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This page is an AI-assisted Turkish summary of the study presented at the 26th World Congress of Psychiatry. The study belongs to the presenting authors; please refer to the original source when citing it.

EV0951

Psychotropic polypharmacy in older adults: a clinical framework for benefit–harm decision-making

PSYCHOTROPIC POLYPHARMACY IN OLDER ADULTS: A CLINICAL FRAMEWORK FOR RISK-BENEFIT DECISION-MAKING

Psychotropic polypharmacy in older adults requires structured, ongoing reassessment involving individualized risk assessment, regular review of indications, dose optimization, and deprescribing of inappropriate medications.

The aim is to provide a clinically oriented decision-making framework based on individualized benefit–harm assessment to guide when to initiate, continue, or modify treatment involving psychotropic polypharmacy in older adults. The method is a narrative review integrating the literature on geriatric pharmacology and psychiatry with major clinical practice guidelines; nonsystematic searches were conducted in major databases and guideline sources, drawing primarily on the AGS Beers Criteria (2023), STOPP/START v3 (2023), and the WHO guideline on rational medication use in older adults with multimorbidity. The poster reports no numerical results, sample, or statistical analyses. Reported adverse outcomes include sedation (the most common, involving central nervous system depression), cognitive decline and delirium risk associated with anticholinergic burden, falls and fractures due to sedation and orthostatic hypotension, behavioral disturbances involving paradoxical reactions and agitation, and the prescribing cascade, in which medication adverse effects are mistaken for new symptoms, leading to additional prescriptions. The pharmacological rationale includes reduced renal clearance, decreased hepatic metabolism, increased volume of distribution for lipophilic drugs, heightened central nervous system sensitivity, increased anticholinergic burden, and changes in receptor density. The proposed four-step framework consists of individualized risk assessment, review of ongoing indications using the Beers and STOPP/START tools, dose optimization according to renal and hepatic function using the “start low, go slow” principle, and minimization of inappropriate medications, emphasizing that structured reassessment breaks the cascade. In conclusion, the authors state that in selected patients for whom harms outweigh benefits, deprescribing should be viewed not as treatment failure but as an effective, evidence-based clinical decision.

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