4CPS-133 Prevalence of third-line treatment quetiapine and overweight/obesity in hospitalised psychiatric patients: a cross-sectional study

<h3>Background and Importance</h3> Patients with psychiatric conditions have higher mortality than the background population which is partly explained by metabolic risk factors. Before the year 2020 the antipsychotic drug, quetiapine, was among the first -or second-line treatment in Denmark for the treatment of several psychotic conditions. In the year 2020 quetiapine became the third-line treatment because of the risks of metabolic adverse effects (MAE) such as weight gain. Due to quetiapine’s affinity to histamine receptors, it is often prescribed off-label in low doses for sleep disturbances as an alternative to benzodiazepines. However, quetiapine causes MAEs dose-dependently, even in small doses. Therefore, antipsychotic drugs with MAEs, such as quetiapine, should be avoided when possible. <h3>Aim and Objectives</h3> This study aimed to observe the number of patients who were prescribed quetiapine and investigate the number of patients with concomitant overweight/obesity. <h3>Material and Methods</h3> This cross-sectional study was conducted during July 2024, in all hospitalised patients in the Psychiatry District East, Region Zealand, Denmark. The ward has had clinical pharmacist services since December 2019. Data were collected by one pharmacist and included sex, age, Body Mass Index, glycated haemoglobin, diabetes diagnoses and prescribed psychopharmaceutic drugs with MAEs (olanzapine, clozapine, quetiapine, sertindole, tricyclic antidepressants, mirtazapine). <h3>Results</h3> A total of 137 patients were consecutively observed. Sixty-eight percent of the patients had prescribed ≥1 drug with MAEs. Thirty-four percent was prescribed quetiapine either once daily or as needed. Twenty-nine percent of the patients with overweight/obesity were prescribed ≥1 drug with MAEs. Fourteen percent of the patients with overweight/obesity had a prescription of quetiapine. <h3>Conclusion and Relevance</h3> The limitations of this study include the short study period and the observational study design precluding causal inference with metabolic risk factors. However, this study observed that one third of the hospitalised patients are prescribed quetiapine, contrary to current guidelines. Furthermore, a notable proportion of the patients treated with drugs with MAEs are overweight/obese. Clinical pharmacists can provide pharmacological consults when a patient is prescribed drugs with MAEs and assist with alternative treatment suggestions. <h3>References and/or Acknowledgements</h3> <h3>Conflict of Interest</h3> No conflict of interest