Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-28T15:18:52.190Z Has data issue: false hasContentIssue false
  • English
  • Français

Benzodiazepine use among older adults with schizophrenia spectrum disorder: prevalence and associated factors in a multicenter study

Published online by Cambridge University Press:  07 May 2019

Jean-Pierre Schuster ,
Nicolas Hoertel ,
Armin von Gunten ,
Anne-Sophie Seigneurie ,
Frédéric Limosin  and
CSA Study group
Jean-Pierre Schuster*
Affiliation:
Old-Age Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland
Nicolas Hoertel
Affiliation:
Department of Psychiatry, AP-HP, Western Paris University Hospitals, 92130 Issy-les-Moulineaux, France INSERM UMR 894, Psychiatry and Neurosciences Center, Paris, France Paris Descartes University, Sorbonne Paris Cité, Paris, France
Armin von Gunten
Affiliation:
Old-Age Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland
Anne-Sophie Seigneurie
Affiliation:
Department of Psychiatry, AP-HP, Western Paris University Hospitals, 92130 Issy-les-Moulineaux, France
Frédéric Limosin
Affiliation:
Department of Psychiatry, AP-HP, Western Paris University Hospitals, 92130 Issy-les-Moulineaux, France INSERM UMR 894, Psychiatry and Neurosciences Center, Paris, France Paris Descartes University, Sorbonne Paris Cité, Paris, France
CSA Study group
Affiliation:
Old-Age Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland
*
Correspondence should be addressed to: Jean-Pierre Schuster, Old-Age Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

Data on psychotropic medications of older patients with schizophrenia spectrum disorder are scarce. Specifically, information about the use of benzodiazepines among older patients with schizophrenia spectrum disorder is very limited. Because benzodiazepine use in older patients has been associated with many disabling side effects, its use in actual practice must be described and questioned. This study aimed at exploring the prevalence of benzodiazepine use and the clinical factors associated with such use among older patients with schizophrenia spectrum disorder.

Methods/Design:

Data from the Cohort of individuals with Schizophrenia Aged 55 years or more (CSA) were used to examine the prevalence of benzodiazepine use among older patients with schizophrenia spectrum disorder. Demographic and clinical characteristics associated with benzodiazepine prescription were also explored.

Results:

The prevalence of benzodiazepine use was 29.8% of older patients with schizophrenia spectrum disorder. These patients were significantly more likely to have medical comorbidities, cognitive and social functioning impairments, to report a lifetime history of suicide attempt, to be institutionalized, and to have been hospitalized in a psychiatric service in the past year compared to those without a benzodiazepine prescription (all p<0.05). There were no between-group differences in schizophrenia severity and psychiatric comorbidity.

Conclusions:

Although it can be hypothesized that benzodiazepine prescription is part of a short-term therapeutic strategy toward patients with more severe trouble or comorbid disorders, our results suggest a strong link between benzodiazepine prescription and a particularly vulnerable subpopulation of older patients with schizophrenia spectrum disorder.

Keywords

elderlyschizophreniabenzodiazepinestreatment
Type
Original Research Article
Information
International Psychogeriatrics , Volume 32 , Issue 4: Issue Theme: Serious Mental Illnesses in Older Adults , April 2020 , pp. 441 - 451
Copyright
© International Psychogeriatric Association 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

¥

Members of the CSA (Cohort of individuals with Schizophrenia Aged 55 years or more) group are as follows:

Jean Adès, Charles Alezrah, Isabelle Amado, Gilles Amar, Ovidiu Andréi, Denis Arbault, Georges Archambault, Gilles Aurifeuille, Hervé Bardou, Michèle Bareil-Guérin, Pierre Barrau, Sarah Barrière, Claudine Barrouillet, Emilie Baup, Nadine Bazin, Béatrice Beaufils, Jalel Ben Ayed, Michel Benoit, Kader Benyacoub, Céline Béra-Potelle, Thérèse Bichet, Françoise Blanadet, Olivier Blanc, Julien Blanc-Comiti, Yvonne Blumenstock, Didier Boussiron, Anne-Marie Bouysse, Alain Brochard, Olivier Brochart, Bastien Bucheron, Marion Cabot, Vincent Camus, Jean-Marc Chabannes, Véronique Charlot, Thomas Charpeaud, Astrid Chevance, Cateline Clad-Mor, Colette Combes, Maricela Comisu, Bernard Cordier, François Costi, Jean-Paul Courcelles, Mercedes Creixell, Henry Cuche, Christine Cuervo-Lombard, Anis Dammak, David Da Rin, Jean-Bernard Denis, Hélène Denizot, Anne Deperthuis, Eric Diers, Smail Dirami, Didier Donneau, Pierre Dreano, Caroline Dubertret, Eric Duprat, Didier Duthoit, Christian Fernandez, Philippe Fonfrede, Nelly Freitas, Philippe Gasnier, Jacques Gauillard, Fabien Getten, Fabien Gierski, Fabien Godart, Raphaël Gourevitch, Aude Grassin Delyle, Juliette Gremion, Hélène Gres, Véronique Griner, Christophe Guerin-Langlois, Christian Guggiari, Olivier Guillin, Hamadi Hadaoui, Emmanuel Haffen, Cécile Hanon, Sadeq Haouzir, Cyril Hazif-Thomas, Anne Heron, Bérengère Hubsch, Isabelle Jalenques, Dominique Januel, Arthur Kaladjian, Jean-François Karnycheff, Oussama Kebir, Marie-Odile Krebs, Christine Lajugie, Marion Leboyer, Pierre Legrand, Michel Lejoyeux, Vincent Lemaire, Evelyne Leroy, Diane Levy-Chavagnat, Antoine Leydier, Chantal Liling, Pierre-Michel Llorca, Philippe Loeffel, Patrice Louville, Stéphane Lucas Navarro, Nicolas Mages, Mohamed Mahi, Odile Maillet, Aude Manetti, Catherine Martelli, Pascal Martin, Marc Masson, Isabelle Maurs-Ferrer, Joelle Mauvieux, Sylvain Mazmanian, Emmanuelle Mechin, Lila Mekaoui, Mostéfa Meniai, Agnès Metton, Amine Mihoubi, Maria Miron, Geneviève Mora, Valérie Niro Adès, Philippe Nubukpo, Cécile Omnes, Stéphanie Papin, Pierre Paris, Christine Passerieux, Jérôme Pellerin, Julie Perlbarg, Sylvie Perron, Annie Petit, François Petitjean, Christophe Portefaix, Dominique Pringuey, Andrei Radtchenko, Hassan Rahiou, Delphine Raucher-Chéné, Anne Rauzy, Lionel Reinheimer, Michel Renard, Margaux René, Charles-Edouard Rengade, Paul Reynaud, Didier Robin, Christelle Rodrigues, Aurélie Rollet, Fabien Rondepierre, Bernard Rousselot, Sarah Rubingher, Ghassen Saba, Jean-Pierre Salvarelli, Jean-Claude Samuelian, Corinne Scemama-Ammar, Franck Schurhoff, Daniel Sechter, Béatrice Segalas, Tiphaine Seguret, Amina Semmak, Frédéric Slama, Sophie Taisne, Mohamed Taleb, Jean-Louis Terra, Dominique Thefenne, Eric Tran, Rémi Tourtauchaux, Marie-Noëlle Vacheron, Pierre Vandel, Valérie Vanhoucke, Emmanuel Venet, Hélène Verdoux, Anne Viala, Gilles Vidon, Murielle Vitre, Jean-Luc Vurpas, Carole Wagermez, Michel Walter, Liova Yon and Xavier Zendjidjian.

References

Airagnes, G.et al. (2016). Benzodiazepine misuse in the elderly: Risk factors, consequences, and management. Current Psychiatry Reports, 18, 89.CrossRefGoogle ScholarPubMed
Abou Kassm, S.et al. (2019). Metabolic syndrome among older adults with schizophrenia spectrum disorder: Prevalence and associated factors in a multicenter study. Psychiatry Research, 275, 238–246.10.1016/j.psychres.2019.03.036CrossRefGoogle ScholarPubMed
Baandrup, L., Fagerlund, B. and Glenthoj, B. (2017). Neurocognitive performance, subjective well-being, and psychosocial functioning after benzodiazepine withdrawal in patients with schizophrenia or bipolar disorder: a randomized clinical trial of add-on melatonin versus placebo. European Archives of Psychiatry and Clinical Neuroscience, 267, 163–171.CrossRefGoogle ScholarPubMed
Ballon, J. and Stroup, T. S. (2013). Polypharmacy for schizophrenia. Current Opinion in Psychiatry, 26, 208–213.CrossRefGoogle Scholar
Barker, M. J.et al. (2004). Cognitive effects of long-term benzodiazepine use: a meta-analysis. CNS Drugs, 18, 37–48.10.2165/00023210-200418010-00004CrossRefGoogle ScholarPubMed
Brunette, M. F.et al. (2003). Benzodiazepine use and abuse among patients with severe mental illness and co-occurring substance use disorders. Psychiatric Services, 54, 1395–1401.CrossRefGoogle ScholarPubMed
Chakos, M. H.et al. (2006). Baseline use of concomitant psychotropic medications to treat schizophrenia in the CATIE trial. Psychiatric Services, 57, 1094–1101.10.1176/ps.2006.57.8.1094CrossRefGoogle ScholarPubMed
Clark, R. E., Xie, H. and Brunette, M. F. (2004). Benzodiazepine prescription practices and substance abuse in persons with severe mental illness. Journal of Clinical Psychiatry, 65, 151–155.10.4088/JCP.v65n0202CrossRefGoogle ScholarPubMed
Cohen, C. I., Meesters, P. D. and Zhao, J. (2015). New perspectives on schizophrenia in later life: implications for treatment, policy, and research. Lancet Psychiatry, 2, 340–350.CrossRefGoogle Scholar
Cohen, C. I. and Murante, T. (2018). A prospective analysis of the role of cognition in three models of aging and schizophrenia. Schizophrenia Research, 196, 22–28.CrossRefGoogle Scholar
Cohen, C. I.et al. (2008). Schizophrenia in later life: clinical symptoms and social well-being. Psychiatric Services, 59, 232–234.CrossRefGoogle ScholarPubMed
Cohen, C. I., Vengassery, A. and Garcia Aracena, E. F. (2017). A longitudinal analysis of quality of life and associated factors in older adults with schizophrenia spectrum disorder. The American Journal of Geriatric Psychiatry, 25, 755–765.CrossRefGoogle ScholarPubMed
Dixon, L. (1999). Dual diagnosis of substance abuse in schizophrenia: prevalence and impact on outcomes. Schizophrenia Research, 35, S93–S100.CrossRefGoogle ScholarPubMed
Dold, M., Li, C., Gillies, D. and Leucht, S. (2013). Benzodiazepine augmentation of antipsychotic drugs in schizophrenia: a meta-analysis and Cochrane review of randomized controlled trials. European Neuropsychopharmacology, 23, 1023–1033.CrossRefGoogle ScholarPubMed
Dold, M.et al. (2012). Benzodiazepines for schizophrenia. The Cochrane Database of Systematic Reviews, 11, CD006391.Google Scholar
Endicott, J., Spitzer, R. L., Fleiss, J. L. and Cohen, J. (1976). The global assessment scale. A procedure for measuring overall severity of psychiatric disturbance. Archives of General Psychiatry, 33, 766–771.CrossRefGoogle ScholarPubMed
Essali, A. and Ali, G. (2012). Antipsychotic drug treatment for elderly people with late-onset schizophrenia. The Cochrane Database of Systematic Reviews, 15, CD004162.Google Scholar
Ewing, J. A. (1984). Detecting alcoholism. The CAGE questionnaire. JAMA, 252, 1905–1907.CrossRefGoogle ScholarPubMed
Fontanella, C. A.et al. (2016). Benzodiazepine use and risk of mortality among patients with schizophrenia: a retrospective longitudinal study. The Journal of Clinical Psychiatry, 77, 661–667.CrossRefGoogle ScholarPubMed
Gray, S. L., Lai, K. V. and Larson, E. B. (1999). Drug-induced cognition disorders in the elderly: incidence, prevention and management. Drug Safety, 21, 101–122.CrossRefGoogle Scholar
Green, M. F. (2006). Cognitive impairment and functional outcome in schizophrenia and bipolar disorder. Journal of Clinical Psychiatry, 67, 3–8.Google ScholarPubMed
Guy, W. (1976). Clinical global impression. In ECDEU Assessment Manual for Psychopharmacology, revised National Institute of Mental Health (pp 76–338). Rockville: US Department of Health, Education, and Welfare Publication (ADM).Google Scholar
Haw, C. and Stubbs, J. (2007). Benzodiazepines—a necessary evil? A survey of prescribing at a specialist UK psychiatric hospital. Journal of Psychopharmacology, 21, 645–649, https://trove.nla.gov.au/work/8580253?q&versionId=9915313 10.1177/0269881106072386CrossRefGoogle Scholar
Hebert, R.et al. (2001). Factors associated with long-term institutionalization of older people with dementia: data from the Canadian Study of Health and Aging. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 56, M693–699.CrossRefGoogle ScholarPubMed
Heinrichs, D. W., Hanlon, T. E. and Carpenter, W. T. (1984). The quality of life scale: an instrument for rating the schizophrenic deficit syndrome. Schizophrenia Bulletin, 10, 388–398.CrossRefGoogle ScholarPubMed
Herniman, S. E.et al. (2017). The psychometric validity of the Center for Epidemiological Studies Depression Scale (CES-D) in first episode schizophrenia spectrum. Psychiatry Research, 252, 16–22.10.1016/j.psychres.2017.02.023CrossRefGoogle Scholar
Hoertel, N., Limosin, F. and Leleu, H. (2014). Poor longitudinal continuity of care is associated with an increased mortality rate among patients with mental disorders: results from the French National Health Insurance Reimbursement Database. European Psychiatry, 29, 358–364.10.1016/j.eurpsy.2013.12.001CrossRefGoogle ScholarPubMed
Hoertel, N.et al. (2019). Subsyndromal and syndromal depressive symptoms among older adults with schizophrenia spectrum disorder: Prevalence and associated factors in a multicenter study. Journal of Affective Disorders, 251, 60–70.10.1016/j.jad.2019.03.007CrossRefGoogle ScholarPubMed
Howard, R., Rabins, P. V., Seeman, M. V. and Jeste, D. V. (2000). Late-onset schizophrenia and very-late-onset schizophrenia-like psychosis: an international consensus. The International Late-Onset Schizophrenia Group. The American Journal of Psychiatry, 157, 172–178.10.1176/appi.ajp.157.2.172CrossRefGoogle ScholarPubMed
Hulkko, A. P.et al. (2017). Lifetime use of psychiatric medications and cognition at 43 years of age in schizophrenia in the Northern Finland Birth Cohort 1966. European Psychiatry, 45, 50–58.CrossRefGoogle Scholar
Jones, S. H., Thornicroft, G., Coffey, M. and Dunn, G. (1995). A brief mental health outcome scale-reliability and validity of the Global Assessment of Functioning (GAF). British Journal of Psychiatry, 166, 654–659.CrossRefGoogle Scholar
Karagianis, J.et al. (2009). Worldwide Schizophrenia Outpatient Health Outcomes (W-SOHO): baseline characteristics of pan-regional observational data from more than 17,000 patients. International Journal of Clinical Practice, 63, 1578–1588.CrossRefGoogle ScholarPubMed
Kitajima, R.et al. (2012). Effects of tapering of long-term benzodiazepines on cognitive function in patients with schizophrenia receiving a second-generation antipsychotic. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 36, 300–306.CrossRefGoogle ScholarPubMed
Kitchens, J. M. (1994). Does this patient have an alcohol problem? JAMA, 272, 1782–1787.10.1001/jama.1994.03520220076034CrossRefGoogle ScholarPubMed
Lehman, A. F. (1996). Measures of quality of life among persons with severe and persistent mental disorders. Social Psychiatry and Psychiatric Epidemiology, 31, 78–88.10.1007/BF00801903CrossRefGoogle ScholarPubMed
Lembke, A., Papac, J. and Humphreys, K. (2018). Our other prescription drug problem. The New England Journal of Medicine, 378, 693–695.CrossRefGoogle ScholarPubMed
Le Strat, Y. and Hoertel, N. (2011). Correlation is no causation: gymnasium proliferation and the risk of obesity. Addiction, 106, 1871–1872.CrossRefGoogle ScholarPubMed
Leucht, S.et al. (2005). Clinical implications of brief psychiatric rating scale scores. British Journal of Psychiatry, 187, 366–371.CrossRefGoogle ScholarPubMed
Liu, S. K.et al. (2002). Deficits in sustained attention in schizophrenia and affective disorders: stable versus state-dependent markers. American Journal of Psychiatry, 159, 975–982.CrossRefGoogle ScholarPubMed
Marriott, R. G., Neil, W. and Waddingham, S. (2006). Antipsychotic medication for elderly people with schizophrenia. The Cochrane Database of Systematic Reviews, 25, CD005580.Google Scholar
Matta, J.et al. (2019). Diet and physical activity in the association between depression and metabolic syndrome: Constances study. Journal of Affective Disorders, 244, 25–32.CrossRefGoogle ScholarPubMed
Meesters, P. D.et al. (2016). Mortality and its determinants in late-life schizophrenia: a 5-year prospective study in a Dutch catchment area. The American Journal of Geriatric Psychiatry, 24, 272–277.10.1016/j.jagp.2015.09.003CrossRefGoogle Scholar
Meesters, P. D.et al. (2013). The care needs of elderly patients with schizophrenia spectrum disorders. The American Journal of Geriatric Psychiatry, 21, 129–137.CrossRefGoogle ScholarPubMed
Morin, A. J.et al. (2011). Psychometric properties of the Center for Epidemiologic Studies Depression Scale (CES-D) in French clinical and nonclinical adults. Revue d’Epidémiologie et de Santé Publique, 59, 327–340.CrossRefGoogle ScholarPubMed
Novick, D.et al. (2005). Use of concomitant medication with antipsychotic treatment in outpatients with schizophrenia: results from the European Schizophrenia Outpatient Health Outcomes (SOHO) study. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 29, 972–982.10.1016/j.pnpbp.2005.06.003CrossRefGoogle ScholarPubMed
Overall, J. E. and Gorham, D. R. (1962). The brief psychiatric rating scale. Psychological Reports, 10, 799–812.CrossRefGoogle Scholar
Radloff, L. S. (1977). The CES-D Scale: a self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.CrossRefGoogle Scholar
Raucher-Chéné, D.et al. (2015). Mental healthcare in older adults with schizophrenia: results from 118 French public psychiatric departments. International Psychogeriatrics, 27, 1749–1750.CrossRefGoogle ScholarPubMed
Robinson, R. G., McHugh, P. R. and Folstein, M. F. (1975). Measurement of appetite disturbances in psychiatric disorders. Journal of Psychiatric Research, 12, 59–68.CrossRefGoogle ScholarPubMed
Schafer, J. L. (1997). Analysis of Incomplete Multivariate Data. New York: Chapman and Hall.CrossRefGoogle Scholar
Sim, F., Sweetman, I., Kapur, S. and Patel, M. X. (2015). Re-examining the role of benzodiazepines in the treatment of schizophrenia: a systematic review. Journal of Psychopharmacology, 29, 212–223.CrossRefGoogle ScholarPubMed
Sun, E. C.et al. (2017). Association between concurrent use of prescription opioids and benzodiazepines and overdose: retrospective analysis. BMJ, 356, j760.CrossRefGoogle ScholarPubMed
Tiihonen, J.et al. (2016). Mortality and cumulative exposure to antipsychotics, antidepressants, and benzodiazepines in patients with schizophrenia: an observational follow-up study. The American Journal of Psychiatry, 173, 600–606.CrossRefGoogle Scholar
Verdoux, H. (2007). The current state of adult mental health care in France. European Archives of Psychiatry and Clinical Neuroscience, 257, 64–70.CrossRefGoogle ScholarPubMed
Verma, S. K.et al. (2002). Substance abuse in schizophrenia: a Singapore perspective. Social Psychiatry and Psychiatric Epidemiology, 37, 326–328.CrossRefGoogle ScholarPubMed
Vulser, H.et al. (2018). Depression, cognitive functions, and impaired functioning in middle-aged adults from the CONSTANCES cohort. The Journal of Clinical Psychiatry, 79, pii: 17m12003.CrossRefGoogle ScholarPubMed
Winter, J. E., MacInnis, R. J., Wattanapenpaiboon, N. and Nowson, C. A. (2014) BMI and all-cause mortality in older adults: a meta-analysis. The American Journal of Clinical Nutrition, 99, 875–890.10.3945/ajcn.113.068122CrossRefGoogle ScholarPubMed
Woods, S. W. (2003). Chlorpromazine equivalent doses for the newer atypical antipsychotics. Journal of Clinical Psychiatry, 64, 663–667.CrossRefGoogle ScholarPubMed
Wu, C. S., Lin, Y. J. and Liu, S. K. (2011). Benzodiazepine use among patients with schizophrenia in Taiwan: a nationwide population-based survey. Psychiatric Services, 62, 908–914.CrossRefGoogle ScholarPubMed