The AMUP study for drug surveillance in psychiatry -: a summary of inpatient data

From 1979 to 1989 the AMUP study (AMUP = Arzneimitteluberwachung in der Psychiatrie) was conducted in two psychiatric hospitals in Germany with the aim to provide a systematic and standardized assessment of all adverse reactions to psychotropic drugs under conditions of routine practice. A total of 60.7% of patients experienced at least one adverse drug reaction (ADR) with probable or definite causality during their stay in the hospital; 37.1% of patients exhibited ADRs that had some therapeutic impact on further treatment. ADRs that led to drug discontinuation were observed in 8.6%. This rate ranged from 9.5 to 5.1% for haloperidol and perazine, the most common neuroleptics at that time sedating antidepressants (AD) rated lower than non-sedating (amitriptyline 5.1%, clomipramine 10.4%). Lithium salts, antiparkinson drugs, and benzodiazepines were associated with considerably lower rates of ADRs than neuroleptics or antidepressants. Severe ADRs occurred in 1.4% of exposed patients (e.g., toxic delirium, grand mal seizures, malignant neuroleptic syndrome, or agranulocytosis). The AMUP data suggest that administration of psychotropic drugs in psychiatric hospitals at that time was a safe, but also inconvenient treatment for many patients due to a wide range of bothersome side effects that compromised patient compliance. The data can serve as a reference base for comparisons with newer compounds introduced to the market over the last decade such as serotonin reuptake inhibitors (SSRIs) and other new AD, atypical neuroleptics, or other new generation psychotropic drugs.