Safety of Psychopharmacotherapy in Patients With a Psychosomatic Profile: A Retrospective Study Using the Global Trigger Tool

INTRODUCTION. Combined psychopharmacotherapy in patients with comorbid psychiatric and somatic disorders creates a high risk of adverse drug reactions (ADRs). The Global Trigger Tool (GTT) enables active screening and quantitative assessment of ADRs developing under the influence of various factors in routine clinical practice and helps identify directions for optimizing therapeutic strategy.

AIM. To evaluate the frequency and structure of ADRs during psychopharmacotherapy in patients with a psychosomatic profile and to identify associations between the use of specific drugs, combined psychopharmacotherapy, and the development of ADRs using the Global Trigger Tool.

MATERIALS AND METHODS. A single-center retrospective study was conducted that included 491 medical records of patients hospitalized in a psychosomatic department from January 2024 to March 2025. A list of 27 triggers, adapted for patients receiving psychopharmacotherapy, was used to identify ADRs. Statistical analysis was performed using Fisher exact test.

RESULTS. Twenty-five types of ADRs were identified. The most frequently recorded were cardiovascular disorders (n=211), anticholinergic effects (n=113), and hematological reactions (n=89). Concomitant use of 2 or more psychotropic drugs was associated with an increase in the incidence of extrapyramidal symptoms (up to 14.1%, p<0.001), acute urinary retention (up to 12.7%, p<0.001), and arterial hypotension (up to 9.4%, p<0.001) that correlated with the number of psychotropic drugs used. Known associations were confirmed: antipsychotics with extrapyramidal symptoms; antidepressants with bleeding; and antiepileptics with hematotoxicity. New hypotheses requiring confirmation were generated: risk of thrombocytopenia with trihexyphenidyl (p=0.006) and periciazine (p=0.005); arterial hypotension with valproic acid (p=0.044); and cardiotoxicity of pramipexole (p=0.006) and levodopa (p=0.012).

CONCLUSIONS. The GTT is an effective method for retrospective safety audit of psychopharmacotherapy. Combined psychopharmacotherapy is an independent modifiable risk factor. New associations between specific drugs and ADRs were identified that require confirmation and validation in prospective studies.

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