Patterns Of Antipsychotic Use Research Articles

P-1100 - Pattern of antipsychotic use and its determinants in iran

Antipsychotic monotherapy is recognized as the treatment of choice for patients with psychosis but concurrent use is increasingly common among both inpatients and outpatients. Previous studies of the prescription patterns of psychotropic medications in psychotic patients have highlighted a high rate of antipsychotic polypharmacy, but data in Iran are sparse. This study seeks to analyze prescribing patterns of antipsychotic use and to estimate associated risks in this patient group. The aim of this study was to investigate the prevalence and its determinants of Antipsychotic Use in patients with psychiatric disorders in the greatest psychiatric hospital (Razi) in Iran. This study was on patients with psychiatric disorder that have discharged from the hospital during four months. We have assessed all patients with psychiatric interview and evaluation of their psychiatric documentations. Results of this study indicated that the most prevalent of psychiatric diagnosis was schizophrenia (33.42%) and then Bipolar I Disorder, Schizoaffective Disorder, Mental Retardation and Amphetamine-Induced Psychotic Disorder. 90.7% of all of patients had taken antipsychotic medications and antipsychotic polypharmacy was in 27.2% of these patients. The most prevalent component of antipsychotic polypharmacy was consisting of Chlorpromazine, Halopreidol and Chlorpromazine, Risperidone and then Chlorpromazine, Olanzapine respectively. There were significant relations between pattern of antipsychotic use and gender, occupation status, type of psychiatric ward, duration of hospitalization and cost of treatment but no relationship with age, educational status and duration of illness. This study suggests that prevalence of antipsychotic polypharmacy is high in in-patient psychiatric patients.

Factors That Influence the Prescription of Antipsychotics for Patients with Schizophrenia in China

ObjectiveTo investigate the patterns of antipsychotic use in China and to analyze the factors that influence antipsychotic prescriptions.MethodsA standardized survey was conducted from May 20 to 24 2002 in five different regions of China with varying economic levels. The patterns of antipsychotic medication use were analyzed in a sample of 4,779 patients with schizophrenia. The survey gathered information on demographic characteristics, clinical profiles, and antipsychotic medications prescribed. Multiple logistic regression was used to analyze factors related to patterns of antipsychotic medication use.ResultsA plurality of patients with schizophrenia was treated with clozapine (39%); this was followed by risperidone, sulpride, chlorpromazine, perphenazine, and haloperidol. More than 56.3% of patients were treated with only one atypical antipsychotic. The mean daily dose of chlorpromazine was 365±253 mg (mean±standard deviation), and 6.5% of patients were treated with depot injections of typical antipsychotic medications. A total of 73.7% (n=3,523) of patients with schizophrenia received monotherapy, 24.8% (n=1,183) received two antipsychotics, 1.1% (n=52) received three antipsychotics, and one received four different antipsychotics. Patients often simultaneously received other classes of medications including anticholinergic agents, benzodiazepines, β-blockers, antidepressants, and mood stabilizers. Economic status and clinical symptoms were the main factors that contributed to the patterns of antipsychotic prescription.ConclusionThe present study suggests that atypical antipsychotic medications, especially clozapine, are the primary psychiatric treatments of choice in the management of schizophrenia in China. Moreover, the economic status and clinical profile of the patient are the major factors affecting the prescription of antipsychotic medication.

Nationwide study of antipsychotic use among community-dwelling persons with Alzheimer's disease in Finland

Antipsychotics continue to be widely used in the treatment of behavioral and psychological symptoms of dementia despite their limited effectiveness and well-known risks, including increased mortality. Our aim was to investigate the national pattern of antipsychotic use among community-dwelling persons with and without Alzheimer's disease (AD) in Finland. The Social Insurance Institution of Finland (SII) identified all persons with a verified diagnosis of AD in Finland on 31 December 2005. A control for each person with AD, matched in terms of age, sex and region of residence, was also identified. Data on reimbursed drug purchases in 2005 were extracted from the Finnish National Prescription Register. Conditional logistic regression analysis was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the use of antipsychotics. The study population comprised 28,089 matched pairs of persons with and without AD (mean age 80.0 years, SD 6.8, 32.2% men). The annual prevalence of antipsychotic use was higher among persons with than without AD (22.1% vs. 4.4%, adjusted OR = 5.91; 95% CI 5.91-6.31). Among persons with AD, the prevalence of antipsychotic use was similar across all age groups. Of the antipsychotic users, 85.2% with AD and 51.3% without AD purchased second generation antipsychotics. Most antipsychotic prescriptions - 67.8% in the AD and 62.9% in the non-AD group - were generated in primary care situations. One-fifth of persons with AD used antipsychotic drugs. Antipsychotic use was six times more prevalent among persons with AD than without AD. Most antipsychotics were prescribed by primary care physicians.

Increasing off-label use of antipsychotic medications in the United States, 1995-2008.

To evaluate patterns of antipsychotic use. DESIGN, SETTING, AND MEASUREMENTS: We used nationally representative data from the IMS Health National Disease and Therapeutic Index to describe outpatient antipsychotic use. The primary outcome was the volume of visits where antipsychotics were used for specific indications (treatment visits). We also quantified use without U.S. Food and Drug Administration approval (off-label use) and off-label use with compendium data suggesting an uncertain evidence base. Antipsychotic use increased from 6.2 million (M) treatment visits (95% CI, 5.4-7.0) in 1995 to 16.7 M visits (15.5-18.2) in 2006, then declined to 14.3 M visits (13.0-15.6) by 2008. A shift occurred from typical agents in 1995 (84% of all antipsychotic visits) to atypical agents by 2008 (93%). As they declined, typical medications shifted toward use in schizophrenia (30% in 1995 to 48% 2008). In contrast, use of atypical agents expanded for bipolar affective disorder (10 to 34%), remained stable for depression (12 to 14%), and declined for schizophrenia (56 to 23%). Overall, antipsychotic use for indications without FDA approval increased from 4.4 M visits in 1995 to 9.0 M in 2008. The estimated cost associated with off-label use in 2008 was US$6.0 billion. Atypical use has grown far beyond substitution for the now infrequently used typical agents. Antipsychotics are increasingly used for conditions where FDA approval and associated clinical evidence is less certain. Despite the value of innovation, the benefits of widening atypical antipsychotic use should be weighed against their cost, regulatory status, and incomplete nature of available evidence.

Prevalence, correlates, and disease patterns of antipsychotic use in Taiwan

The population-based National Health Insurance database was used to investigate the prevalence, correlates, and disease patterns of antipsychotic use in Taiwan. The National Health Research Institutes provided a database of 200,000 random subjects for study. A random sample of 145 304 subjects was obtained, aged > or =18 years in 2004. Study subjects who had been given at least two antipsychotic drug prescriptions during this year were identified. The factors associated with any antipsychotic use were identified. The proportion of antipsychotic use for psychiatric and non-psychiatric disorders was also examined. The 1-year prevalence of antipsychotic use was 3.5%. Antipsychotic use was found to be more prevalent by age; for women; for individuals with a lower insurance amount; for individuals with disability; and among those subjects who lived in the central or southern area. Among subjects with antipsychotic use, higher proportions of psychiatric disorders were found for schizophrenia, anxiety state, major depressive disorder, neurotic depression, dementia, and bipolar disorder. With respect to medical disorder, higher proportions of antipsychotic use were found for diseases of the digestive system; symptoms, signs, and ill-defined conditions; diseases of the respiratory system, musculoskeletal system and connective tissue, circulatory system, nervous system and sense organs, and genitourinary system. Higher proportions of antipsychotic use were found for schizophrenia, depressive disorder, anxiety disorder, dementia, and bipolar disorder. More than 60% of subjects used antipsychotics for non-psychiatric disorders in Taiwan, which deserves further study for the sake of patient safety.

Changing Trends in Pediatric Antipsychotic Use in Florida's Medicaid Program

This study describes the changing trends in antipsychotic use among youths aged 18 years and younger and in age subgroups (zero to five, six to 12, and 13 to 18 years) in the Florida Medicaid program. The study used Florida Medicaid claims data associated with approximately 1.2 million children and adolescent enrollees per year to describe monthly antipsychotic use from July 2002 to December 2005. A preliminary examination of trends indicated that antipsychotic use might be different for the periods before May 2004 and after April 2004. For this reason, piecewise regression was used to compare the trends for these two periods. This study found significant increases in the use of antipsychotic medications for all three age groups from July 2002 to April 2004. The greatest rate of growth was for the 13- to 18-year age group, and the least rate of growth was for the zero- to five-year age group. From May 2004 to December 2005 antipsychotic utilization trends were flat for youths age 18 years and younger and for the six- to 12-year and the 13- to 18-year age groups. For preschool-age children (the zero- to five-year age group), there was a slight but significant decline in antipsychotic use. Significant changes were also observed in the specific second-generation antipsychotic agents prescribed. Although risperidone remained the most frequently prescribed antipsychotic, its use declined significantly from May 2004 to December 2005. Olanzapine use also declined during this period. On the other hand, aripiprazole use increased significantly throughout the study period, with usage among the 13- to 18-year age group almost equaling that of risperidone by December 2005. The lack of growth in antipsychotic prescribing after the spring of 2004 represents a significant departure from historical trends. Although some in-state policies may have affected these trends, it appears that the timing and extent of the changes occurred shortly after the Food and Drug Administration required warnings on second-generation antipsychotic medications related to weight gain, glucose levels, and diabetes. They appeared immediately after the black box warning for pediatric antidepressant medications, and they appeared shortly after the Joint American Diabetes and American Psychiatric Association Consensus Statement. These factors suggest the existence of a prescribing community that is responsive to evidence and to professional and regulatory actions based on it.

The SOHO (Schizophrenia Outpatient Health Outcome) Study

The European SOHO (Schizophrenia Outpatient Health Outcome) study is an observational, naturalistic study of the outpatient treatment of schizophrenia. The patient recruitment and assessment began in September 2000 and finished in early 2005. A total of 10 972 adult patients from ten European countries who were initiating or changing antipsychotic medication for the treatment of schizophrenia within the normal course of care have been enrolled. The patients have been followed at regular intervals over the 3-year timeframe of the study. Evaluation includes clinical severity, measured with the Clinical Global Impression (CGI) scale; health-related quality of life; social functioning; and medication tolerability. The 6- and 12-month results have been published so far and have demonstrated that the patients in whom treatment was initiated with olanzapine or clozapine or who were started on more than one antipsychotic of any class at baseline tended to have somewhat greater improvement than patients treated with other atypical or typical antipsychotics, both in terms of symptoms measured with the CGI and quality of life. Numbers of social contacts increased with the treatment, but other aspects of social functioning did not show any significant change. Atypical antipsychotics as a class were associated with a lower frequency of extrapyramidal symptoms (EPS) and anticholinergic use than typical antipsychotics. The frequency of EPS was lowest in the clozapine-, quetiapine- and olanzapine-treated patients, at around 10%. The atypical antipsychotics also conferred a lower risk for tardive dyskinesia than the typical antipsychotics. Weight gain occurred in all treatment cohorts over the first 12 months of treatment and was statistically significantly greater in the patients who started treatment with olanzapine and clozapine. Prolactin- and sexually-related adverse events were frequent at baseline assessment: amenorrhoea was present in around one- third of women, impotence in around 40% of men, and loss of libido in 50% of both male and female patients. Patients treated with olanzapine, clozapine and quetiapine were significantly less likely to have sexual/endocrine-related dysfunctions after 6 months of treatment (the 12-month results of this parameter are yet to be published) than those in the other treatment cohorts (typical antipsychotics, risperidone and amisulpride). Concomitant medication use during the study has been high, ranging from 5% to 29% for anticholinergics, 8% to 23% for antidepressants, 22% to 37% for anxiolytics and 7% to 19% for mood stabilisers, depending on the type of antipsychotic prescribed. Fewer olanzapine-, quetiapine- and clozapine-treated patients used concomitant anticholinergics or anxiolytics/hypnotics. The current results from the SOHO study indicate that differences in effectiveness and tolerability do exist between the antipsychotics. Future results from the study will be published during the coming months and years, and will allow patterns of antipsychotic use in routine clinical practice (including how often and why changes are made) to be determined. This important information is likely to impact on the future use of antipsychotics and will assist clinicians in refining the use of these drugs and improving the outcome of patients to whom they are prescribed.

High-Cost Use of Second-Generation Antipsychotics Under California's Medicaid Program

The high costs associated with second-generation antipsychotic medications raise concerns that prior-authorization restrictions may be implemented to restrict use. This study assessed patterns of antipsychotic use to identify uses that are associated with high economic cost but for which there is no documented efficacy. California Medicaid fee-for-service pharmacy claims were analyzed from May 1999 through August 2000 for patients who received risperidone, olanzapine, or quetiapine. Of the 116,114 patients who received at least one of these agents, 4.1 percent received a combination regimen. Polypharmacy was the most expensive form of second-generation antipsychotic use, costing up to three times more per patient than monotherapy. Restricting polypharmacy may reduce costs and prevent the need for prior-authorization restrictions.