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Pharmacotherapy of psychiatric inpatients with adjustment disorder: current status and changes between 2000 and 2016

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Abstract

Adjustment disorder is a temporary change in behaviour or emotion as a reaction to a stress factor. Therapy consists of psychotherapy, and pharmacotherapy can be advised. However, data on the real-life pharmacological treatment are sparse. Prescription data for 4.235 psychiatric inpatients diagnosed with adjustment disorder in the time period 2000–2016 were analysed. The data were obtained from the Drug Safety Programme in Psychiatry (AMSP). Data were collected on two reference days per year; prescription patterns and changes over time were analysed. Of all patients, 81.2% received some type of psychotropic drug. Mostly antidepressants (59.8%), antipsychotics (35.5%), and tranquilisers (22.6%) were prescribed. Prescription rates for antidepressants decreased slightly over the years, while rates for antipsychotics increased, especially for atypical antipsychotics. It is important to note that the diagnosis “adjustment disorder” is most likely a working diagnosis that is used for patients in immediate need of psychiatric aid. Overall, pharmacotherapy for inpatients with this diagnosis is mostly symptom-oriented and focuses on depressive moods, agitation and anxiety. Therapy regimes changed over time and show an increased use of atypical antipsychotics with sedative properties. However, for most of the medication, there are neither evidence-based studies nor guidelines, and drugs might be contraindicated in some cases.

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Acknowledgements

This study was supported by the AMSP Drug Safety Programme, Hannover, Germany. The analysis of the data and this publication were made possible by a grant from Immanuel Clinic Rüdersdorf. We thank Frederike Bredy for proof reading and language editing.

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Authors and Affiliations

  1. Brandenburg Medical School, Immanuel Klinik Rüdersdorf, University Clinic for Psychiatry and Psychotherapy, 15562, Rüdersdorf, Germany

    Timo Greiner, Beatrice Haack, Martin Heinze & Michael Schneider

  2. Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, 30625, Hannover, Germany

    Sermin Toto & Stefan Bleich

  3. Department of Psychiatry, Ludwig-Maximilians-University, 80336, Munich, Germany

    Renate Grohmann

  4. Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsmedizin Rostock, 18147, Rostock, Germany

    Frank Faltraco

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  1. Timo Greiner
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Correspondence to Timo Greiner.

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Conflict of interest

T Greiner, B. Haack, F. Faltraco, M. Schneider and M. Heinze declare no conflict of interests. The AMSP Drug Safety Programme is based on non-profit associations in the German-speaking countries Germany, Austria and Switzerland. In recent years, financial support has been contributed by almost all the pharmaceutical companies involved in CNS research. Since 1993 educational and research grants have been awarded by the following pharmaceutical companies to the three national non-profit associations of the AMSP: Austrian companies: AstraZeneca Österreich GmbH, Boehringer Ingelheim Austria, Bristol–Myers Squibb GmbH, CSC Pharmaceuticals GmbH, Eli Lilly GmbH, Germania Pharma GmbH, GlaxoSmithKline Pharma GmbH, Janssen-Cilag Pharma GmbH, Lundbeck GmbH, Novartis Pharma GmbH, Pfizer Med Inform, Servier Pharma Austria, Wyeth Lederle Pharma GmbH. German companies: Abbott GmbH & Co. KG, AstraZeneca GmbH, Aventis Pharma Deutschland GmbH GE–O/R/N, Bayer Vital GmbH & Co. KG, Boehringer Mannheim GmbH, Bristol-Myers-Squibb, Ciba Geigy GmbH, Desitin Arzneimittel GmbH, Duphar Pharma GmbH & Co. KG, Eisai GmbH, esparma GmbH Arzneimittel, GlaxoSmithKline Pharma GmbH & Co. KG, Hoffmann-La Roche AG Medical Affairs, Janssen-Cilag GmbH, Janssen Research Foundation, Knoll Deutschland GmbH, Lilly Deutschland GmbH Niederlassung Bad Homburg, Lundbeck GmbH & Co. KG, Nordmark Arzneimittel GmbH, Novartis Pharma GmbH, Organon GmbH, Otsuka-Pharma Frankfurt, Pfizer GmbH, Pharmacia & Upjohn GmbH, Promonta Lundbeck Arzneimittel, Rhone-Poulenc Rohrer, Sanofi-Synthelabo GmbH, Sanofi-Aventis Deutschland, Schering AG, Servier Pharma, SmithKlineBeecham Pharma GmbH, Solvay Arzneimittel GmbH, Synthelabo Arzneimittel GmbH, Dr Wilmar Schwabe GmbH & Co., Thiemann Arzneimittel GmbH, Trommsdorff GmbH & Co. KG Arzneimittel, Troponwerke GmbH & Co. KG, Upjohn GmbH, Wander Pharma GmbH, Wyeth-Pharma GmbH. Swiss companies: AHP (Schweiz) AG, AstraZeneca AG, Bristol–Myers Squibb AG, Desitin Pharma GmbH, Eli Lilly (Suisse) S.A., Essex Chemie AG, GlaxoSmithKline AG, Janssen-Cilag AG, Lundbeck (Suisse) AG, Mepha Schweiz AG/Teva, MSD Merck Sharp & Dohme AG, Organon AG, Pfizer AG, Pharmacia, Sandoz Pharmaceuticals AG, Sanofi-Aventis (Suisse) S.A., Sanofi-Synthe´labo SA, Servier SA, SmithKlineBeecham AG, Solvay Pharma AG, Vifor SA, Wyeth AHP (Suisse) AG, Wyeth Pharmaceuticals AG. S. Bleich, R. Grohmann and S. Toto are project managers of the AMSP programme. S. Toto has been a member of the advisory board for Otsouka and has received speaker‘s honoria from Janssen-Cilag, Lundbeck, Otsouka and Servier.

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Greiner, T., Haack, B., Toto, S. et al. Pharmacotherapy of psychiatric inpatients with adjustment disorder: current status and changes between 2000 and 2016. Eur Arch Psychiatry Clin Neurosci 270, 107–117 (2020). https://doi.org/10.1007/s00406-019-01058-1

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  • DOI: https://doi.org/10.1007/s00406-019-01058-1

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