(216) Bidirectional Relationship Between Urinary Retention and The Use of Antipsychotics

Sunday, August 28, 2022

8:00 AM – 1:45 PM CEST

Location: Hall C

Publication Number: 1261

Presenting Author(s)

Grace (Hsin Min) Wang
– University of Florida Department of Pharmaceutical Outcomes and Policy, Gainesville, Florida, United States

Co-Author(s)

Scott M. Vouri, PharmD, PharmD, PhD, PhD
– Assistant Professor, University of Florida College of Pharmacy, Gainesville, Florida, United States
Edward Lai, PhD
– Associate Professor, National Cheng Kung University, National Cheng Kung University, Tainan City, Tainan, Taiwan (Republic of China)

Background: Previous studies have suggested that urinary retention (UR) can induce delirium, which may require the use of antipsychotics. However, antipsychotics have also been reported to worsen UR due to their anticholinergic side effects, which may constitute a vicious circle between UR and the use of antipsychotics.

Objectives: To investigate this bidirectional relationship between UR and the use of antipsychotics.

Methods: We performed sequence symmetry analyses using Taiwan’s National Health Insurance Database between 2001 and 2012. To evaluate the use of antipsychotics following UR-induced delirium, we selected new users of UR treatments (i.e., alpha-1 antagonists or 5-alpha reductase inhibitors) who initiated antipsychotics within one year before or after UR treatment initiation. We excluded patients with a competing diagnosis to ensure that the use of antipsychotics was for delirium, including schizophrenia, bipolar disorder, depression, and dementia. To assess UR following antipsychotic use, we selected new users of antipsychotics who initiated bethanechol within one year before or after antipsychotic initiation. Patients with a record of benign prostatic hyperplasia (BPH) diagnosis was excluded to ensure that the use of bethanechol was for drug-induced UR. Sequence ratio (SR) was calculated to estimate the temporality of drug pairs (UR treatments – antipsychotics and antipsychotics – bethanechol). We calculated the adjusted SR (aSR) by dividing the crude SR by null-effect SR to address the prescribing trends.

Results: Patients were more likely to initiate antipsychotics after relative to before UR treatment initiation (aSR 1.23, 95% CI 1.21-1.26). Specifically, the adjusted aSR were higher in the subgroups of patients diagnosed with BPH (aSR 1.42, 95% CI 1.38-1.46), aged 70+ years (aSR 1.43, 95% CI 1.39-1.47), and male (aSR 1.26, 95% CI 1.24-1.29). Moreover, we found a higher probability of patients initiating bethanechol after relative to before antipsychotic initiation (aSR 1.11, 95% CI 1.08-1.14). The aSR increased in the subgroups of patients diagnosed with schizophrenia (aSR 5.38, 95% CI 4.56-6.35), bipolar disorder (aSR 2.11, 95% CI 1.86-2.40), depression (aSR 1.27, 95% CI 1.21-1.34), and dementia (aSR 1.14, 95% CI 1.08-1.20).

Conclusions: Our results suggested a potential bidirectional relationship between UR and antipsychotic treatment. The finding warrants the attention to psychotic symptoms caused by UR, and UR resulted from antipsychotic use.