Prescription Of Atypical Antipsychotics Research Articles

Atypical Antipsychotic Prescribing in Australian Children and Adolescents: A Survey of Medical Practitioners.

Prescriptions for atypical antipsychotics in children and adolescents are increasing globally. However, a precise understanding of the clinical variables and evidence that prescribers consider before using these agents is lacking. While empirical literature on the long-term safety and efficacy of these medications is available, the literature concerning their use in these younger age groups is relatively sparse. In this study, we examined the current prescribing patterns of medical professionals employed by a public health service in Australia. A survey examining their current practice when prescribing atypical antipsychotics to children and adolescents was completed by 103 physicians. Questions were asked about commonly prescribed atypical antipsychotics, indications, dose ranges, target symptoms, duration of treatment, and the evidence base(s) used when making treatment decisions. Physicians prescribed atypical antipsychotics for a wide range of indications in this age group, with the most common agents being risperidone, quetiapine, and olanzapine. Adverse effects were reported as the main reason for treatment discontinuation. More than half of the respondents indicated that the most common source of guidance/evidence they referred to when initiating prescriptions were peers or expert opinion. Children and adolescents were prescribed a number of atypical antipsychotics for a variety of indications, with variable perceived confidence and a relatively heavy reliance on "own or peer experience" as opposed to good quality evidence. Challenges exist for both prescribers and policymakers, and further "head-to-head" studies are needed in this age group to ensure that a balance is maintained between therapeutic benefit and safety.

Selective Prescribing of Atypical Antipsychotics to Medicare Beneficiaries

Selective Prescribing of Atypical Antipsychotics to Medicare Beneficiaries

On- and Off-Label Atypical Antipsychotic Prescription Trends Across a Nine-Year Period Among Adolescents Pre- to Post-COVID-19

ObjectiveThis study examined atypical antipsychotic prescribing by Food and Drug Administration (FDA) approved-use (on-label) status for adolescents before and during the COVID-19 pandemic. MethodsRetrospective data were collected from electronic health records (EHRs) of adolescents aged 10–17 years in Kaiser Permanente Northern California. New outpatient atypical antipsychotic prescription orders during 2013–2021 were evaluated. Prescriptions were categorized as on-label if linked in EHRs to autism, psychosis, bipolar disorder, or Tourette’s diagnoses; otherwise, they were potentially off-label (herein, off-label). Trend analysis of monthly prescribing rates assessed slope change at pandemic onset for the cohort and by sex and age groups. ResultsAmong 5828 patients, 74.5% of new antipsychotic orders were off-label in 2021. Overall prescribing decreased significantly until early 2020 (slope = −0.045, P < .01) but then significantly increased through 2021 (post-March 2020 slope change = 0.211, P = .01). Off-label prescriptions increased at a similar rate during the COVID-19 time period, but on-label prescriptions did not change significantly. Males and younger adolescents (ages 10–14 years) showed significant decreases until early 2020, while females and older adolescents (ages 15–17 years) did not. Females and younger adolescents exhibited significant increases in overall and off-label prescribing rates following pandemic onset; older adolescents exhibited increases in overall prescriptions while males had no detectable changes. ConclusionsAntipsychotic prescribing declined slightly but then increased significantly following COVID-19 onset for overall and off-label prescriptions. Pandemic onset differentially impacted antipsychotic prescribing by sex and age, with overall and off-label prescribing driven by increases among female and younger adolescents.

Workshop I: Evidence-informed approach to prescribing of atypical antipsychotics to manage behaviors in Neurocognitive disorders: Results of a pilot study

Background:The LuBAIR™ Paradigm is a novel approach to ascribe meaning to behavioral expressions in advanced neurocognitive disorders when the reliability of a clinical assessment is limited. The meaning ascribed to each behavioral category was used to identify those who are likely to respond to the use of atypical antipsychotics in their management. De-prescribing was attempted on patients who qualified to enter this retrospective study. De-prescribing was defined as successful if individuals were completely withdrawn from AAP and remained off them for 60 days without the re-emergence of behaviors.Methods:The LuBAIR™ Inventory was filled on two occasions. The data collected on the second occasion, in the successful and failed de-prescribed groups, were compared in this retrospective study. MANOVA, Chi-Square paired t-test statistical analyses were used to detect the differences in the behavioral categories between the two cohorts. Cohen d was used to measure effect size.Results:Patients who did not have Mis-Identification and Goal-Directed Expressions were more likely to successfully de-prescribe: X2 (1, N = 40) = 29.119 p &lt; 0.0001 and X2 (1, N = 40) = 32.374, p &lt; 0.0001, respectively. Alternatively, the same behavioral categories were more likely to be present in patients who failed de-prescribing: MANOVA and paired t-test (p &lt; 0.0001).Conclusion:Atypical antipsychotics, in their role as an antipsychotic and mood stabilizer, may be used to manage Mis-Identification and Goal-Directed Expressions, respectively.

Five-year trend of antipsychotic prescription practices in a district Hospital in Ghana: A retrospective study.

Antipsychotics are the mainstay treatment for psychotic conditions. Their prescription, however, should come with some caution since the consequences of their side effects can be dire for the patient receiving the prescription. Because of inadequate experts in low-middle-income countries, non-experts are trained through the Mental Health Gap Action Program (MHGAP) to reduce the treatment gap. This retrospective study analyzed the trend of antipsychotic prescriptions in a district hospital where mental health services are delivered by non-experts. This was a retrospective descriptive study that gathered data between 2015 and 2019 from the electronic database of the hospital. Statistical analysis was conducted using SPSS version 20. We reported the descriptive statistics of our findings in the form of frequencies and percentages. There was a year-on-year increase in antipsychotic prescriptions over the study period. Starting with 48.1% in 2015 to 56.4% in 2019. The main condition for which antipsychotics were prescribed was psychosis (58.6%), followed by substance use disorder (SUD) (26%). Patients with age ≥ 50 received the most prescription of antipsychotics. Starting from 2015, there was a high percentage of typical antipsychotic prescriptions (90.14%) with atypical antipsychotics being 9.86% and by 2019 atypical antipsychotic prescriptions had shot up to 74.8%. Polypharmacy prescription rate was 8.1% over the study period. Antipsychotics are essential in the treatment of psychosis and other mental health conditions. Prescribers need to know more about these drugs to prescribe them appropriately and to minimize the likelihood of side effects among patients who use these drugs.

Off-label use of atypical antipsychotics- Where are we?

IntroductionNowadays, In the exercise of psychiatric clinical activity, the prescription of atypical antipsychotics is a widespread practice.However, despite the approval in the treatment of psychoses and bipolar affective disorder, where its effectiveness is clearly demonstrated, these drugs are off-label prescribed in most of the clinical situations.ObjectivesThis work aims to clarify which atypical antipsychotics are most frequent prescribed and the clinical conditions where their off-label prescription is more common.MethodsBibliographic research in the Pubmed® database using the terms “atypical antipsychotics and off-label use”ResultsAccording to the scientific literature consulted, the off-label prescription of atypical antipsychotics may represent about 70% of the total prescription of these psychotropic drugs.Risperidone, olanzapine, quetiapine and aripiprazole are the most off-label prescribed among the atypical antipsychotics.The psychiatric conditions where atypical antipsychotics are most often off-label prescribed are addictive disorders, anxiety disorders, post-traumatic stress disorder, personality disorders, eating disorders, insomnia and dementia, where therapeutic benefits are demonstrated when carefully selected.ConclusionsThe off-label prescription can be interpreted from two points of view. On the one hand, it can guide innovation in clinical practice and improve symptoms in patients who do not respond to standard treatments. On the other hand, it may be associated with negative consequences due to the lack of data on safety and efficacy in these situations.Despite widespread prescribing of atypical antipsychotics, there is no evidence-based recommendation beyond psychoses and bipolar affective disorder.Thus, when prescribed, we must proceed with careful monitoring and consider the risks and benefits in relation to off-label prescription.Disclosure of InterestNone Declared

Evidence-Based Use of Atypical Antipsychotics in the Care of Children and Adolescents

Atypical antipsychotics are increasingly used to treat children and adolescents with a variety of mental and behavioral symptoms, despite restrictive U.S. Food and Drug Administration indications. A recent taskforce advocates for a symptom-based approach to atypical antipsychotic use, rather than by diagnosis alone. Cautious prescribing of atypical antipsychotics should only take place after careful diagnostic assessment, review of prior treatments, and trials of other evidence-based medications. When used, monitoring metabolic indicators is crucial for the health and safety of patients. Risperidone and aripiprazole are highlighted as two different types of atypical antipsychotics commonly used to treat youth. [Journal of Psychosocial Nursing and Mental Health Services, 61(1), 8-11.].

Antipsychotic selection strategies: the need for a holistic approach

To describe the connections between strategies for antipsychotic prescribing and clinical, socio-psychological factors of treatment adherence in patients with psychotic disorders. The study included 83 inpatients with schizophrenic spectrum disorders (F2x) - 67%, affective disorders (F3x) - 15%, neurotic and personality (F4x + F6x) - 9%, organic diseases of the central nervous system (F0x) - 9%. We used a visual analog scale for patients' subjective severity of their condition, locus control test, Internalized stigma of mental disorder scale (ISMI), Treatment motivation assessment questionnaire (TMAQ), and Medication Compliance Scale (MCS), which also includes BPRS, SANS, GAF scales. Dispersion analysis (p≤0.05), effect sizes calculation (Cohen's d/Cramer's V) were performed (ES). The options for prescribed antipsychotics did not depend on positive and negative symptoms, social maladjustment, suicidality, disease recurrence. The outpatient use of more than one antipsychotic was associated with socio-demographic differences in patients, high internality in life failures (ES=0.98), self-stigmatization (ES=0.94) due to the psychiatric stereotypes endorsement (ES=1.03), and social self-isolation (ES=1.08). Prescription of atypical antipsychotics during hospitalization was associated with subjectively less severe condition in patients (ES=0.7), their position of active cooperation with a doctor (ES=1.08), high internality of achievements (ES=0.99), lower psychiatric stereotypes endorsement (ES=1.19), social self-isolation (ES=1.58). Depot antipsychotic was predominantly an option for patients with secondary education (ES=0.34). Types and forms of antipsychotic treatment were associated not with clinical but with social and psychological patients' characteristics. The prescription of atypical antipsychotics, including depot forms, is specifically associated with not only treatment adherence, but with a favorable profile of patients' motivation for treatment.

Implementation and evaluation of a curriculum on the assessment and treatment of disruptive behaviour disorders.

Disruptive behaviour disorders (DBDs)—which can include or be comorbid with disorders such as attention-deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder and disruptive mood dysregulation disorder—are commonly seen in paediatric practice. Given increases in the prescribing of atypical antipsychotics for children and youth, it is imperative that paediatric trainees in Canada receive adequate education on the optimal treatment of DBDs. We describe the development, dissemination, and evaluation of a novel paediatric resident curriculum for the assessment and treatment of DBDs in children and adolescents. Pre–post-evaluation of the curriculum showed improved knowledge in participants.

Factors associated with the transition of adolescent inpatients from an intensive residential ward to adult mental health services.

Transition of young people from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) is a complex process. Transition rates are heterogeneously reported, with wide definitions and ranges. Few data are available regarding predictive factors of a successful transition. We explored factors associated with transition in a cohort of former inpatients of a Children and Adolescents Intensive Treatment Ward (CAITW). Socio-demographic and clinical features of patients previously admitted to CAITW were matched to AMHS data for those patients having reached age requirements. We built multiple logistic regression models to identify factors associated with transfer to AMHS (either inpatient or outpatient) and with successful retention in treatment (RIT) at six (short RIT), 12 (intermediate RIT) and 24months after transfer (long RIT). From a cohort of 322 inpatients, 126 reached the age threshold for transfer to AMHS in the study period. The transfer rate was 50%. Two years after transition-age boundary, CAMHS-AMHS continuity of care was found in 40% and disengagement in 6% of cases. Longer and multiple hospitalizations, atypical antipsychotics prescription and a diagnosis of psychotic disorders were factors associated with short and intermediate RIT. A positive psychiatric family history was negatively associated with successful short and intermediate RIT. Diagnosis of psychosis and learning-supported school attendance were associated with long RIT. Young adults with a history of psychiatric inpatient admission as children or adolescents have a relatively high rate of transition to AMHS. A diagnosis of psychosis seems to be the strongest predictor for transition in these patients. Further research should focus on patients' schooling needs and on children of parents with mental health problems to enhance family and educational system engagement.

PMH26 Real World Evidence Analysis of Atypical Antipsychotics, Cardio-Metabolic Profiles and Related Costs: DATA from the Italian Administrative Database of Fondazione Ricerca E Salute (RES)

To assess cardio-metabolic events (CMEs) over 3 years after the atypical antipsychotics (AAPs) prescription in patients with/without predisposing conditions (PCs) for CMEs and related costs in the Italian National Health System (NHS) perspective. From the ReS database, among adults with at least one AAP prescription in 2015 (index date), new AAP users were identified by the absence of antipsychotic prescriptions in two previous years. They were split according to the presence/absence of CMEs (diabetes, cerebrovascular and ischemic heart disease) and PCs (hyperglycaemia, dyslipidaemia and obesity). Subjects without CMEs but with PCs (A) and those without CMEs/PCs (B) were paired 1:1 with controls (same clinical status but without any AAPs prescriptions). The 3-year CME probability (Kaplan Meier survival curves), the amount of AAPs prescribed up to 1 year before the CME, and annual healthcare costs (pharmaceuticals, hospitalizations and outpatient specialist services) were described in the NHS perspective. Out of >4 million adults of the 2015 ReS database, 50,893 patients (1.2%) with at least one AAP prescription were selected. New users were 12,128 (incidence: 2.8 x1,000). The 3-year CME probability was 17.0% and 7.9%, respectively for cohort A and B, vs 13.7% and 5.2% for controls (p<.01). Throughout 1 year before the CME, 74.0% and 79.2% received one AAP, while 1.3% and 0.6% received 2 AAPs, cohorts A and B respectively. The annual average per capita NHS cost was €7,171 (A) and €5,268 (B), vs €6,196 and €5,776 (respective controls). Hospitalizations were key cost drivers in all cohorts. This real-world evidence (RWE) analysis outlined the CME probability of over 3 years according to the presence/absence of PCs in new users of AAPs and related costs, in the perspective of the NHS. This findings showed RWE at the time of a first AAP prescription and in the presence of specific patients’ cardio-metabolic profiles.

Use of Antipsychotics in Patients with Behavioral and Psychological Symptoms of Dementia: Results of a Spanish Delphi Consensus

Background: Behavioral and psychological symptoms of dementia (BPSD) are difficult to manage and associated with poor outcome. Objectives: The aim of this study was to reach consensus on the use of antipsychotics in patients with BPSD in Spain. Methods: A qualitative, multicenter, two-round Delphi study was carried out, with the participation of specialists involved in the care of dementia patients throughout Spain. They completed a 76-item questionnaire related to the identification of BPSD, treatment with antipsychotics, follow-up of patients, barriers for the use of atypical antipsychotics, and effects of antipsychotics on quality of life. Results: A total of 162 specialists in neurology, psychiatry, and geriatrics (61% men) with a mean (SD) age of 45.9 (10) years participated in the study. Almost all participants (96.9%) strongly agreed that atypical antipsychotics are safer and better tolerated than typical antipsychotics. There was agreement on the importance to review the indication and dose of the antipsychotic drug at least every 3 months. There was consistent high rate of agreement on the beneficial impact of atypical antipsychotics on the quality of life of patients with dementia and their caregivers. A consensus was also reached on the need of detecting BPSD in patients with dementia as it decreases the quality of life of both patients and caregivers, and the need to routinely screen for dementia in elderly patients with no previous psychiatric history in the presence of suggestive symptoms of BPSD. Finally, the participants in the study agreed that administrative barriers for the prescription of atypical antipsychotics in Spain hinder the access to this drug group and favor the prescription of typical antipsychotics. Conclusions: The participants in the study agreed that atypical antipsychotics should be preferred to typical antipsychotics in the management of BPSD. Wide consensus was reached about the importance of early identification of BPSD in persons with cognitive impairment, the use and management of atypical antipsychotic drugs and their favorable impact on patients and caregiver’s quality of life.

A thematic analysis assessing clinical decision-making in antipsychotic prescribing for schizophrenia

BackgroundIn recent decades atypical antipsychotics have increased treatment options available for schizophrenia, however there is conflicting evidence concerning the trade-off between clinical efficacy and side effects for the different classes of antipsychotics. There has been a consistent increase in atypical antipsychotic prescribing compared to typical, despite evidence showing that neither class is superior. This leads to the question of whether prescribers are selective in their uptake of research evidence and clinical guidelines and if so, what influences their choice.. This study aims to identify the factors that contribute to the prescribing choice and how these can be used to aid knowledge translation and guideline implementation.MethodsA thematic analysis study was conducted using data from 11 semi-structured interviews with clinicians with experience in prescribing for schizophrenia.ResultsThe analysis identified five themes underpinning prescribing behaviour: (1) ownership and collaboration; (2) compromise; (3) patient involvement; (4) integrating research evidence; and (5) experience.ConclusionThe themes mapped to various degrees onto current models of evidence-based decision making and suggest that there is scope to re-think the guideline implementation frameworks to incorporate recurring themes salient to clinicians who ultimately use the guidelines. This will further translation of future evidence into clinical practice, accelerating clinical progress.

Nationwide Epidemiologic Study of Atypical Antipsychotic Use Among Pediatric Population with Mental Illness in Korea.

Objective: This population-based epidemiologic study aimed to analyze the prevalence and trends of atypical antipsychotic (AAP) use and identify factors associated with AAP prescribing among children and adolescents in Korea. Methods: Using the Health Insurance Review and Assessment Service-Pediatric Patients Sample data between 2010 and 2014, we assessed the prevalence of and secular trends in AAP use; utilization of individual AAP drug based on the type of healthcare services, healthcare institutions, and health security programs; and factors associated with AAP use. Results: The average annual prevalence of AAP use was 417 per 100,000 children and adolescents, which increased by 40% from 2010 to 2014. The major AAP drug of choice has shifted from risperidone (72.70% and 49.29% in 2010 and 2014, respectively) to aripiprazole (11.31% and 34.64% in 2010 and 2014, respectively). Quetiapine was mainly prescribed for inpatients. Therefore, hospitals have 2-3 times higher proportion of quetiapine use than clinics. A prominent difference exists in the prescribing rates and AAP drug of choice based on income level. Patients enrolled in the Medical Aid (MA) program had a higher AAP prescription rate than those enrolled in the National Health Insurance (NHI) program (adjusted odds ratio: 7.78). Moreover, MA recipients were more frequently prescribed with cheaper alternatives, such as risperidone, compared with NHI recipients. Conclusion: AAP has been increasingly used among the pediatric population in Korea. Future studies are needed to identify the causes of this increase and establish evidence on appropriate AAP use. In addition, relevant policies should be developed to ensure that low-income mentally ill children could take advantage of the best available therapy.

A Pharmacy-Based Electronic Handoff Tool to Reduce Discharge Prescribing of Atypical Antipsychotics Initiated in the Intensive Care Unit: A Quality Improvement Initiative

Purpose: To evaluate whether a pharmacist-initiated electronic handoff tool can reduce the overall, and potentially inappropriate, hospital discharge prescribing rate of atypical antipsychotics (AAP) initiated in AAP-naive critically ill adults. Methods: This pre–post quality improvement study was initiated in 5 intensive care units (ICUs) at a large academic medical center. An electronic handoff tool (iVent) was utilized in the post-intervention period to enhance pharmacist communication at inpatient transitions of care. Results: Of the 358 included patients, the proportion of hospital survivors with an AAP initiated in the ICU receiving a hospital discharge prescription was not different between the pre- and post-intervention period (28.6% vs 22.2%, P = .12). The proportion of ICU survivors with an AAP continued at the time of ICU transfer to the floor was reduced post-intervention (78.7% vs 66.7%, P = .012). Additionally, the overall proportion of a patient’s hospitalization receiving an AAP was also reduced (50.4% vs 42.8%, P = .008). A multivariate logistic regression demonstrated thatutilization of the electronic handoff tool was not associated with a reduction in hospital discharge prescribing of an AAP (odds ratio [OR]: 0.97, 95% confidence interval [CI]: 0.57-1.65). Conclusions: A pharmacy-initiated electronic handoff tool may reduce the proportion of AAP-naive ICU survivors with an AAP continued at the time of ICU transfer. The handoff tool was not associated with a significant reduction in the discharge prescribing rates of AAPs for hospital survivors, but a clinically meaningful reduction was possibly achieved due to enhanced communication enabled by this tool.

Atypical antipsychotic prescribing in elderly patients with depression.

Atypical antipsychotics are used as monotherapy or as augmentation therapy for management of late-life depression. However, little is known about utilization pattern of atypical antipsychotics in depression in the elderly. The objective of this study was to examine the prescribing practices and predictors of atypical antipsychotics and augmentation therapy in elderly outpatient visits with depression. This retrospective cross-sectional study used the National Ambulatory Medical Care Survey (NAMCS) and outpatient department component of the National Hospital Ambulatory Medical Care Survey (NHAMCS) data from 2010 and 2011. The study included elderly (age ≥ 65years) outpatient visits with depression. Descriptive weighted analysis was performed to determine the prescribing practices of atypical antipsychotics and multivariable logistic regression analyses were performed to determine the factors associated with the prescription of atypical antipsychotics and augmentation therapy in outpatient visits. According to the national surveys, there were about 22 million outpatent visits for depression during the study period; atypical antipsychotics were prescribed in 3.53% (95% CI, 2.02-5.04) of the visits. Among depression patients who were using antidepressants, 4.86% (95% CI, 3.07-6.04) used as an augmentation therapy. Multivariable regression analysis revealed that Hispanics (odds ratio [OR]=0.33; 95% CI, 0.12-0.90) were associated with decreased likelihood of antipsychotic prescription, whereas personality disorder and obsessive compulsive disorder (OR=10.23; 95% CI, 2.80-37.40) were associated with increased likelihood of prescribing antipsychotics. For augmentation therapy, Hispanics (OR=0.06; 95% CI, 0.02-0.24) and primary physicians (OR=0.24; 95% CI, 0.09-0.69) were associated with decreased likelihood; and obsessive compulsive disorder and personality disorder (OR=7.56; 95% CI, 1.75-32.69) were associated with increased likelihood of antipsychotic prescription. Less than 4% of the elderly visits with depression were prescribed atypical antipsychotics. Both clinical and demographic factors contribute to antipsychotic prescribing in elderly patients with depression.

Changes in Neutrophil Count After Antipsychotic Prescription Among a Retrospective Cohort of Patients With Benign Neutropenia

There is a paucity of literature regarding the effect of antipsychotics on absolute neutrophil count (ANC) of patients with benign neutropenia (BN). We evaluated the change in ANC after atypical antipsychotic prescription (excluding clozapine) in a retrospective cohort of 22 patients with BN. Records of all patients with BN who were prescribed antipsychotics and who had ANC measured before and during antipsychotic treatment were obtained from Bronx VA Medical Center between 2005 and 2015 (inclusive). Twenty-two patients met criteria for inclusion. Individual and group mean ANC were calculated before treatment and during treatment. A paired, two-tailed t test was performed on the group ANC means. The group mean pretreatment ANC was 1.24 ± 0.220 K/cmm, and the mean ANC during the time of antipsychotic prescription increased to 1.40 ± 0.230 K/cmm, with a P value of 0.0045, t value of 3.18, degrees of freedom equal to 21, and 95% confidence interval of 1.30 to 1.49 K/cmm. There was a statistically significant increase in ANC among our cohort during the time of antipsychotic prescription. All BN patients who were prescribed antipsychotics maintained a stable neutrophil count, with none of the 22 patients with BN in this study developing agranulocytosis during treatment. Although this study is limited by a low patient count as well as other demographic factors, these findings provide initial evidence regarding the safety of prescribing atypical antipsychotics to BN patients. Further studies are needed to replicate these findings and assess for effects of individual medications.

Trends in the prescribing of atypical antipsychotics in elderly patients with dementia in Korea .

In 2005, the Food and Drug Administration warned that atypical antipsychotics (AAPs) increased mortality in elderly patients with dementia. We investigated AAP prescribing in elderly patients with dementia in the ambulatory setting in Korea and the factors affecting AAP prescribing in elderly patients with dementia. Subjects ≥65years of age with at least one diagnosis of dementia (ICD-10: F00-F03, G30, G31.8) from January 1 to December 31, 2013 were identified from a health insurance database. Using multiple logistic regression analysis to estimate adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for AAP prescribing in elderly patients with dementia, AAP user prevalence was estimated and presented by dementia type, individual AAP, medical institution, and region. A total of 61,550 elderly patients with dementia were identified: 6,504 (9.8%) received AAPs, 12.3% of them had Alzheimer's disease; only 2 patients with vascular dementia were prescribed AAPs (0.04%). Female patients were less likely to be prescribed AAPs than male patients. The likelihood of AAP prescribing was higher for patients aged 70 years and older than for those <70 years. AAP prescribing was higher for patients visiting secondary care institutions (OR, 1.12; 95% CI, 1.65-1.74) than for those visiting primary care institutions, and for patients in cities (OR, 1.57; 95% CI, 1.52-1.62) than for those in metropolitan regions. Although the prevalence of AAP prescribing has decreased, especially among patients with vascular dementia, it remains high. Efforts to reduce AAP use should focus on secondary care institutions in nonmetropolitan regions. .

PREDICTORS OF ATYPICAL ANTIPSYCHOTIC TREATMENT IN AN AD CLINICAL POPULATION

Use of atypical antipsychotics (AAs) to control behavioral and psychiatric symptoms of dementia (BPSD) is controversial. We sought to understand the prevalence of BPSD and indications for AA use in an AD population treated at an academic memory disorders center. Clinical information of consenting patients in our center is collected in a standardized format and stored electronically. Diagnoses are made according to NINCDS-ADRDA criteria. The Neurosychiatric Inventory (NPI) (Copyright Jeffrey L. Cummings, M.D.) was added to the standard assessment battery in 2007. Patients were included if they had a diagnosis of probable AD or amnestic MCI, an NPI at baseline and at one or more annual visits. The total number of NPI symptoms reported at each visit was calculated. The prevalence of each NPI symptom and the proportion with an AA prescription was evaluated at the first annual follow-up (Visit 2). Longitudinal logistic regression was used to calculate the odds of AA treatment for each symptom over all follow-up visits after adjusting for age, sex, race, education, duration of symptoms at the baseline visit, MMSE score, number of symptoms, and total NPI severity and distress scores. Of 291 patients meeting inclusion criteria, 10.5% had no psychiatric symptoms at V2, 39.2% had 1–3, 30.6% had 4–6, and 19.7% had 7–12. The three most prevalent symptoms were agitation (47.8%), apathy (44.7%), and irritability (44.7%). Of patients with at least one symptom, 10.5% were taking an AA. Longitudinal regression modeling indicated that male sex (OR=2.08, 95% CI=1.08, 4.00), total number of symptoms (OR for each additional symptom=1.11, 95% CI=1.03, 1.19), MMSE score (OR=1.11 for each point decline, 95% CI=1.09, 1.15), but not NPI severity or NPI distress scores, increased the odds of treatment with an AA. Adjusting for these variables, only hallucinations (OR= 1.73, 95% CI=1.02, 2.93) and disinhibition (OR=1.69, 95% CI=1.10–2.62) were associated with a significantly increased odds of AA treatment. In this AD population, male sex, severity of dementia and overall BPSD burden were independently associated with AA use. Hallucinations and disinhibition were the only individual symptoms that increased the odds of AA use.

Usual Course of Treatment and Predictors of Treatment Utilization for Patients With Posttraumatic Stress Disorder.

Posttraumatic stress disorder (PTSD) is a debilitating psychiatric illness that frequently remains undiagnosed and untreated. While extensive research has been conducted among veterans, little research has evaluated course of treatment for PTSD in a general hospital setting. We utilized data from the Partners HealthCare Research Patient Data Registry to evaluate mental health treatment utilization, including psychotherapy and pharmacotherapy, by patients with recently diagnosed primary PTSD following DSM-IV criteria between January 1, 2002, and June 30, 2011. We additionally evaluated predictors of treatment utilization 6 months postdiagnosis. Among 2,475 patients with recently diagnosed primary PTSD, approximately half (55.7%) had any therapy visit and 10% had at least 12 therapy visits in the 6 months following diagnosis. Approximately half (47.0%) received a psychiatric prescription, with 29.3% receiving a selective serotonin reuptake inhibitor (SSRI), 11.8% receiving an atypical antipsychotic, and 24.4% receiving a benzodiazepine. Latinos were 25% (95% CL = 1.09, 1.43) more likely to have an SSRI prescription, 35% (95% CL = 1.05, 1.75) more likely to have an atypical antipsychotic prescription, and 28% (95% CL = 1.19, 1.38) more likely to receive any psychotherapy. Women were 49% (95% CL = 0.42, 0.63) less likely to have an atypical antipsychotic prescription. Patients with Medicare were 23% (95% CL = 0.67, 0.88) less likely to have any psychotherapy, and patients with Medicaid were 35% (95% CL = 0.46, 0.92) less likely to have 12 or more therapy visits. Many patients with a primary diagnosis of PTSD do not receive psychotherapy, and psychiatric prescriptions, including atypical antipsychotics and benzodiazepines, are common. Future research is needed to determine the quality of care received and explore subpopulation-specific barriers limiting access to care.