Complex psychotropic polypharmacy presents a persistent therapeutic dilemma in psychiatric inpatient facilities worldwide. Clinicians often balance acute behavioral stabilization against long-term metabolic, cognitive, and cardiovascular hazards. Consequently, implementing multi-professional medication reviews in psychiatry has emerged as a promising structural approach to optimize pharmacological regimens. A French university hospital study by Lebrat and colleagues evaluated how multi-professional medication reviews transform inpatient prescribing patterns. The investigators conducted a robust retrospective, pre-post observational study across four psychiatric wards between August 2017 and December 2023. By comparing patient admissions before and after implementing these collaborative reviews, the researchers assessed changes in medication burdens. Ultimately, their findings offer critical real-world evidence demonstrating that structured collaboration among psychiatrists, clinical pharmacists, and nursing teams curbs drug overuse and improves patient safety.

The Growing Burden of Inpatient Psychotropic Polypharmacy

Inpatient psychiatric wards frequently manage patients who experience severe, acute, or treatment-refractory disorders. Consequently, clinicians frequently combine multiple psychotropic medications to control distressing behavioral symptoms. However, cross-titrations, adjunctive sedatives, and prophylactic medications often persist indefinitely without scheduled reassessments. This cumulative prescribing habit exposes vulnerable patients to serious iatrogenic complications. For instance, cumulative anticholinergic burdens significantly heighten the danger of acute delirium, urinary retention, severe constipation, and long-term cognitive deterioration. Similarly, prolonged co-prescription of antipsychotics and benzodiazepines markedly elevates sedation risks, respiratory depression, metabolic dysfunction, and sudden cardiac events. In low- and middle-income healthcare systems like India, psychiatric polypharmacy also strains family finances and complicates long-term medication adherence. Therefore, clinical teams urgently require systematic institutional mechanisms to reconcile prescriptions, re-evaluate therapeutic indications, and initiate prudent deprescribing before discharge.

Implementing Medication Reviews in Psychiatry

Multi-professional medication reviews (MPMRs) represent formal, interdisciplinary evaluations designed to ensure rational pharmacotherapy through structured team collaboration. Rather than relying solely on individual attending psychiatrists, this model pairs physicians directly with clinical pharmacists and ward nurses. During these scheduled sessions, the pharmacist systematically scrutinizes the patient's complete pharmaceutical profile alongside serum laboratory parameters and clinical history. Meanwhile, nurses supply critical real-time observations regarding treatment adherence, sedation levels, motor symptoms, and subjective tolerability. Furthermore, the team identifies non-indicated drugs, duplicative therapies, dangerous drug-drug interactions, and excessive dosages. Together, the team formulates an evidence-based, patient-centered pharmaceutical care plan. Because all team members participate actively in the final decision-making, the resulting deprescribing choices gain broader institutional support. Consequently, this collaborative framework avoids clinical inertia and ensures deliberate, coordinated deprescribing protocols during inpatient hospitalization.

Significant Reductions in High-Risk Drug Classes

The landmark study evaluated clinical outcomes using paired statistical analyses and mixed linear models adjusted for patient age, sex, admission ward, and total hospitalization duration. Crucially, the implementation of collaborative reviews led to a statistically significant decrease in total prescribed medications, achieving an average reduction of 1.1 drugs per patient. More impressively, overall psychotropic medications dropped by an average of 1.5 drugs per individual. The secondary analyses revealed striking targeted reductions in several high-risk pharmacotherapeutic classes. Prescribed benzodiazepines decreased markedly by 0.8 agents per patient, while anticholinergic medications dropped by 0.7 agents. Furthermore, antipsychotic prescriptions fell by 0.3 agents, and laxatives decreased by 0.2 agents. Interestingly, maintenance medications such as mood stabilizers and antidepressants showed no significant numerical decline. Therefore, these findings confirm that the intervention promoted selective, rational deprescribing rather than arbitrary reductions in essential psychiatric maintenance therapy.

Clinical Practice Implications and Gender Disparities

The study also revealed intriguing demographic nuances, particularly regarding gender differences in deprescribing rates. Male inpatients experienced significantly greater reductions in total psychotropics than female inpatients, suggesting subtle behavioral or pharmacokinetic prescribing biases that merit prospective exploration. Nevertheless, the clinical takeaway remains decisive: routine multi-professional medication reviews eliminate redundant medications without destabilizing acute psychiatric symptoms. For practicing psychiatrists and hospital administrators, these outcomes underscore the urgent necessity of integrating clinical pharmacists into routine ward rounds. Pharmacists bring unique pharmacodynamic insight that complements psychiatric expertise, particularly when deciphering complicated hepatic drug interactions or subtle anticholinergic toxicity. When clinical teams institutionalize regular prescription audits, they construct a reliable safety barrier against prescribing cascades. Ultimately, this multidisciplinary vigilance protects fragile patients from preventable adverse drug reactions while enhancing overall therapeutic efficacy.

Overcoming Implementation Barriers in Hospital Settings

Although the therapeutic benefits of medication reviews are undeniable, successful hospital-wide implementation requires overcoming notable operational hurdles. First, institutional leaders must address clinical time constraints and administrative skepticism regarding interprofessional workflow changes. Many psychiatric facilities operate with heavy patient caseloads and scarce clinical pharmacy personnel. However, hospitals can optimize efficiency by stratifying patients using electronic screening tools to prioritize individuals with severe polypharmacy or elevated anticholinergic risk scores. Additionally, junior medical staff require continuous training in deprescribing algorithms and tapering strategies to prevent acute withdrawal rebound. Establishing shared electronic health records and standardized review templates also streamlines communication across departments. By embedding these structured reviews into routine discharge planning, hospitals can ensure sustainable medication reconciliation. Consequently, healthcare institutions can foster a robust culture of medication safety that protects patients across every stage of psychiatric care.

What is a multi-professional medication review in psychiatry?

A multi-professional medication review is a structured, collaborative clinical evaluation conducted jointly by psychiatrists, clinical pharmacists, and nursing personnel. The multidisciplinary team systematically evaluates a patient's complete medication regimen to optimize therapeutic efficacy, identify dangerous drug-drug interactions, eliminate inappropriate or duplicative therapies, and minimize unnecessary adverse medication risks.

Which psychiatric medication classes showed the greatest reduction?

The study demonstrated that collaborative reviews produced the most substantial deprescribing reductions in high-risk medication classes. Specifically, researchers documented statistically significant decreases in overall psychotropics, benzodiazepines, anticholinergic agents, antipsychotics, and laxatives. Conversely, fundamental maintenance therapies, including mood stabilizers and antidepressants, remained appropriately stable without arbitrary reductions.

How can hospitals successfully integrate collaborative medication reviews?

Hospitals can successfully integrate collaborative reviews by embedding clinical pharmacists directly into inpatient psychiatric ward teams and conducting scheduled case conferences. Utilizing electronic medical records to identify high-risk patients experiencing severe polypharmacy also maximizes clinical efficiency. Standardized tapering protocols, institutional deprescribing guidelines, and continuous interprofessional education further ensure consistent implementation.

Disclaimer: This content is for informational and educational purposes only and does not constitute medical advice, diagnosis, or treatment. It is intended to support, not replace, the clinical judgment of healthcare professionals. While based on peer-reviewed research, clinical contexts vary, and medical knowledge evolves rapidly. Healthcare providers should verify critical drug details and exercise independent clinical judgment. Patients should always consult qualified healthcare providers regarding medical conditions or treatment decisions. Refer to the latest local and national guidelines for clinical practice.

References

Lebrat M et al. Impact of multi-professional medication reviews (MPMRs) on medication prescriptions in psychiatry. PLoS One. 2026. doi: 10.1371/journal.pone.0358539. PMID: 42766546.

Garfinkel D, Mangin D. Feasibility study of a systematic approach for discontinuation of multiple medications in older adults: addressing polypharmacy. Arch Intern Med. 2010;170(18):1648-1654.

Stubbs B, et al. EPA guidance on physical activity as a treatment for severe mental illness. Eur Psychiatry. 2018;54:124-144.