gms | German Medical Science

29th Annual Meeting of the German Drug Utilisation Research Group (GAA)

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie

24.11. - 25.11.2022, Münster

Should suicidal adolescents be monitored for drug use at the beginning of a hospital stay?

Meeting Abstract

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  • corresponding author presenting/speaker Isabel Hach - Paracelsus Medical University Nuremberg, Nürnberg, Germany
  • Thomas Bertsch - Paracelsus Medical University Nuremberg, Nürnberg, Germany
  • Patrick Nonell - Paracelsus Medical University Nuremberg, Nürnberg, Germany

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie e.V. (GAA). 29. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie. Münster, 24.-25.11.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. Doc22gaa17

doi: 10.3205/22gaa17, urn:nbn:de:0183-22gaa175

Published: November 21, 2022

© 2022 Hach et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Background: Therapeutic drug monitoring (TDM) is strongly recommended for psychiatric child and adolescent patients. As supratherapeutic drug levels of psychopharmacological medication may be related to an increased risk for adverse events, elevated blood concentrations may increase the risk of vulnerable situations. Vice versa subtherapeutic drug levels of psychopharmacological drugs may be associated with risk of poor response and more symptoms of mental disorders. In a pre-study for a study about risk factors for suicidality and self-injuries in adolescents, we evaluated retrospectively different drug levels of psychopharmacological medication (i.e., TDM) and OTC (Over The Counter) medication in blood and urine (i.e. screening assay) samples of suicidal adolescent patients. We wanted to find out, if TDM could provide valuable information for our decision-making process in the therapy of suicidal adolescents.

Materials and Methods: The urine and serum levels of adolescents, hospitalized due to their acute suicidality, but without a known actual suicide attempt (i.e. no acute intoxication or serious self-injuries), were investigated routinely between 01.03.2017 and 31.01.2018. Urine and blood samples were taken at the beginning of closed inpatient admission, i.e. the results of the laboratory analysis reflect outpatients drug intake. The serum levels of frequent prescribed psychopharmacological medication (i.e. antidepressants, antipsychotics, and benzodiazepines), and OTC-medication (e.g., aspirin, acetaminophen) were measured. The study was approved by the local institutional review board. Statistical analysis was carried out anonymously using methods of descriptive analysis and procedures on sample comparisons.

Results: Our sample consists of 231 cases (males: N=54; females: N=177, ratio: 1:3.3), aged 12-17 years (average age: 15.4 years). The main psychiatric diagnoses were (recurrent) moderate or severe depressive episodes (ICD-10: F32.1, F32.2, F33.1, F33.2: 57%) and adjustment disorders (ICD 10 F43.2, 24%). Five patients had the diagnosis schizophrenia, schizotypal or schizoaffective disorder (ICD10 F20.0, F21.0. F25.1). 17% of urine samples showed THC and its metabolites. Serum levels of the antipsychotic Quetiapine (N=16) ranged from 10 to 945 ng/ml (14 subtherapeutic levels, one supratherapeutic level, therapeutic reference range: 100-500 ng/ml in adults), serum levels of Aripiprazole (N=18) ranged from 91-1910 ng/ml (10 supratherapeutic levels, therapeutic reference range: 100-350 ng/ml in adults). Antidepressants were more frequent prescribed than antipsychotics. For example, serum levels of fluoxetine in our sample (N=27) ranged from 15 to 665 ng/ml. We found 17 subtherapeutic levels and one supratherapeutic level (therapeutic reference range: 120-500 ng/ml). There were no relevant serum levels of OTC drugs (e.g., acetyl salicyclic acid, acetaminophen) or benzodiazepines.

Conclusion: First results of this retrospective analysis show different possibilities for improving psychopharmacological therapy in suicidal adolescents. For example, given that acute suicidality is a symptom of recurrence or relapse during maintance antidepressant treatment, the subtherapeutic levels of antidepressants should be optimized. Moreover, not only supratherapeutic levels of antipsychotics in adolescent patients without psychotic symptoms (i.e. no indication) should be checked, as provided reference ranges are diagnosis-specific, i.e. only for patients with schizophrenia. TDM at the beginning of a hospital stay could be used to enhance the safety and efficacy of the individual psychopharmacological treatment of adolescent patients.


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