-267. https://doi.org/10.1038/jes.2013.1
Reductions in Residential Wood Smoke Concentrations and Infiltration Efficiency using Electrostatic Air Cleaner Interventions
Amanda J. Wheeler, Mark Gibson, Tony J. Ward, Ryan W. Allen, Judy Read Guernsey, Matt Seaboyer, James Kuchta, Richard Gould and Dave Stieb. (2013). Reductions in Residential Wood Smoke Concentrations and Infiltration Efficiency using Electrostatic Air Cleaner Interventions. 12th International Conference on Indoor Air Quality and Climate 2011. Curran Associates, Inc..
Optimization of a Passive Sampling Method for Determination of Airborne Naphthalene for Residential Indoor Air Monitoring
Amanda J. Wheeler, Phil Fellin, Henrik Li, Mark D. Gibson, Judy Read Guernsey, Keith Van Ryswsk, Leonora Marro, Huda Masoud, Roger Sutcliffe and Marie-Eve Héroux. (2013). Optimization of a Passive Sampling Method for Determination of Airborne Naphthalene for Residential Indoor Air Monitoring. 12th International Conference on Indoor Air Quality and Climate 2011. Curran Associates, Inc..
Development and validation of the TefTex electrostatic wipe for indoor dust sampling
Theodore Konya, Juliet Ewaze, Bruce Urch, Huan Shu, Jason Curran, Mary Speck, Ryan Allen, Jeff Brook, Miriam Diamond, Greg Evans, Tim Takaro, Amanda Wheeler and James Scott. (2013). Development and validation of the TefTex electrostatic wipe for indoor dust sampling. 10th International Conference on Healthy Buildings 2012. Brisbane, Australia Curran Associates, Inc..
Characteristics of naphthalene and its sources in Edmonton, Alberta residences during winter and summer 2010
Warren Kindzierski, Phyllis Chui, Xiangfei Li, Keith Van Ryswyk, Amanda Wheeler, Marie-Eve Heroux, Leonora Marro and Phil Fellin. (2013). Characteristics of naphthalene and its sources in Edmonton, Alberta residences during winter and summer 2010. 12th International Conference on Indoor Air Quality and Climate 2011. Curran Associates, Inc.. pp. 2529-2534
Assessment of Indoor and Outdoor Air Pollution in a Residential High-Rise
Gary Mallach, Ryan H Kulka, Russell Dietz, Lance Wallace, Halûk Özkaynak, Ron Williams, Amanda Wheeler, Marie-Ève Heroux and Markey Johnson. (2013). Assessment of Indoor and Outdoor Air Pollution in a Residential High-Rise. 12th International Conference on Indoor Air Quality and Climate 2011. Curran Associates, Inc.. pp. 141-142
Ambient ozone concentrations and the risk of perforated and nonperforated appendicitis : A multicity case-crossover study
Kaplan, Gilaad G., Tanyingoh, Divine, Dixon, Elijah, Johnson, Markey, Wheeler, Amanda J., Myers, Robert P., Bertazzon, Stefania, Saini, Vineet, Madsen, Karen, Ghosh, Subrata and Villeneuve, Paul J.. (2013). Ambient ozone concentrations and the risk of perforated and nonperforated appendicitis : A multicity case-crossover study. Environmental Health Perspectives. 121(8), pp. 939-943. https://doi.org/10.1289/ehp.1206085
A randomized double-blind crossover study of indoor air filtration and acute changes in cardiorespiratory health in a First Nations community
Weichental, S., Mallach, G., Kulka, R., Black, A., Wheeler, A., You, H., St-Jean, M., Kwiatkowski, R. and Sharp, D.. (2013). A randomized double-blind crossover study of indoor air filtration and acute changes in cardiorespiratory health in a First Nations community. Indoor Air. 23(3), pp. 175-184. https://doi.org/10.1111/ina.12019
A new exposure metric for traffic-related air pollution? An analysis of determinants of hopanes in settled indoor house dust
Sbihi, Hind, Brook, Jeffrey R., Allen, Ryan W., Curan, Jason H., Dell, Sharon, Mandhane, Piush, Scott, James A., Sears, Malcolm R., Subbarao, Padmaja, Takaro, Timothy K., Turvey, Stuart E., Wheeler, Amanda J. and Brauer, Michael. (2013). A new exposure metric for traffic-related air pollution? An analysis of determinants of hopanes in settled indoor house dust. Environmental Health. 12, pp. 1-11. https://doi.org/10.1186/1476-069X-12-48
A cohort study of intra-urban variations in volatile organic compounds and mortality, Toronto, Canada
Villeneuve, Paul J., Jerrett, Michael, Su, Jason, Burnett, Richard T., Chen, Hong, Brook, Jeffrey, Wheeler, Amanda J., Cakmak, Sabit and Goldberg, Mark S.. (2013). A cohort study of intra-urban variations in volatile organic compounds and mortality, Toronto, Canada. Environmental Pollution. 183, pp. 30-39. https://doi.org/10.1016/j.envpol.2012.12.022
Self management of chronic conditions in a rural and remote context
Sav, Adem, King, Michelle, Kelly, Fiona, McMillan, Sara, Kendall, Elizabeth, Whitty, Jennifer and Wheeler, Amanda. (2013). Self management of chronic conditions in a rural and remote context. Australian Journal of Primary Health. https://doi.org/10.1071/PY13084
'You say treatment, I say hard work' : Treatment burden among people with chronic illness and their carers in Australia
Sav, Adem, Kendall, Elizabeth, McMillan, Sara, Kelly, Fiona, Whitty, Jennifer, King, Michelle and Wheeler, Amanda. (2013). 'You say treatment, I say hard work' : Treatment burden among people with chronic illness and their carers in Australia. Health and Social Care in the Community. https://doi.org/10.1111/hsc.12052
Burden of treatment for chronic illness: A concept analysis and review of the literature
Sav, Adem, King, Michelle A., Whitty, Jennifer, Kendall, Elizabeth, McMillan, Sara S., Kelly, Fiona, Hunter, Beth and Wheeler, Amanda. (2013). Burden of treatment for chronic illness: A concept analysis and review of the literature. Health Expectations. 18(3), pp. 1 - 13. https://doi.org/10.1111/hex.12046
Community pharmacy in Australia : A health hub destination of the future
McMillan, Sara, Wheeler, Amanda, Sav, Adem, King, Michelle, Kendall, Elizabeth, Whitty, Jennifer and Kelly, Fiona. (2013). Community pharmacy in Australia : A health hub destination of the future. Research in Social and Administrative Pharmacy. https://doi.org/10.1016/j.sapharm.2012.11.003
Patient-centred approaches to health care: A Systematic reivew of randomized controlled trials
McMillan, Sara, Kendall, Elizabeth, Sav, Adem, King, Michelle, Whitty, Jennifer, Kelly, Fiona and Wheeler, Amanda. (2013). Patient-centred approaches to health care: A Systematic reivew of randomized controlled trials. Medical Care Research and Review. 70(6), pp. 567 - 596. https://doi.org/10.1177/1077558713496318
Urinary polycyclic aromatic hydrocarbons as biomarker of exposure to PAHs in air : A pilot study among pregnant women
Nethery, Elizabeth, Wheeler, Amanda J., Fisher, Mandy, Sjödin, Andreas, Li, Zheng, Romanoff, Lovisa C., Foster, Warren and Arbuckle, Tye E.. (2012). Urinary polycyclic aromatic hydrocarbons as biomarker of exposure to PAHs in air : A pilot study among pregnant women. Journal of Exposure Science and Environmental Epidemiology. 2(1), pp. 70-81. https://doi.org/10.1038/jes.2011.32
Multi-season, multi-year concentrations and correlations amongst the BTEX group of VOCs in an urbanized industrial city
Miller, Lindsay, Xu, Xiaohong, Grgicak-Mannion, Alice, Brook, Jeffrey and Wheeler, Amanda. (2012). Multi-season, multi-year concentrations and correlations amongst the BTEX group of VOCs in an urbanized industrial city. Atmospheric Environment. 61, pp. 305-315. https://doi.org/10.1016/j.atmosenv.2012.07.041
Intraurban concentrations, spatial variability and correlation of ambient polycyclic aromatic hydrocarbons (PAH) and PM2.5
Anastasopoulos, Angelos T., Wheeler, Amanda, Karman, Deniz and Kulka, Ryan H.. (2012). Intraurban concentrations, spatial variability and correlation of ambient polycyclic aromatic hydrocarbons (PAH) and PM2.5. Atmospheric Environment. 59, pp. 272-283. https://doi.org/10.1016/j.atmosenv.2012.05.004
Factors influencing variability in the infiltration of PM2.5 mass and its components
MacNeill, M., Wallace, L., Kearney, J., Allen, R. W., Van Ryswyk, K., Judek, S., Xu, X. and Wheeler, A.. (2012). Factors influencing variability in the infiltration of PM2.5 mass and its components. Atmospheric Environment. 61, pp. 518-532. https://doi.org/10.1016/j.atmosenv.2012.07.005
A cohort study relating urban green space with mortality in Ontario, Canada
Villeneuve, Paul J., Jerrett, Michael, Su, Jason G., Burnett, Richard T., Chen, Hong, Wheeler, Amanda J. and Goldberg, Mark S.. (2012). A cohort study relating urban green space with mortality in Ontario, Canada. Environmental Research. 115, pp. 51-58. https://doi.org/10.1016/j.envres.2012.03.003
Treatment burden among people with chronic illness : What are the consumer health organisations saying?
Sav, Adem, McMillan, Sara, Kelly, Fiona, Kendall, Elizabeth, Whitty, Jennifer, King, Michelle and Wheeler, Amanda. (2012). Treatment burden among people with chronic illness : What are the consumer health organisations saying? Chronic Illness. 9(3), pp. 220 - 232. https://doi.org/10.1177/1742395312463411
The daily and seasonal variability in residential concentrations of aldehydes in two Canadian cities
Heroux, Marie-Eve, Dobbin, Nina, Gibson, Mark, Guernsey, Judy, Kindzierski, Warren, Van Ryswyk, Keith and Wheeler, Amanda. (2011). The daily and seasonal variability in residential concentrations of aldehydes in two Canadian cities. 12th International Conference on Indoor Air Quality and Climate 2011. United States: Curran Associates, Inc.. pp. 2254-2259
Windsor, Ontario Exposure Assessment Study : Design and methods validation of personal, indoor, and outdoor air pollution monitoring
Wheeler, Amanda J., Xu, Xiaohong, Kulka, Ryan, You, Hongyu, Wallace, Lance, Mallach, Gary, Van Ryswyk, Keith, MacNeill, Morgan, Kearney, Jill, Rasmussen, Pat E., Dabek-Zlotorzynska, Ewa, Wang, Daniel, Poon, Raymond, Williams, Ron, Stocco, Corinne, Anastassopoulos, Angelos, Miller, J. David, Dales, Robert and Brook, Jeffrey R.. (2011). Windsor, Ontario Exposure Assessment Study : Design and methods validation of personal, indoor, and outdoor air pollution monitoring. Journal of the Air and Waste Management Association. 61(3), pp. 324-338. https://doi.org/10.3155/1047-3289.61.3.324
Windsor, Ontario Exposure Assessment Study : Design and methods validation of personal, indoor, and outdoor air pollution monitoring
Wheeler, Amanda J., Xu, Xiaohong, Kulka, Ryan, You, Hongyu, Wallace, Lance, Mallach, Gary, Ryswyk, Keith Van, MacNeill, Morgan, Kearney, Jill, Rasmussen, Pat E., Dabek-Zlotorzynska, Ewa, Wang, Daniel, Poon, Raymond, Williams, Ron, Stocco, Corinne, Anastassopoulos, Angelos, Miller, J. David, Dales, Robert and Brook, Jeffrey R.. (2011). Windsor, Ontario Exposure Assessment Study : Design and methods validation of personal, indoor, and outdoor air pollution monitoring. Journal of the Air and Waste Management Association. 61(2), pp. 142-156. https://doi.org/10.3155/1047-3289.61.2.142
Validation of continuous particle monitors for personal, indoor, and outdoor exposures
Wallace, Lance A., Wheeler, Amanda J., Kearney, Jill, Van Ryswyk, Keith, You, Hongyu, Kulka, Ryan H., Rasmussen, Pat E., Brook, Jeff R. and Xu, Xiaohong. (2011). Validation of continuous particle monitors for personal, indoor, and outdoor exposures. Journal of Exposure Science and Environmental Epidemiology. 21(1), pp. 49-64. https://doi.org/10.1038/jes.2010.15
The transferability of NO and NO2 land use regression models between cities and pollutants
Allen, Ryan W., Amram, Ofer, Wheeler, Amanda J. and Brauer, Michael. (2011). The transferability of NO and NO2 land use regression models between cities and pollutants. Atmospheric Environment. 45(2), pp. 369-378. https://doi.org/10.1016/j.atmosenv.2010.10.002
Spatial variability and application of ratios between BTEX in two Canadian cities
Miller, Lindsay, Xu, Xiaohong, Wheeler, Amanda, Atari, Dominic Odwa, Grgicak-Mannion, Alice and Luginaah, Isaac. (2011). Spatial variability and application of ratios between BTEX in two Canadian cities. The Scientific World Journal. 11, pp. 2536-2549. https://doi.org/10.1100/2011/167973
Residential indoor and outdoor ultrafine particles in Windsor, Ontario
Kearney, J., Wallace, L., MacNeill, M., Xu, X., VanRyswyk, K., You, H., Kulka, R. and Wheeler, A. J.. (2011). Residential indoor and outdoor ultrafine particles in Windsor, Ontario. Atmospheric Environment. 45(40), pp. 7583-7593. https://doi.org/10.1016/j.atmosenv.2010.11.002
Residential indoor and outdoor coarse particles and associated endotoxin exposures
Wheeler, Amanda J., Dobbin, Nina A., Lyrette, Ninon, Wallace, Lance, Foto, Mark, Mallick, Ranjeeta, Kearney, Jill, Van Ryswyk, Keith, Gilbert, Nicolas L., Harrison, Ian, Rispler, Kathleen and Héroux, Marie-Eve. (2011). Residential indoor and outdoor coarse particles and associated endotoxin exposures. Atmospheric Environment. 45(39), pp. 7064-7071. https://doi.org/10.1016/j.atmosenv.2011.09.048
Personal, indoor, and outdoor concentrations of fine and ultrafine particles using continuous monitors in multiple residences
Wheeler, Amanda J., Wallace, Lance A., Kearney, Jill, Van Ryswyk, Keith, You, Hongyu, Kulka, Ryan, Brook, Jeffrey R. and Xu, Xiaohong. (2011). Personal, indoor, and outdoor concentrations of fine and ultrafine particles using continuous monitors in multiple residences. Aerosol Science and Technology. 45(9), pp. 1078-1089. https://doi.org/10.1080/02786826.2011.580798
IndoorOutdoor Ultrafine Particles in 50 Residences in Edmonton, Canada
Lance Wallace, Amanda Wheeler, Jill Kearney, Marie-Ève Héroux, Keith Van Ryswyk, Fay Li and Warren Kindzierski. (2011). IndoorOutdoor Ultrafine Particles in 50 Residences in Edmonton, Canada. 12th International Conference on Indoor Air Quality and Climate 2011. Curran Associates, Inc..