Patterns Of Antipsychotic Use Research Articles

Patterns of Antipsychotic Use in Belgian Nursing Homes 2017-2022: Admission is a Decision Point

ObjectivesChronic antipsychotic use among nursing home (NH) residents carries risks with uncertain benefits. Despite guidelines recommending restricted use, these agents remain widely prescribed. This study investigates chronic antipsychotic use in Belgian NHs. DesignWe examined the evolution of chronic antipsychotic use, associated NH resident profiles, impact of NH admissions, and variation among Belgian NHs in a retrospective dynamic cohort study between 2017 and 2022. Setting and ParticipantsAntipsychotic dispensation rates were extracted for members of the Independent Health Insurance Funds in NHs. Prescription trends and resident profiles were evaluated for around 15,000 residents yearly (n = 14,733-15,451) from 2017 to 2022 and variation was assessed among 59 NHs. The impact of NH admission was analyzed for 9647 admissions between 2020 and 2022, and variation was evaluated among 22 NHs. MethodsFor 22 antipsychotics identified at the ATC3 level, chronic use was defined as ≥80 defined daily doses (DDD) and/or ≥16 weekly dispensations per year. We analyzed changes in the 4 most frequently used antipsychotics (haloperidol, olanzapine, quetiapine, risperidone) on NH admission, with chronic use defined as ≥80 minimal prescribed doses (MPD) annually. ResultsThe prevalence of chronic antipsychotic use among NH residents decreased from 24% in 2017 to 22.5% in 2022 (P = .002). Factors associated with higher antipsychotic use included younger age, greater dependency, and lower socioeconomic status. Upon NH admission, 30% (n = 818 of 2723) of residents discontinued treatment, while in 33% (n = 949 of 2854) treatment was initiated, predominantly with quetiapine or risperidone. This led to a small but significant increase of 1.4% after admission (P < .001). Defining chronic use as ≥80 MPD annually appeared to be more sensitive in measuring chronic antipsychotic use. Conclusions and ImplicationsChronic antipsychotic use remains widespread in Belgian NHs, with care transition as an important decision point. Further research should explore effects of safer (de)prescribing strategies on patient well-being.

Exploring Antipsychotic Use for Delirium Management in Adults in Hospital, Sub-Acute Rehabilitation and Aged Care Settings: A Systematic Literature Review.

International guidelines discourage antipsychotic use for delirium; however, concerns persist about their continued use in clinical practice. We aimed to describe the prevalence and patterns of antipsychotic use in delirium management with regard to best-practice recommendations. Primary outcomes investigated were prevalence of use, antipsychotic type, dosage and clinical indication. Eligibility criteria: studies of any design that examined antipsychotic use to manage delirium in adults in critical care, acute care, palliative care, rehabilitation, and aged care were included. Studies of patients in acute psychiatric care, with psychiatric illness or pre-existing antipsychotic use were excluded. we searched five health databases on 16 August, 2023 (PubMed, CINAHL, Embase, APA PsycInfo, ProQuest Health and Medical Collection) using MeSH terms and relevant keywords, including 'delirium' and 'antipsychotic'. Risk of bias: as no included studies were randomised controlled trials, all studies were assessed for methodological quality using the Mixed Methods Appraisal Tool. descriptive data were extracted in Covidence and synthesised in Microsoft Excel. Included studies: 39 studies published between March 2004 and August 2023 from 13 countries (n = 1,359,519 patients). Most study designs were retrospective medical record audits (n = 16). in 18 studies, participants' mean age was ≥65 years (77.79, ±5.20). Palliative care had the highest average proportion of patients with delirium managed with antipsychotics (70.87%, ±33.81%); it was lower and varied little between intensive care unit (53.53%, ±19.73%) and non-intensive care unit settings [medical, surgical and any acute care wards] (56.93%, ±26.44%) and was lowest in in-patient rehabilitation (17.8%). Seventeen different antipsychotics were reported on. In patients aged ≥65 years, haloperidol was the most frequently used and at higher than recommended mean daily doses (2.75 mg, ±2.21 mg). Other antipsychotics commonly administered were olanzapine (mean 11 mg, ±8.54 mg), quetiapine (mean 64.23 mg, ±43.20 mg) and risperidone (mean 0.97 mg, ±0.64 mg). The use of antipsychotics to manage delirium is strongly discouraged in international guidelines. Antipsychotic use in delirium care is a risk for adverse health outcomes and a longer duration of delirium, especially in older people. However, this study has provided evidence that clinicians continue to use antipsychotics for delirium management, the dose, frequency and duration of which are often outside evidence-based guideline recommendations. Clinicians continue to choose antipsychotics to manage delirium symptoms to settle agitation and maintain patient and staff safety, particularly in situations where workload pressures are high. Sustained efforts are needed at the individual, team and organisational levels to educate, train and support clinicians to prioritise non-pharmacological interventions early before deciding to use antipsychotics. This could prevent delirium and avert escalation in behavioural symptoms that often lead to antipsychotic use.

Patterns of suboptimal antipsychotic use and misuse in Australia: What can routinely collected data tell us?

There are increasing concerns about harms related to suboptimal antipsychotic use. Here we describe recent population-based trends in antipsychotic use and harms in Australia and identify population groups exhibiting patterns of use likely to contribute to these harms. Using population-based data from the Australian Pharmaceutical Benefits Scheme (2015-2020), poisoning calls to the New South Wales (NSW) Poisons Information Centre (2015-2020) and poisoning deaths in all coronial records (2005-2018) in Australia, we measured trends in the prevalence of antipsychotic use and related deaths and poisonings. We applied latent class analyses to identify patterns of antipsychotic use that may contribute to harms. Quetiapine and olanzapine had the highest prevalence of use between 2015 and 2020. Noteworthy trends included increases of 9.1% and 30.8% in quetiapine use and poisonings, while olanzapine use decreased by 4.5% but poisonings increased by 32.7%. Quetiapine and olanzapine poisonings and related deaths had the highest rates of co-ingestion of opioids, benzodiazepines and pregabalin compared to other antipsychotics. We identified six distinct population groups using antipsychotics: (i) ongoing high-dose use with sedatives (8%), (ii) ongoing use (42%), (iii) ongoing use with analgesics and sedatives (11%), (iv) long-term low-dose use (9%), (v) sporadic use (20%) and (vi) sporadic use with analgesics (10%). Ongoing potentially suboptimal antipsychotic use and associated harms highlight the need to monitor such patterns of use, for example through prescription monitoring systems.

Antipsychotic treatment patterns in refugees and their Swedish-born peers with first-episode non-affective psychosis: findings from the REMAIN study

Previous studies suggest that migrants tend to utilise antipsychotics less often than their native-born peers. However, studies examining antipsychotic use among refugees with psychosis are lacking. To compare the prevalence of antipsychotic drug use during the first 5 years of illness among refugees and Swedish-born individuals with a newly diagnosed non-affective psychotic disorder, and to identify sociodemographic and clinical factors associated with antipsychotic use. The study population included refugees (n = 1656) and Swedish-born persons (n = 8908) aged 18-35 years during 2007-2018, with incident diagnosis of non-affective psychotic disorder recorded in the Swedish in-patient or specialised out-patient care register. Two-week point prevalence of antipsychotics use was assessed every 6 months in the 5 years following first diagnosis. Factors associated with antipsychotic use (versus non-use) at 1 year after diagnosis were examined with modified Poisson regression. Refugees were somewhat less likely to use antipsychotics at 1 year after first diagnosis compared with Swedish-born persons (37.1% v. 42.2%, age- and gender-adjusted risk ratio 0.88, 95% CI 0.82-0.95). However, at the 5-year follow-up, refugees and Swedish-born individuals showed similar patterns of antipsychotic use (41.1% v. 40.4%). Among refugees, higher educational level (>12 years), previous antidepressant use and being diagnosed with schizophrenia/schizoaffective disorder at baseline were associated with an increased risk of antipsychotics use, whereas being born in Afghanistan or Iraq (compared with former Yugoslavia) was associated with decreased risk. Our findings suggest that refugees with non-affective psychotic disorders may need targeted interventions to ensure antipsychotic use during the early phase of illness.

The impact of antipsychotic adherence on acute care utilization

BackgroundNon-adherence to psychotropic medications is common in schizophrenia and bipolar disorders (BDs) leading to adverse outcomes. We examined patterns of antipsychotic use in schizophrenia and BD and their impact on subsequent acute care utilization.MethodsWe used electronic health record (EHR) data of 577 individuals with schizophrenia, 795 with BD, and 618 using antipsychotics without a diagnosis of either illness at two large health systems. We structured three antipsychotics exposure variables: the proportion of days covered (PDC) to measure adherence; medication switch as a new antipsychotic prescription that was different than the initial antipsychotic; and medication stoppage as the lack of an antipsychotic order or fill data in the EHR after the date when the previous supply would have been depleted. Outcome measures included the frequency of inpatient and emergency department (ED) visits up to 12 months after treatment initiation.ResultsApproximately half of the study population were adherent to their antipsychotic medication (a PDC ≥ 0.80): 53.6% of those with schizophrenia, 52.4% of those with BD, and 50.3% of those without either diagnosis. Among schizophrenia patients, 22.5% switched medications and 15.1% stopped therapy. Switching and stopping occurred in 15.8% and 15.1% of BD patients and 7.4% and 20.1% of those without either diagnosis, respectively. Across the three cohorts, non-adherence, switching, and stopping therapy were all associated with increased acute care utilization, even after adjusting for baseline demographics, health insurance, past acute care utilization, and comorbidity.ConclusionNon-continuous antipsychotic use is common and associated with high acute care utilization.

LB1532. The Impact of COVID-19 on nursing home residents’ clinical, functional, and psychosocial outcomes

Abstract Background Data on COVID-19 related nursing home infections and mortality accumulated at a rapid pace; yet little is known about the impact of nursing homes’ response to COVID-19 on resident clinical, functional, and psychosocial outcomes. Methods We examined aggregated Minimum Data Set (MDS) assessments to describe resident outcomes using an interrupted times series methodology for three timeframes: pre-COVID (1/2019 to 2/2020), pandemic (3/2020–12/2021), and vaccination (1/2021-6/2021). Data included 307,558 federally mandated resident MDS assessments from 60,846 resident in 489 nursing homes in a Mid-Western state. We calculated MDS based quality measures (QM) using definitions available from Centers for Medicare and Medicaid Services. Each QM-based outcome was fit to a logistic regression model using the method of generalized estimating equations. Results None of the QMs displayed a statistically significant trend pre-COVID. The prevalence of excessive weight loss and ADL decline increased sharply during the pandemic and reversed that trend with vaccination. Pressure ulcers among high-risk residents followed a similar trend, although pandemic and vaccination-related regression parameters for that QM were only marginally significant (p = .08). Pain worsened during the pandemic and vaccination period approaching significance (p=.07). Antipsychotic medication use worsened in the pandemic (p&amp;lt; .001) and did not improve in the vaccination period. Other QMs including any fall, fall with major injury, and incontinence did not exhibit statistically significant change in trend. Prevalence Profiles Circles: Observed proportions, Dashed Line: Model expected value, Solid Lines: 95% confidence limits for expected values Conclusion We noted significant changes in QMs for antipsychotic use, ADL loss, and weight loss, with the latter two improving in the vaccination period. Isolation, disease outbreaks, and staffing issues in facilities could have affected these QMs. Data variability may have limited our ability to detect other changes. Antipsychotics may have increased with the need to reduce wandering and other behaviors common in the nursing home population; behaviors high risk for spreading COVID-19. Why antipsychotic use did not improve during the vaccination period is less clear. Data beyond June of 2021 may help clarify the pattern of antipsychotic use. Disclosures Lori Popejoy, PhD, RN, FAAN, New Path: Board Member|New Path: Ownership Interest Amy Vogelsmeier, PhD, RN, FAAN, New Path: Board Member|New Path: Ownership Interest Marilyn Rantz, PhD, RN, FAAN, New Path: Board Member|New Path: Ownership Interest.

Antipsychotic prescribing patterns in Australia: a retrospective analysis

BackgroundTo examine real-world patterns of antipsychotic use in patients with schizophrenia Australia.MethodsThis retrospective cohort analysis was conducted using the Australian Commonwealth Department of Human Services Pharmaceutical Benefits Scheme (PBS) 10% sample data. Included data were for patients aged 16-years or older who initiated treatment for the first time with a PBS-reimbursed antipsychotic medication for schizophrenia between July 2013 and September 2017. Patterns of treatment usage were summarised descriptively. Differences in prescribing patterns by age and prescribing year were reported. Treatment persistence was estimated using Kaplan-Meier methods, with differences explored using log-rank tests. Values of p < 0.05 were considered statistically significant.Results6,740 patients, representing 8,249 non-unique patients, received prescriptions for antipsychotic medications. Patients were aged 16 years to over 85 years (54.5% were < 55 years) and two-thirds of patients were male (61%). The majority of treatment episodes (62%, n = 5,139/8,249) were prescribed an atypical oral antipsychotic. Typical long-acting antipsychotic therapies (LATs) were prescribed 19% of the treatment episodes (n = 1,608/8,249. There was a small increase in prescribing of atypical LAT and typical LAT and a small decrease in atypical oral and clozapine prescribing over the study period. Treatment persistence was greatest in patients treated with clozapine, than in those treated with atypical LATs.ConclusionsWhile the majority of patients receive atypical antipsychotic medications, one in five continue to use older typical LAT therapies. Patient age and time on therapy may be associated with choice of therapy. Persistence to atypical LAT therapy is better than for other treatment modalities in this real-world cohort.

Prescribing pattern of antipsychotic medication for first-episode psychosis: a retrospective cohort study

ObjectiveGuidelines for antipsychotic use in first-episode psychosis (FEP) recommend that medication be chosen initially on the basis of side effect profile with doses at the lower end of the range....

PHARMACOLOGICAL MANAGEMENT OF LATE-LIFE PSYCHOSIS: BALANCING BENEFITS AND RISKS ASSOCIATED WITH TREATMENTS TO OPTIMIZE OUTCOMES

This session will present new knowledge related to pharmacological management of older adults with LLP. The first presentation will provide an overview of the existing randomized controlled trial evidence related to the use of antipsychotics in LLP. New evidence on the patterns of antipsychotics among older adults with LLP from a population-based real world study. This study will provide an overview of the characteristics of this population including medical and psychiatric comorbidity. The patterns of antipsychotic use will be described in this population including measures of polypharmacy and dosages. The second session will then present evidence on the association between patterns of antipsychotic use and all-cause mortality among older adults with LLP. This study will describe who various prescribing patterns and subpopulations of individuals with LLP who may be at increased risk of mortality in association with antipsychotics. The third presentation will focus on the use of long-acting injectable medications (LAIs) in older adults with LLP. The frequency with which LAI are used in older adults with LLP will be described along with the characteristics of older adults who are prescribed LAI and the patterns of LAI in this population. The final presentation will provide an overview of an integrated care pathway for older adults with LLP and present evidence for the utility of care pathways for older adults with LLP. Attendees will learn new information related to the use of antipsychotics in LLP and identify strategies to optimize prescribing for this vulnerable and growing population.

Prevalence and patterns of antipsychotic use and their associations with mental health and problem behaviours among older adults with intellectual disabilities.

There are concerns that antipsychotics may be used inappropriately in adults with intellectual disability for problem behaviours in the absence of a diagnosed mental health condition. The aim was to examine the prevalence and patterns of antipsychotic use and their association with problem behaviours and mental health conditions in older adults with intellectual disability. Cross-sectional data were drawn from Wave 2 (2013/2014) of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA). Medication data were available for 95.6% (n=677). Those who reported antipsychotic use and reported psychotic or other mental health conditions and those who reported problem behaviours were compared. In total, 45.1% (n=305) had antipsychotics, and of those with antipsychotic use and diagnosis information (n=282), 25.9% (73) had a psychotic disorder. 58% of those exposed to antipsychotics reported problem behaviours. Reported use of antipsychotics significantly exceeded reported doctor's diagnosis of psychotic conditions in this study.

Analisis Rasionalitas Penggunaan Antipsikotik pada Pasien Skizofrenia di Instalasi Rawat Inap RSJD Atma Husada Mahakam Samarinda Tahun 2016

Schizophrenia is a chronic heterogeneous syndrome characterized by irregular mindset, delusion, hallucination, improper behavioral changes, and psychosocial dysfunction. The purpose of this research was to know the pattern of antipsychotic use and rationality of antipsychotic use in schizophrenia patient at Inpatient Installation of Atma Husada Mahakam Psychiatric Hospital Samarinda in 2016 based on right indication, right drug selection, right patient, and right dose. The study was use descriptive non-experimental method with retrospective data collection from medical record of patients with purposive sampling technique. The samples used was 94 patients who received antipsychotic with age range 17-55 years and had a complete medical history. The data obtained were analyzed according to Guideline Texas Medication Algorithm Project Procedural Manual of Schizophrenia Treatment Algorithms. Based on the results obtained data of single antipsychotic the most widely used was haloperidol as 39 prescriptions (53.42%). The use of the most commonly prescribed combination of two antipsychotic was combination of clozapine-haloperidol as 19 prescriptions (38,00%), while combination of three prescribed antipsychotic was combination of chlorpromazine-risperidone-clozapine and haloperidol-risperidone-clozapine each as 1 prescription (50,00%). The rationale of antipsychotic use obtained percentage of right indication was 100%, right drug selection 95,20%, right patient 100%, and right dose 100%.

PMH27 - Age Disparities in Off-Label Use of Antipsychotics Among Wa Medicare-D Beneficiaries

Medicare, which covers all adults over age 65 and younger adults with work disabilities, is the largest public health insurance program in the US. Program drug costs have risen dramatically in the past two decades, due in part to a jump in prescribing of psychiatric medications. This study analyzes patterns of antipsychotic use among Washington state Medicare beneficiaries in 2013. We used Medicare claims data to ascertain the program enrollment status of Medicare beneficiaries, omitting decedents and beneficiaries who added or dropped drug coverage during the 12 month observation period. Our preliminary study sample consisted of all living WA adults (over age 21) continuously enrolled in Medicare Part D or Medicare Advantage in 2013 (N=614,632). We then used the Part D Drug Event file to identify beneficiaries within this subgroup who filled one or more antipsychotic prescriptions (N=39,541). About 6.4% of WA residents continuously enrolled in Medicare Part D or Medicare Advantage received one or more antipsychotic prescriptions. Younger Medicare beneficiaries (aged 21-64) were prescribed antipsychotics at nearly six times the rate of those over age 65 or older (20.0% vs. 3.4%). The majority of antipsychotic users (51.2%) did not appear to have an FDA indicated diagnosis of schizophrenia, major depression, or bipolar and manic disorders. Use for nonindicated diagnoses was more common in older age groups. For example, 84% of antipsychotic users over age 75 do not have an indicated diagnosis, but 51.9% have Alzheimer’s or another dementia. Most WA Medicare beneficiaries who use antipsychotics are under age 65. This group receives early Medicare coverage because they are unable to work due to a disabling health condition, and psychiatric conditions are a very common cause of work disability. Consequently, most younger beneficiaries use antipsychotics for indicated diagnoses.

T231. PALIPERIDONE LONG-ACTING INJECTABLE (LAI) IS ASSOCIATED WITH A LOWER INTAKE OF BENZODIAZEPINES AND A LOWER NUMBER OF ADMISSIONS COMPARED WITH OTHER LAIS IN A COHORT OF PATIENTS WITH SCHIZOPHRENIA

BackgroundSchizophrenia is characterized by a chronic course that in most of cases requires continued and long-term treatment by the use of long acting injectables (LAI). Several LAI formulations have been available and increased the number of pharmacotherapeutic options for schizophrenia. However, there are no formal recommendations regarding the use of specific LAIs for the treatment because there are only a few available studies and even fewer studies assessing which LAI formulation is more effective or suppose an advantage. Many studies has been published regarding the prescription patterns of oral anti-psychotic and the transition to a LAI treatment in real-life settings but the patterns and predictors of use of different LAI formulations, and the effect of introducing new LAI drugs has drawn even less attention. The aim of this study was to analyze the anti-psychotic LAI prescription patterns during a 3-years follow-up period in Murcia, Spain, and to identify predictors of medication changes associated to the use of LAIs.Methodswe designed a non-interventional, naturalistic and retrospective study using all patients from the health department corresponding to the Reina Sofía University Hospital, Murcia, Spain who were diagnosed of schizophrenia and treated with long-acting injectables (LAIs) between the years 2015–2017. Data, pertaining to patients older than 18 years old, were extracted from electronic medical records. Demographic variables, the use of LAIs, the rates for antipsychotic polypharmacy, combined use of different antipsychotic classes with a special focus on atypical antipsychotics, and psychotropic polypharmacy using benzodiazepines, mood stabilizers, and other relevant drugs were identified, as well as, the number of admissions and suicidal attempts.ResultsNo statistical differences were observed regarding demographic variables between LAIs users. However, the number of admissions to a hospital or acute relapses where significantly lower (p<0.05) in the group treated with paliperidone LAI versus the others LAIs. In addition, our results showed that paliperidone, aripiprazole, zuclopentixol and riperidone LAIs are associated with 15.85; 47.86; 25 and 49.25 mg/day of diazepam, respectively. One way ANOVA showed that paliperidone LAI was associated with a significant (p<0.01) less intake of benzodiazepines when compared to others LAIs. ANOVA failed to show differences when the dose of oral anti-psychotics co-administered with LAIS were compared.DiscussionPolypharmacy is the most common pattern of antipsychotic use in this region of Spain. Use of atypical antipsychotics is extensive. Most patients receive psychiatric co-medications such as anxiolytics. Polypharmacy is associated with the use of aripiprazole or zuclopentixol and these groups of patients showed more admissions to a hospital. In contrast, paliperidone LAI group showed less admissions and less use of benzodiazepines. Our results indicate that paliperidone LAI could improve the long-term management of patients with schizophrenia.

International trends in antipsychotic use: A study in 16 countries, 2005–2014

The objective of this study was to assess international trends in antipsychotic use, using a standardised methodology. A repeated cross-sectional design was applied to data extracts from the years 2005 to 2014 from 16 countries worldwide. During the study period, the overall prevalence of antipsychotic use increased in 10 of the 16 studied countries. In 2014, the overall prevalence of antipsychotic use was highest in Taiwan (78.2/1000 persons), and lowest in Colombia (3.2/1000). In children and adolescents (0–19 years), antipsychotic use ranged from 0.5/1000 (Lithuania) to 30.8/1000 (Taiwan). In adults (20–64 years), the range was 2.8/1000 (Colombia) to 78.9/1000 (publicly insured US population), and in older adults (65+ years), antipsychotic use ranged from 19.0/1000 (Colombia) to 149.0/1000 (Taiwan). Atypical antipsychotic use increased in all populations (range of atypical/typical ratio: 0.7 (Taiwan) to 6.1 (New Zealand, Australia)). Quetiapine, risperidone, and olanzapine were most frequently prescribed. Prevalence and patterns of antipsychotic use varied markedly between countries. In the majority of populations, antipsychotic utilisation and especially the use of atypical antipsychotics increased over time. The high rates of antipsychotic prescriptions in older adults and in youths in some countries merit further investigation and systematic pharmacoepidemiologic monitoring.

Patterns of Antipsychotic use Among Community-Dwelling Elderly Patients with Dementia: Impact of Regulatory Warnings

Purpose: In Canada, regulatory warnings on cerebrovascular effects of risperidone and olanzapine in the elderly population with dementia were issued, respectively, in 2002 and 2004, and those on mortality associated with all atypical antipsychotics (APs) in 2005. These warnings led to a decrease in the prescription of APs, but effects on patterns of usage remain poorly examined. We conducted a study to assess the association between warnings and patterns of AP use in a population of community-dwelling elderly with dementia. Methods: A retrospective cohort of 10,969 community-dwelling elderly (age 66+) with dementia who were new users of APs between 1st January 2000 and 31st December 2009 was assembled through the Quebec drug claims database (RAMQ). Association between regulatory warnings and rate of initiation of AP treatment was evaluated through interrupted time series analysis. Effects of the 2005 warning on cerebrovascular history in treated patients, and AP usage patterns (dosage, duration) were assessed, respectively through multivariate logistic regression and multiple linear regression analysis. Results: The proportion of AP treatments initiated with risperidone decreased over time while that of quetiapine increased and of olanzapine remained stable. Controlling for covariates, the cerebrovascular risk profile of treated patients did not change after the 2005 warning (OR=1.05, 95%CI: 0.90 – 1.22). A small decrease in mean prescribed daily dose for risperidone was observed after the 2005 warning (-0.05 mg, p<0.001) while an increase was observed for olanzapine (+0.34 mg, p=0.009) and quetiapine (+1.27 mg, p=0.40). No change in treatment duration was observed (p=0.19). Conclusion: Although regulatory warnings led to a decrease in the use of atypical APs, these products are still widely prescribed off-label in the elderly population with dementia. Channelling of APs toward patients with lower cerebrovascular risks and changes in prescription practices were not apparent after the warnings

Trends, correlates, and disease patterns of antipsychotic use among elderly persons in Taiwan.

We used the population-based database to investigate the trends, correlates, and disease patterns of antipsychotic use among elderly people in Taiwan. The National Health Research Institutes provided a database of 1,000,000 random subjects for health service studies. We analyzed a sample of subjects over the age of 65 years from 1997 to 2005. The trends in and factors associated with antipsychotic use were detected. We also examined the proportions of antipsychotics used for psychiatric and medical disorders. The 1-year prevalence of antipsychotic use in elderly persons increased from 9.8% in 1997 to 12.8% in 2005. The prevalence of first-generation antipsychotic (FGA) use increased from 9.8% to 11.6%, and the prevalence of second-generation antipsychotic (SGA) use increased greatly from 0.01% to 2.02%. Higher prevalence of both FGAs and SGAs were associated with age and higher Charlson Comorbidity Index scores. Psychiatric disorders were commonly found in SGA users (80.8%), whereas only 19.3% of the FGA users had psychiatric disorders. Among the major psychiatric disorders, greater proportions of antipsychotic use were for senile and presenile organic psychotic conditions, other organic psychotic conditions, and affective psychoses. FGAs were much more commonly prescribed for nonpsychiatric disorders, including diseases of symptoms, signs, and ill-defined conditions, the digestive system, and the respiratory system. The prevalence of antipsychotic use, particularly the use of SGAs, increased greatly from 1997 to 2005 among elderly persons in Taiwan. SGAs were most used by subjects with psychiatric disorders, and FGAs were most used by those with nonpsychiatric disorders.

A Non-Interventional Naturalistic Study of the Prescription Patterns of Antipsychotics in Patients with Schizophrenia from the Spanish Province of Tarragona.

BackgroundThe analysis of prescribing patterns in entire catchment areas contributes to global mapping of the use of antipsychotics and may improve treatment outcomes.ObjectiveTo determine the pattern of long-term antipsychotic prescription in outpatients with schizophrenia in the province of Tarragona (Catalonia-Spain).MethodsA naturalistic, observational, retrospective, non-interventional study based on the analysis of registries of computerized medical records from an anonymized database of 1,765 patients with schizophrenia treated between 2011 and 2013.ResultsThe most used antipsychotic was risperidone, identified in 463 (26.3%) patients, followed by olanzapine in 249 (14.1%), paliperidone in 225 (12.7%), zuclopenthixol in 201 (11.4%), quetiapine in 141 (8%), aripiprazole in 100 (5.7%), and clozapine in 100 (5.7%). Almost 8 out of 10 patients (79.3%) were treated with atypical or second-generation antipsychotics. Long-acting injectable (LAI) formulations were used in 44.8% of patients. Antipsychotics were generally prescribed in their recommended doses, with clozapine, ziprasidone, LAI paliperidone, and LAI risperidone being prescribed at the higher end of their therapeutic ranges. Almost 7 out of 10 patients (69.6%) were on antipsychotic polypharmacy, and 81.4% were on psychiatric medications aside from antipsychotics. Being prescribed quetiapine (OR 14.24, 95% CI 4.94–40.97), LAI (OR 9.99, 95% CI 6.45–15.45), psychiatric co-medications (OR 4.25, 95% CI 2.72–6.64), and paliperidone (OR 3.13, 95% CI 1.23–7.92) were all associated with an increased likelihood of polypharmacy. Being prescribed risperidone (OR 0.54, 95% CI 0.35–0.83) and older age (OR 0.98, 95% CI 0.97–0.99) were related to a low polypharmacy probability.ConclusionsPolypharmacy is the most common pattern of antipsychotic use in this region of Spain. Use of atypical antipsychotics is extensive. Most patients receive psychiatric co-medications such as anxiolytics or antidepressants. Polypharmacy is associated with the use of quetiapine or paliperidone, use of a LAI, younger age, and psychiatric co-medication.

Prevalence and Patterns of Antipsychotic Use in Youth at the Time of Admission and Discharge From an Inpatient Psychiatric Facility

The objective of this study was to examine the prevalence and patterns of antipsychotic use in children and adolescents at the time of admission and discharge from a tertiary care inpatient psychiatric facility. This retrospective analysis included all patients 18 years and younger, who were admitted and discharged from a child and adolescent tertiary care inpatient psychiatric facility between May 1, 2008 and December 31, 2009. Data for medications at admission were obtained using a province-wide network that links all pharmacies in British Columbia, Canada to a central set of data systems, whereas data for medications at discharge were obtained using the Department of Pharmacy's (British Columbia Children's Hospital, Vancouver, British Columbia, Canada) inpatient computer database. Apart from antipsychotics, overall drug use included antidepressants, mood stabilizers, benzodiazepines, anticholinergics, stimulants, and sleep medications. Referral and discharge diagnoses were also examined. During the study period, 335 patients were admitted and discharged from the tertiary care inpatient psychiatric facility. Significantly, more patients were prescribed with an antipsychotic at the time of discharge from hospital compared with that of the time when they were admitted to hospital (51.6% vs 30.7%; P < 0.0001). Antidepressants were most often coprescribed with an antipsychotic at admission and discharge (32.0% vs 42.2%, respectively) followed by attention-deficit/hyperactivity disorder medications (22.3% vs 24.9% at admission and discharge, respectively) and anticonvulsants (19.4% vs 19.1% at admission and discharge, respectively). Whether the significant increase in antipsychotic use seen from the time of admission to discharge is solely attributed to clinical worsening or other variables requires further investigation.

Does a history of suicide attempt predict higher antipsychotic dosage in schizophrenia?

Antipsychotic dosage is generally adjusted by physicians depending on the stability of the patient and the response to that particular drug. Our hypothesis is that patients with previous suicide attempt are prescribed higher doses of antipsychotics. We examined the dosage and patterns of antipsychotic use in regard to past suicidal behaviour. For this study, 304 subjects with schizophrenia spectrum disorders between the ages of 18 and 75 were recruited. A cross-sectional assessment was used for this study, in which data were collected from each patient through an interview and self-report questionnaires. The percentages of the Compendium of Pharmaceuticals and Specialties (CPS) maximum recommended daily dose were applied to standardize antipsychotic dosages across different treatments. We compared the standardized dosage of antipsychotics in schizophrenics with previous suicide attempts and those who have never attempted suicide. Applying the ANCOVA, our preliminary results show no significant difference (P = 0.467) in antipsychotic dosage in the attempters and non-attempters. The prescribed clozapine dosage fails to show a significant relationship with suicidal history (P >0.05). In summary, our analysis does not show antipsychotic dosage adjustment based on past suicide attempt, after controlling for the current suicidal ideation and hopelessness.

Trends, correlates, and disease patterns of antipsychotic use among children and adolescents in Taiwan

We used Taiwan's population-based National Health Insurance database to investigate the trends, correlates, and disease patterns of antipsychotic use among children and adolescents. The National Health Research Institutes provided a database of 1,000,000 random subjects for study. We chose subjects who were aged 18years or younger during 1997-2005. In this sample, subjects who were given at least one antipsychotic prescription, including first-generation antipsychotics (FGAs) or second-generation antipsychotics (SGAs), were identified. Trends, prevalence, and associated factors of antipsychotic use were determined. The proportion of antipsychotic use for psychiatric and medical disorders was also analyzed. The 1-year prevalence of SGA use increased from 0.00% in 1997 to 0.09% in 2005, whereas the 1-year prevalence of FGA use ranged from 2.24 to 3.43% during this same period, with no significant change. Age and male gender were associated with higher SGA use. Among SGA users, the greatest proportion suffered from psychiatric disorders, including tics, hyperkinetic syndrome of childhood, schizophrenia, affective disorders, and autism. Among FGA users, a larger proportion was for medical conditions, including diseases of the digestive and respiratory systems. The prevalence of pediatric SGA use increased greatly from 1997 to 2005. Among pediatric subjects using antipsychotics, SGAs were mostly used for psychiatric disorders, whereas FGAs were mostly prescribed for medical conditions. Future research will focus on indication, dosage, frequency, duration, adverse effects, and off-label use of antipsychotics in the pediatric population.