APPLIED PSYCHOLOGY LABORATORY East Tennessee State University http://www.etsu.edu/apl/ Johnson City, Tennessee

1. What Are We On? Investigating Anxiety and Mood Disorders and Multiple Drug Prescriptions in Primary Care Yasmin A. Stoss, Michael T. Miesner, Ryne Druery & Chris S. Dula APPLIED PSYCHOLOGY LABORATORY East Tennessee State University http://www.etsu.edu/apl/ Johnson City, Tennessee DISCUSSION RESULTS INTRODUCTION • Though newer Serotonin Re-uptake Inhibitors (SSRIs) may be safer when used alone, there are data suggesting they are more dangerous when combined with other medications (polytherapy), due to their pharmacodynamicand pharmacokinetic properties (Settle, 1992). • A growingnumber of options for treating mood disorders seems to encourage prescription ofmultiple mood-altering and psychotropic agents. However, polytherapy has not been shown to be associated with superior clinical improvement or shorter hospitalization but was associated with higher body weight (Centorrino, et. al., 2007). • Polytherapy involving antipsychotic drugs continues to increase despite limited empirical evidence for greater effectiveness and findings suggesting safety concerns (Centorrino, et. al., 2007). • Use of antidepressants in the treatment of bipolar depression was found to be highly prevalentand sustained, despite limited evidence of efficacy orsafety in this context (Baldessarini, et. al., 2007). • It is critical to continue efficacy research in medicinal treatments of mood and other mental disorders, but it is likewise vital to better understand physician prescription patterns. Data was analyzed using Analysis of Variance (ANOVA). Chart notation of anxiety was not significantly related to prescription quantity, F(1,96) = 3.487 with p = .065. Chart notions of mood disorders did differ significantly as a function of prescription quantity, F(1,96)= 8.771, p=.004. • Anxiety was not found to be significantly related to prescription quantity. This was unexpected and is interesting considering the overlap between anxiety and mood disorders in treatment. • Previous studies depict the common use of polytherapy despite lack of greater effectiveness. The data partially supports H2, as it relates to polytherapy of two drug classes.. However monotherapy in this instance is more common. The most common combinations found in this study were first SSRIs and Anticonvulsants and second SSRIs and Antipsychotics. Frequency of Treatment with Polytherapy LIMITATIONS • Data were collected only from one primary care site. • There was no way to verify that the medical charts were complete in regards to patients’ full medical histories. Thus, some patients may have had relevant but unnoted diagnoses from previous physicians. • The scope of this project limited the gathering the diagnostic types of affective disorders as well as the severity of the potential disorders, due to the nature of the medical chart review procedures. • One of the problems in detecting a mental health disorder in primary care is the ability for a patient to effectively communicate with their PCP. This may be in part to many patients having trouble overcoming the negative stigma associated with seeking mental health treatment. HYPOTHESES HYPOTHESES • H1: Patients with chart notations or diagnoses of mood and or anxiety will not have been prescribed significantly more mental health drugs in combination (Polytherapy) than other affective disorders. • H2: A diagnosis of either a mood or anxiety disorder may lead to a increased number of multiple drug prescriptions.(e.g. SSRI’s, TCA’s, Antipsychotics, Benzodiazepines, or Anticonvulsants). IMPLICATIONS & FUTURE DIRECTIONS Most Common drugs prescribed in combination • Future studies might seek to further test the efficacy of polytherapyfor mood and anxiety diagnosed patients versus monotherapy and other forms of treatment. • Ongoing research seeks to determine how accurate physicians are at detecting and treating affective disorders in primary care. • Physicians in the primary care setting might be educated on affective disorders and how to refer possibly afflicted patients to mental health care professionals, in addition to providing relevant medications. METHOD • Participants: 100 medical charts were reviewed at a rural family medicine clinic. Patients were between 18 and 90 years old with a mean age of 49.84, SD= 17.79. • Method: Data was collected by 8 undergraduates trained to review charts in an integrated primary care practice. Data were recorded pertaining to the number of drugs a patient was prescribed, the types of drugs prescribed, and the relation of drug prescription to mental health conditions noted in patient’s charts. Data was matched up with the categories for mental illness types to see if any relation presented itself between the existence of a particular kind of mental disorder and the number of types of drugs a patient was prescribed. REFERENCES Centorrino, F., Cincotta, S. L., Talamo, A., Fogarty, K. V., Guzzetta, F., Saadeh, M. G., et al. (2008). Hospital use of antipsychotic drugs: Polytherapy. Psychiatry: Interpersonal and Biological Processes, 49, 65–69. Prairie, E., Cor-, N., Hanover, E., & Diego, S. (2008). Psychotropic Medications for Patients With Bipolar Disorder in the United States: Polytherapy and Adherence. October, 59 (10). Settle, E. C. (1992). Antidepressant side effects: Issues and options [Monograph]. Journal of Clinical Psychiatry, 10,48–61. CONTACT: Yasmin A. Stoss, zyas1@goldmail.etsu.edu or Chris S. Dula, dulac@etsu.edu