Deprescribing of Antipsychotics and Z-Drugs in a Geriatric Psychiatry Outpatient Clinic

Abstract

The use of antipsychotics and Z-drugs in elderly individuals has raised concerns regarding their adverse effects. This study investigates the deprescribing of these medications in geriatric patients attending a psychiatry outpatient clinic. The sample included patients using these medications, which are considered inappropriate for the elderly. The majority of participants were around 70 years of age, with a predominance of females. Deprescribing occurred in more than half of the cases, primarily influenced by individual clinical factors. Many participants exhibited cognitive impairments, particularly in attention and orientation (ACE-R), underscoring the importance of deprescribing these medications, as they can exacerbate cognitive dysfunction, increase the risk of falls, and contribute to delirium. First-generation antipsychotics, with their sedative and anticholinergic effects, worsen cognitive impairment, while second-generation antipsychotics, though safer, still pose risks of excessive sedation and extrapyramidal side effects. Z-drugs affect cognition by inducing excessive sedation, confusion, and dependence. Deprescribing should be done gradually to avoid complications. While this study did not find a direct link between deprescribing and cognitive improvements, the practice is essential to mitigate the risks associated with psychotropic medications. Continuous monitoring post-withdrawal is crucial to prevent complications and improve cognitive and overall functioning. A multidisciplinary team, including psychiatrists, geriatricians, pharmacists, and therapists, should collaborate to adjust treatment and explore non-pharmacological alternatives and behavioral interventions.