Patterns Of Psychotropic Medication Use Research Articles

A cross-sectional study of recent patterns of psychotropic medication use in children and adolescents in Ireland.

There has been a global rise in prescribing of psychotropic medications. Variations in patterns of use, according to age, gender and drug class type, have also been reported. This study aimed to analyse patterns of psychotropic medication use in Ireland according to age group, gender and drug class type, to determine if variations exist, and identify specific nuances to be addressed in future research. A retrospective, repeated, cross-sectional study of the Irish pharmacy claims database (community setting dispensing data) was conducted. Yearly prevalence of children/adolescents receiving dispensed psychotropic medications was analysed from January 2017 to December 2021, across years, age groups (5-15, 5-11 and 12-15 years), gender and drug class type. All available data were used. Yearly prevalence was the mean number of patients receiving medication per month per 1000 eligible population during a given year. Negative binomial regression was used to examine association of year, age group and gender on prevalence. In the 12-15 years group, prevalence for all selected psychotropic medications in 2021 in males was almost twice that in females (19.92/1000 vs 10.62/1000). In the 5-11 years group, prevalence was three times higher in males than females (7.56/1000 vs 2.49/1000). Overall, there was a higher rate of increase in females and higher usage in older children. This study found variations in psychotropic medication use in children/adolescents, depending on age, gender and drug class type. Further research is needed to determine whether variations have resulted in treatment disparities for certain cohorts.

Cluster B personality disorders and psychotropic medications: a focused analysis of trends and patterns across sex and age groups.

This study investigated sex and age differences in patterns of psychotropic medication use before and after the initial diagnosis of Cluster B personality disorders (PDs) and analyzed trends over time. Analyzing data from the Quebec Integrated Chronic Disease Surveillance System for individuals newly diagnosed with Cluster B PD (≥ 14 years) between 2002 and 2018 and under the provincial public drug plan, we calculated yearly and monthly proportions of individuals exposed to psychotropic medications during the year before and after their diagnosis by sex and age. Robust Poisson regression models assessed the association between sex and exposure to psychotropic medications after the diagnosis of Cluster B PD. Among 87,778 individuals with a first Cluster B PD diagnosis (mean age: 44.5 years; 57.5% women), the proportion of users increased post-diagnosis. Notably, after diagnosis, females were more likely to receive psychiatric medications (between 78.9% and 83.7% during the study period vs. 72.8% and 76.8%). Males were less likely than females to receive antidepressants (adjusted prevalence ratio (aPR): 0.83; 99% confidence interval (CI): 0.82-0.85) and anxiolytics (aPR: 0.86; 99%CI: 0.84-0.88), whereas they had higher exposure to antipsychotics (aPR: 1.04; 99%CI: 1.02-1.06) and ADHD medications (aPR: 1.14; 99%CI: 1.07-1.2). Age-specific trends showed increased ADHD medication use among younger patients (14-24 years), and anxiolytic use predominated in those aged ≥ 65 years. Psychotropic medication use was high among Cluster B PD patients, with differences in medication classes according to age and sex. The marked sex and age differences in psychotropic medication use among Cluster B PD patients underscore the need for a sex-sensitive and age-specific approach in psychiatric care.

Psychotropic Medication Prescription Patterns in Down Syndrome in a Large Pediatric Specialty Clinic.

Objectives: Patterns of psychotropic medication use in children and adolescents with Down syndrome (DS) are largely unknown. Clinical decisions are often made from evidence and experience from individuals with autism spectrum disorder (ASD) or intellectual disability (ID). Methods: Longitudinal data from 670 children with DS who received care in a specialty DS clinic from March 2021 to February 2024 were collected. After each clinic visit, the clinician indicated the presence or absence of co-occurring neurodevelopmental (ND) or mental health (MH) diagnoses, as well as whether the individual was prescribed a psychopharmacological treatment. We used descriptive statistics and analyzed associations between psychotropic medication use, co-occurring ND/MH conditions, and demographic data. Results: 19.1% of patients were prescribed at least one psychotropic medication at their most recent clinical visit. Alpha-agonists were the most commonly prescribed medication class (30.8%), followed by stimulants (18.9%), and antidepressants (16.7%). There was a significant difference in psychotropic medication use by age, with older children having increased odds of being prescribed a psychotropic medication. There were no differences in psychotropic medication use across sex (p = 0.10), race (p = 0.10), or household income (p = 0.16). Conclusions: We found that one-fifth of patients with DS were prescribed psychotropic medications. Nearly every individual with DS who was prescribed a psychotropic medication had a co-occurring ND/MH condition, yet these rates were lower than what have been reported in children with ID, ASD, and attention deficit/hyperactivity disorder. Further research needs to include those with DS to further understand medication efficacy and safe dosing practices to ensure optimal outcomes.

Changes in Psychiatric Medication Use During the COVID-19 Pandemic in a Pediatric Long-Term Care Facility.

Background: Coronavirus disease 2019 (COVID-19) caused a global pandemic that dramatically altered infection control procedures in long-term care facilities. Mental health decline among residents of geriatric facilities during the pandemic has been described (Ferro Uriguen et al., 2022). Our study aims to evaluate psychological effects of the pandemic on residents of a pediatric long-term care facility, a population comprised of medically complex children. To characterize this, we compared patterns of psychotropic medication use during the COVID-19 pandemic to those of the prepandemic period among residents of a 76-bed pediatric long-term care facility. Methods: We conducted a retrospective study of psychotropic medication use from January 2019 to August 2022 using de-identified monthly facility medication refill data. Linear multivariable regression models were used to estimate the level and trends in the monthly rates of medication refills per 10,000 bed days among resident children before and after the pandemic onset. Six classes of psychotropic medications were analyzed including antipsychotics, antidepressants and anxiety medications, trazodone, clonidine, mood stabilizers, and gabapentin. Results: The pandemic onset was associated with a significant increase in the monthly prescribing rates of antidepressant and anxiety medications (20.83; 95% CI, 3.96-37.71; p = 0.017), mood stabilizers (10.44; 95% CI, 5.79-15.09; p < 0.001), and trazodone (-27.66; 95% CI, -40.44 to 14.88; p < 0.001) above those expected by prepandemic trends. The trend in trazodone use changed significantly during the pandemic from decreasing prepandemic to increasing (2.21; 95% CI, 1.28-3.14; p < 0.001). Antidepressant, anxiety medication, and gabapentin use increased throughout the study. Antidepressant and anxiety medication use surged early in the pandemic, but then continued growth at their prior rates of use. Discussion: Increased use of antidepressant and anxiety medications and trazodone suggests a possible impact of the COVID-19 pandemic on rates of anxiety, depression, sleep disturbance, and agitation among children with severe intellectual and developmental disabilities living in long-term care.

Psychotropic Medication Use in Children and Youth with Autism Enrolled in Medicaid.

Children with autism frequently present with complex mental health diagnoses and psychotropic medications are often a component of comprehensive biopsychosocial treatment plans for these conditions. The purpose of this study is to provide rates and patterns of psychotropic medication use, and predictors thereof, in childrenand youth with autism enrolled in Medicaid across the US. This study examined national Medicaid claims from 2008 to 2016 of all children and youth with autism ages 0-21 years enrolled in Medicaid. Psychotropic medication use was examined across several child and youth characteristics, including age, co-occurring mental health conditions, sex, and race and ethnicity. About half of children and youth with autism enrolled in Medicaid had at least one psychotropic prescription in a year, a number that decreased slightly across the study period due to decreases in the prescription of antipsychotics. As new medications for autism or co-occurring conditions are developed and deployed, and as the understanding of the characteristics of the population of children with autism evolves, studying rates of medication usage helps to understand utilization patterns and differences in access to quality care.

Psychotropic medication use pre and post-diagnosis of cluster B personality disorder: a Quebec’s health services register cohort

BackgroundCluster B personality disorders (PDs) are considered some of the most severe mental health conditions. Scarce evidence exists about the real-world utilization of psychotropics for cluster B PD individuals.ObjectiveWe aimed to uncover trends and patterns of psychotropic medication use among individuals diagnosed with cluster B PD in the year before and after their diagnosis and to identify factors associated with medication use in a large cohort of individuals newly diagnosed with cluster B PDs.MethodsWe conducted a population-based observational study using Quebec’s health services register. We identified Quebec residents aged ≥14 years and insured with the provincial drug plan with a first diagnosis of cluster B PD recorded between April 1, 2002, and March 31, 2019. Cluster B PD was defined with ICD-9/10 diagnostic codes. We retrieved all claims for the main psychotropic medication classes: antipsychotics, antidepressants, anxiolytics, mood stabilizers, and attention-deficit/hyperactivity disorder (ADHD) medications. We calculated the proportion of individuals exposed to these medication classes and analyzed trends over the years using robust Poisson regression models, adjusting for potential confounders. We used robust Poisson regression to identify factors associated with medication class use.ResultsWe identified 87,778 new cases of cluster B PD, with a mean age of 44.5 years; 57.5% were women. Most frequent psychiatric comorbidities in the five years before cluster B PD diagnosis were depression (50.9%), anxiety (49.7%), and psychotic disorders (37.5%). Most individuals (71.0%) received at least one psychotropic during the year before cluster B PD diagnosis, and 78.5% received at least one of these medications in the subsequent year. The proportion of users increased after the diagnosis for antidepressants (51.6–54.7%), antipsychotics (35.9–45.2%), mood stabilizers (14.8–17.0%), and ADHD medications (5.1–5.9%), and remained relatively stable for anxiolytics (41.4–41.7%). Trends over time showed statistically significant increased use of antipsychotics and ADHD medications, decreased use of anxiolytics and mood stabilizers, and a stable use of antidepressants.ConclusionPsychotropic medication use is highly prevalent among cluster B PD individuals. We observed an increase in medication use in the months following the diagnosis, particularly for antipsychotics, antidepressants, and mood stabilizers.

Patterns of Psychotropic Medication Use among Individuals with Traumatic Brain Injury.

The relationship between psychotropic medication use and traumatic brain injury (TBI) is not well understood. The objective of this study was to describe patterns of psychotropic medication use during the months before and after TBI and compare with a non-TBI cohort. We conducted a retrospective cohort study using administrative claims data for a commercially insured population from 2008 to 2014, and assessed monthly prevalence of psychotropic medication use by class before and after TBI (or matched index in the non-TBI controls). We tested time trends and quantified rates of increase using autoregressive models, and determined whether TBI impacted psychotropic medication use using difference-in-difference models. Compared with those without TBI (n = 414,708), individuals with TBI (n = 207,354) were more likely to receive any psychotropic medication both before (36.9% vs. 19.5%, p < 0.001) and after TBI (48.2% vs. 25.7%, p < 0.001). Prior to TBI, the rate of monthly increase in use of psychotropic medications in the TBI cohort was three to four times the rate observed in the non-TBI cohort, and was highest for antidepressants in both cohorts. After accounting for between-group and time trends, TBI was associated with increased use of several psychotropic medications including antipsychotics (rate ratio [RR] 1.08; 95% confidence interval [CI] 1.07, 1.09) and anxiolytics (RR 1.05; 95% CI 1.04, 1.06). Patterns of psychotropic medication use differed significantly between individuals with and without TBI. These results suggest that a better understanding of events leading up to and following TBI is needed to elucidate the role psychotropic medications play in the natural history of TBI.

Psychotropic Medication in Intellectual and Developmental Disabilities: Patterns of Use and Recommendations for Monitoring Effects

Purpose of Review The purpose of this paper is to provide a brief review of the patterns of psychotropic medication use in individuals with intellectual and developmental disabilities (IDD) and recommendations for monitoring the effects of these medications.

Neuropsychiatric profile and psychotropic medication use in adults with autism spectrum disorder: results from the Australian Longitudinal Study of Adults with Autism.

Children and adolescents with autism spectrum disorder (ASD) are a highly medicated group. Few studies have examined the neuropsychiatric profile and patterns of psychotropic medication use among adults with ASD. To describe and compare the neuropsychiatric profile and psychotropic medication use in a cohort of adults with ASD and non-autistic controls. Baseline data from a survey-based, longitudinal study of adults with ASD in Australia. Participants were 188 adults with ASD and 115 controls aged 25-80 years. ASD was associated with increased odds of psychotropic medication use even when controlling for the presence of any neurological or psychiatric disorder. There were no corresponding indications for 14.4% of psychotropic medications prescribed to adults with ASD. This study found substantial psychotropic prescribing for adults with ASD. Patterns of psychotropic medication use may reflect prescribing for behavioural indications despite limited evidence to support this practice. None.

Patterns of Early Mental Health Diagnosis and Medication Treatment in a Medicaid-Insured Birth Cohort

ImportanceThe increased use of psychiatric services in the US pediatric population raises concerns about the appropriate use of psychotropic medications for very young children.ObjectiveTo assess the longitudinal patterns of psychotropic medication use in association with diagnosis and duration of use in a Medicaid-insured birth cohort.Design, Setting, and ParticipantsA cohort design was applied to computerized Medicaid administrative claims data for 35 244 children born in a mid-Atlantic state in 2007 and followed up for up to 96 months through December 31, 2014. Children were included in the birth cohort if they had an enrollment record at birth or within 3 months of birth and at least 6 months of continuous enrollment from birth. The cohort represents 92.2% of 38 225 Medicaid-insured newborns in 2007.ExposuresMental health treatments from birth through age 7 years.Main Outcomes and MeasuresCumulative incidence of first psychiatric diagnosis and psychotropic medication use (monotherapy or concomitant use of psychotropic medications) from birth through age 7 years, total and by sex, and the cumulative incidence of the use of psychosocial services (age, 0-7 years) as well as the annual duration of medication use (ie, number of days of psychotropic medication use among children 3-7 years of age).ResultsOf the 35 244 children in the cohort, 17 267 were girls and 17 977 were boys. By age 8 years, 4550 children in the birth cohort (19.7% [percentage adjusted for right censoring]) had received a psychiatric diagnosis (International Classification of Diseases, Ninth Revision, Clinical Modification codes 290-319); 2624 of these diagnoses (57.7%) were behavioral (codes 312, 313, or 314). Girls were more likely than boys to receive an incident psychiatric diagnosis of adjustment disorder (355 of 1598 [22.2%] vs 427 of 2952 [14.5%]; P < .001) or anxiety disorder (114 of 1598 [7.1%] vs 120 of 2952 [4.1%]; P < .001). By age 8 years, 2196 children in the cohort (10.2% [percentage adjusted for right censoring]) had received a psychotropic medication. Among medication users, 1763 of 2196 (80.5% [percentage adjusted for right censoring]) received monotherapy, 343 of 2196 (16.4% [percentage adjusted for right censoring]) received 2 medication classes concomitantly, and 90 of 2196 (4.3% [percentage adjusted for right censoring]) received 3 or more medication classes concomitantly for 60 days or more (range, 78-180 days). The annual median number of days of psychotropic medication use among medicated children increased with age, reaching 210 of 365 days for children 7 years of age. Among children 7 years of age, the median number of days of use of an antipsychotic (193 days [interquartile range, 60-266 days]), stimulant (183 days [interquartile range, 86-295 days]), or α-agonist (199 days [interquartile range, 85-305 days]) exceeded half of the year.Conclusions and RelevanceMedicaid-insured children received substantial mental health services and had prolonged exposure to psychotropic medications in the early years of life. These findings highlight the need for outcomes research in pediatric populations.

Patterns of use, knowledge, and perceived effects of sedating medication on driving: A questionnaire survey of Japanese drivers who use sedating medication

ObjectiveThis study was designed to investigate patterns of medication use among drivers using pharmaceutical drugs, the subjective impact of medication use on driving, and knowledge about the effects of medication use on driving. MethodsAn online survey was administered to a sample of Japanese drivers (n = 1424, age range 21–79 years) to investigate the use pattern of major sedating medications such as cold/sinus drugs, anxiolytics, hypnotics, and antidepressants. The strength of association between variables pertaining to the use of sedating medications and self-reported at-fault crash involvement was explored using a series of multivariate logistic regression models. ResultsOn average, respondents reported using 2.7 sedating medications over the past two years (standard deviation = 1.8; range = 0–11). The pattern of psychotropic medication use was diverse, and the use of multiple psychotropic medications was common. Respondents could be grouped into four subgroups in terms of multiple medication use. Irrespective of the type of medication taken, respondents noticed few adverse side effects of medication on driving and generally did not adhere to driving-related product warnings; some respondents were unaware of important facts such as the exacerbation of the effects of medication effects when combining medications. Multivariate logistic regression analyses showed that the presence of a higher number of sedating agents in the medication taken was positively associated with reporting an at-fault crash in the last two years, having longer driving distance, being a commercial driver, receiving more traffic tickets, and having a higher tendency for rules violations. ConclusionsThe present study showed that medication use by drivers is diverse and complex, that most drivers are not sufficiently informed of the potentially impairing effects of medication, and that poly-medication use appeared prevalent among those who use psychotropic medications. In line with previous studies, the current study reveals a need for better communication between health experts and patients and for education of all stakeholders. The results also highlighted the need for systematic investigation into cause of crash in light of potential contribution of sedating medication used by the driver, given the low autopsy rate for fatally injured drivers in Japan.

Psychotropic medication use in Australia, 2007 to 2015: Changes in annual incidence, prevalence and treatment exposure

To examine changes in annual patterns of psychotropic medication use in Australia from 2007 to 2015. We used a 10% sample of individual-level nationwide dispensing claims for concessional beneficiaries dispensed psychotropic medications (stratified by class, subclass) to investigate annual trends and changes in the incidence and prevalence of use, median annual duration of exposure, proportion of people with single psychotropic dispensing and median defined daily doses per person dispensed each medicine per year. Over the study period, there was a 26.1% decrease in the incidence and a 2.6% increase in the prevalence of all psychotropic medicine use. We observed a decrease in the annual incidence and prevalence of antidepressants (11.6% and 16.8%, respectively) but increases in the median annual duration of exposure (7.4%). Amitriptyline had the highest proportion of single dispensings of all antidepressants throughout the study period (26.5% in 2015) and defined daily doses per person dispensed each medicine per year increased by 20% for antidepressants overall. Benzodiazepine use decreased across all measures over the study period apart from long-term use (exposure for >240 days of the year), which in 2015 was 23.6% of those dispensed a benzodiazepine. We observed a relative increase in the incidence and prevalence of antipsychotic use (14.2% and 26.8%, respectively), and haloperidol had the highest proportion of single dispensings of any antipsychotic throughout the study period (47.5% in 2015). We observed a relative increase in the incidence and prevalence of attention-deficit hyperactivity disorder medication use of 114.0% and 101.8%, respectively, over the study period. Increasing doses and treatment durations of antidepressants warrants further investigation due to concerns about overuse. Single dispensings of amitriptyline and haloperidol may indicate off-label use and long-term use of benzodiazepines remains problematic. Despite increases in attention-deficit hyperactivity disorder medication use, prevalence of use is still much lower than the estimated prevalence of attention-deficit hyperactivity disorder in the adult population.

Pattern of psychotropic medication use over two decades in Australian women.

Few population-based studies have been used to investigate secular trends in psychotropic medication use. Therefore, the aim of this study was to examine psychotropic medication use over time using data from the Geelong Osteoporosis Study, an on-going, population-based, cohort study of Australian women. Of the 1494 women recruited at Time 1 (1993-1997), self-reported medication use from Time 2 (2004-2008) and/or Time 3 (2011-2014) was available for 889 women. Prevalence of antidepressant/antipsychotic/anxiolytic/sedative/anticonvulsant use by age and cohort strata was calculated using bootstrapping methods. Simultaneous age-cohort patterns were evaluated using logistic regression techniques. The prevalence of any psychotropic medication use increased from 8.0% (95% confidence interval = [6.3, 9.8]) at Time 1 to 26.0% (95% confidence interval = [22.4, 29.4]) at Time 3, translating to a 4.3-fold increase in the likelihood of psychotropic medication use over the study period (odds ratio = 4.3, 95% confidence interval = [3.2, 5.8], p < 0.001). This increase was driven by the use of antidepressants (odds ratio = 6.4, 95% confidence interval = [4.2, 9.5], p < 0.001) and anticonvulsants (odds ratio = 4.4, 95% confidence interval = [1.8, 11.1]) and modest increases in the use of anxiolytic agents (odds ratio = 1.9, 95% confidence interval = [1.1, 3.1]) and sedatives (odds ratio = 1.7, 95% confidence interval = [1.6, 1.9]). The prevalence of any psychotropic medication use increased with increasing age (40-59.9 years: odds ratio = 1.9, 95% confidence interval = [1.5, 2.6]; 60-79.9 years: odds ratio = 2.6, 95% confidence interval = [1.9, 3.5], compared to the 20- to 39.9-year group). Use of selective serotonin reuptake inhibitors increased dramatically over the study period (odds ratio = 15.3, 95% confidence interval = [7.0, 33.4]). Use of psychotropic medication has increased substantially over the past two decades, especially among older women. Further investigations into the correlates and outcomes of the increased use of psychotropic medications are warranted.

Racial and ethnic differences in psychotropic medication use among community-dwelling persons with dementia in the United States

ABSTRACTObjectives: Little is known about the patterns of psychotropic medication use in community-dwelling minority persons with dementia (PWD). The purpose of this study was to investigate racial/ethnic differences in psychotropic medication use across a diverse population of community-dwelling PWD and to examine the extent to which caregiver characteristics influence this use.Method: Data were drawn from the baseline assessment of the Resources for Enhancing Alzheimer's Caregiver Health II trial. Generalized linear models were used to identify racial/ethnic differences in psychotropic medication use. Akaike Information Criterion (AIC) model selection was used to evaluate possible explanations for observed differences across racial/ethnic group.Results: Differences in anxiolytic and antipsychotic medication use were observed across racial/ethnic groups; however, race/ethnicity alone was not sufficient to explain those differences. Perceptions of caregiving and caregiver socioeconomic status were important predictors of anxiolytic use while PWD characteristics, including cognitive impairment, functional impairment, problem behavior frequency, pain, relationship to the caregiver, sex, and age were important for antipsychotic use.Conclusion: Racial/ethnic differences in psychotropic medication use among community-dwelling PWD cannot be explained by race/ethnicity alone. The importance of caregiver characteristics in predicting anxiolytic medication use suggest that interventions aimed at caregivers may hold promise as an effective alternative to pharmacotherapy.

3.49 FIRST EXPOSURE TO PSYCHOTROPIC MEDICATION IN A BIRTH COHORT OF MEDICAID-INSURED PRESCHOOLERS

A population-based cohort of preschoolers in a Medicaid-insured mid-Atlantic state was analyzed longitudinally from birth to age five years by estimating the median time to the first psychotropic medication exposure, regardless of mental or medical usage; by describing longitudinal patterns of psychotropic medication use by year of age; and by exploring leading clinician-reported diagnosis by year of age.

Patterns of Psychotropic Medication at Admission for Youth in Residential Care

High levels of psychotropic medication use and polypharmacy are common for emotionally and behaviorally troubled youth entering residential care. Polypharmacy has often been characterized as an especially serious problem in this vulnerable population. Latent Class Analysis was used to identify medication subgroups for 636 youth in an intensive residential program. Additionally, auxiliary analyses (e.g., diagnoses, demographics, expressed problem behaviors) were used to identify the personal and behavioral attributes associated with individuals in each of the latent classes. Three distinct medication patterns emerged: low/no psychotropic medication, the combination of antidepressant and antipsychotic medications, and multiple psychotropic medications. The latent classes were significantly different from one another on 12 of the 14 variables, helping explicate how patient and clinical characteristics underlie patterns of psychotropic medication use. Findings of this study, combined with additional research, hold promise for leading to improved, youth-centered prescribing practices. Our findings also highlight the need for careful monitoring of the types and range of medications that some youth are prescribed, and research on how youth with certain background characteristics are more likely to get prescribed multiple psychotropic medications. For youth experiencing higher levels of psychotropic polypharmacy, medication regimens need thoughtful reassessment using the principle of sufficiency as the foundation for medication management.

Patterns of psychotropic medication use in inpatient and outpatient psychiatric settings in Saudi Arabia.

ObjectiveTo study the pattern of psychotropic medication use and compare this pattern between inpatient and outpatient psychiatric settings in Saudi Arabia.MethodThis cross-sectional observational study was conducted between July 2012 and June 2014 on patients seeking psychiatric advice at major hospitals in five main regions of Saudi Arabia. Male (n=651) and female (n=594) patients who signed the informed consent form and were currently or had been previously using psychotropic medications, irrespective of the patient’s type of psychiatric diagnosis and duration of the disease, were included. A total of 1,246 patients were found to be suitable in the inclusion criteria of whom 464 were inpatients while 782 were outpatients.ResultsSeveral studied demographic factors have shown that compared with outpatients, inpatients were more likely to be male (P=0.004), unmarried (P<0.001), have less number of children (1–3; P=0.002), unemployed (P=0.001), have a lower family income (<3,000 SR; P<0.001), live in rural communities (P<0.001), have a lower body mass index (P=0.001), and are smokers (P<0.001); however, there were no differences with regard to age or educational levels. The current frequency of use of psychotropic medications in overall patients was antipsychotics (76.6%), antidepressants (41.4%), mood stabilizers (27.9%), and antianxiety (6.2%). However, compared to outpatients, the current use of medications for inpatients was more frequent (93.8% vs 89.9%, P=0.019) with inpatients more likely to be treated with multiple medications (2.1 vs 1.8 medications). A similar trend was observed in the case of antipsychotics, high potency first-generation antipsychotics, second-generation antipsychotics, mood stabilizers, and antianxiety medicines where inpatients were more frequently treated with these medications for all psychiatric diagnoses when compared with outpatients. On the contrary, in the case of antidepressant treatment, an opposite trend was observed with more number of treated outpatients in comparison to inpatients. Among elderly patients, 75.9% received antipsychotics, mainly second-generation formulations (67.2%), whereas only 41% received antidepressants and 13.8% received mood stabilizers.ConclusionBased upon the present study data, it is concluded that among all the psychotropic medications, antipsychotics were heavily used and the frequency was found to be significantly high in the case of inpatients compared with outpatients. Such a practice may lead to multiple negative consequences among the Saudi psychiatric patient population. Further, extensive use of sodium valproate in the case of bipolar disorder, and also among females either in childbearing age or during pregnancy is also the cause of concern and warrants logical use. Overall, this study may help in assessing the burden of psychiatric illness within specific patient demographics and might be effectively used to strategically plan health resources allocation, generate new treatment hypothesis, or be used as a source of evidence that could further integrate other observational studies.

Medication burden in bipolar disorder: A chart review of patients at psychiatric hospital admission

Individuals with bipolar disorder (BD) often receive complex polypharmacy regimens as part of treatment, yet few studies have sought to evaluate patient characteristics associated with this high medication burden. This retrospective chart review study examined rates of complex polypharmacy (i.e., ≥4 psychotropic medications), patterns of psychotropic medication use, and their demographic and clinical correlates in a naturalistic sample of adults with bipolar I disorder (BDI; N=230) presenting for psychiatric hospital admission. Using a computer algorithm, a hospital administrator extracted relevant demographic, clinical, and community treatment information for analysis. Patients reported taking an average of 3.31 (S.D.=1.46) psychotropic medications, and 5.94 (S.D.=3.78) total medications at intake. Overall, 82 (36%) met criteria for complex polypharmacy. Those receiving complex polypharmacy were significantly more likely to be female, to be depressed, to have a comorbid anxiety disorder, and to have a history of suicide attempt. Women were significantly more likely than men to be prescribed antidepressants, benzodiazepines, and stimulants, even after controlling for mood episode polarity. Study data highlight the high medication burden experienced by patients with BD, especially those who are acutely symptomatic. Data also highlight the particularly high medication burden experienced by women with BD; a burden not fully accounted for by depression.

Acute inpatient treatment, hospitalization course and direct costs in bipolar patients with intellectual disability

To explore the impacts of intellectual disability (ID) on psychotropic medication use, length of hospital stay (LOS) and direct hospitalization costs during inpatient treatment for acute bipolar episodes, all 17,899 index hospitalizations due to acute bipolar episodes between 1998 and 2007 in Taiwan were identified from a total population health insurance claims database, amongst which 544 subjects had a concomitant diagnosis of ID. Pattern of psychotropic medication use, LOS, discharge outcome and direct costs during hospitalization were compared between bipolar patients with ID and without ID and multivariate models controlling for major cost confounders were used to explore the impacts of ID on LOS, discharge outcome and inpatient costs. The results indicated that, compared to bipolar patients without ID, bipolar patients with ID were younger, had longer LOS and received significantly lower daily equivalent dosages of antipsychotics, mood stabilizers, lithium and benzodiazepines. Significantly more bipolar patients with ID could not be discharged successfully. The longer LOS possibly reflected slower clinical stabilization, conservative use of medications and difficulty in community placement. The lower average daily reimbursements indicated that treatment of bipolar patients with ID were under-funded, whereas the higher total direct costs resulting from prolonged LOS placed greater economic straint on healthcare system. The findings support that bipolar patients with ID are clinically unique but relatively under-supported during acute hospitalization. Modifying current pharmacological intervention, health care resources allocation and community supporting structure is paramount to reducing LOS and improving hospitalization outcome.

Trends in Psychotropic Medication Use for Medicaid-Enrolled Preschool Children

Pharmoepidemiological studies have reported dramatic increases in the use of psychotropic medications for very young children in the 1990s, but more recent trends have not been well-documented. This study describes patterns of psychotropic medication use for Medicaid-enrolled preschool children and identifies factors associated with psychotropic medication use. Using Medicaid claims data, we conducted a trend analysis of psychotropic medication prescribing patterns for the population of preschool children (aged 2–5 years) continuously enrolled in Ohio’s Medicaid program from 2002 to 2008 (N = 559,275). Children were identified as users of psychotropic medications if they had at least one prescription claim during the study period (N = 23,019). The overall rate of psychotropic medication use increased only slightly from 1.7 to 1.9 % between 2002 and 2008. Significant increases in the use of stimulants, alpha-agonist medications, and especially antipsychotics, which more than doubled from .2 % in 2002 to .5 % in 2008, were balanced by significant decreases in the use of antidepressants and mood stabilizers. Of those treated with psychotropic medications, a little over a quarter (28.4 %) had a mental health assessment, 23.7 % had a visit with a psychiatrist, and 29.7 % had a psychotherapy visit. Children who were older, white, male, disabled, and in foster care were more likely to receive psychotropic medications. The diagnoses most associated with psychotropic medication use were ADHD, bipolar disorder, and disruptive behavior disorders. In conclusion, our data suggest growth in the proportion of preschoolers being treated with antipsychotics, stimulants and alpha agonists, primarily for behavioral disturbances and aggressive symptoms. Most preschool children prescribed psychotropic medication do not receive the psychosocial services recommended by current treatment guidelines.