Prescription Of Psychotropic Drugs Research Articles

A study of prescription patterns of psychotropic medications in psychiatric outpatient department in a tertiary care center in North Karnataka

Background: Utilization pattern of drugs varies from place to place and is influenced by differing patient characteristics, type of disease prevalent, cultural and environmental influences, socioeconomic status, availability of newer drugs, and prescribing habit of physicians. However, their utilization in actual clinical practice, effectiveness, and safety in real-life situation need continuous studies. Hence, our aim to analyze the drug prescribing pattern in various psychiatric illnesses. Aims and Objective: In the present days, there is a growing concern over the magnitude of psychiatric illnesses occurring and the health indicators that implicate the importance of rational prescribing of psychotropic drugs. Materials and Methods: Our study was prospective observational study which was conducted for a period of 4-months in a psychiatric outpatient department. A total of 530 patients medical records were assessed for analyzing the prescription pattern. Usage of using the World Health Organization drug indicators was followed. Results: In the present study, majority of the patients (44.5%) were in the age group of 20–40 years. Depression was the (37.1%) most prevalent psychiatric disease followed by anxiety (27.4). Antidepressants (38%) were the most commonly prescribed antipsychotic medication followed by anxiolytics (21%). It was found that average number of the psychotropic drugs per prescription was 1.8. Conclusion: Antidepressants were the most commonly used psychotropic drugs. Generic drugs were prescribed more.

Changing trends in anti-psychotic prescription pattern in Pakistan.

Background and Objective:This study was designed to identify the changing trends in Anti-psychotic prescription pattern in Pakistan. It was part of the research project Research on East Asian Psychotropic Prescription Pattern (REAP) carried out to identify the prescription patterns of schizophrenic patients in different countries located in Asia.Our objective was to assess the trend and change of psychotropic drug prescriptions for patients with schizophrenia.Methods:The design of the study was quantitative and of descriptive epidemiology. This study was carried out from 30th March 2017. Data was collected on a unified protocol by the Psychiatrists from Pakistan. Three (3) centers i.e., Lahore, Karachi and Islamabad provided the data. Indoor and outdoor cases with Schizophrenia were recruited. A web based recording system for collection of data done at Taipei Taiwan, and statistical analysis was performed and transferred to all participating centers including Pakistan.Results:The main findings of the study were that majority of the patients were prescribed antipsychotic poly pharmacy drug. It was also found that Anxiolytics, anti-depressants and Anti-parkinsonian drugs were also co-prescribed.Conclusion:It was concluded that antipsychotic poly pharmacy along with Anxiolytics, anti-depressants and Anti-parkinsonian drugs were prescribed to patients with schizophrenia in Pakistan.

Prevalence and clinical features of atypical depression among patients with major depressive disorder in China.

Little is known about the demographic and clinical features of the atypical subtype of major depressive disorder (MDD) patients in China. This study set out to investigate the prevalence of atypical depression in MDD patients in China, and identify its demographic and clinical features. The study was conducted in 13 major psychiatric hospitals or in the psychiatric units of general hospitals in China, and recruited a sample of 1172 patients diagnosed with MDD. The patients' demographic and clinical features and prescriptions of psychotropic drugs were collected using a standardized questionnaire designed for the study. The prevalence of atypical depression was 15.3%. In multiple logistic regression analyses, compared to the non-atypical depression patients, the atypical depression patients were more likely to have depressive episodes with suicide ideation and attempts (OR = 1.49, 95% CI = 1.06, 2.10, P = 0.023), depressive episodes with psychotic features (OR = 2.15, 95% CI = 1.43, 3.22, P < 0.001), seasonal depressive episodes (OR = 1.77, 95% CI = 1.12, 2.78, P = 0.014), an earlier age of onset (OR = 0.98, 95% CI = 0.96, 0.99, P = 0.001), and lifetime depressive episodes (OR = 1.07, 95% CI = 1.01, 1.13, P = 0.020). The assessment of atypical features was not based on a validated rating scale. Our results indicate that atypical depression is common in Chinese patients with MDD. MDD with atypical features may be more severe and debilitating than patients with non-atypical features.

Psychotropic drug-prescribing correlates of disorganized speech in Asians with schizophrenia: The REAP-AP study

BackgroundAlthough disorganized speech is seen as one of the nuclear features of schizophrenia, there have been few reports of disorganized speech-associated psychotropic drug-prescribing patterns in large samples of schizophrenia patients. ObjectiveWe aimed to examine the prevalence of disorganized speech and its correlates in terms of psychotropic drug prescribing, using the data from the Research on Asian Psychotropic Patterns for Antipsychotics (REAP-AP) study. MethodA total of 3744 patients with the ICD-10 diagnosis of schizophrenia were enrolled from 71 survey centers in 15 Asian countries/areas. An essential criterion of disorganized speech was that it was “severe enough to impair substantially effective communication” as defined in the DSM-5. A binary logistic model was fitted to identify the psychotropic drug-prescribing correlates of disorganized speech. ResultsAfter adjusting for the potential effects of confounding variables, the binary logistic regression model showed that the presence of disorganized speech was directly associated with adjunctive use of mood stabilizers (P < 0.001) and cumulative diazepam equivalent dose (P < 0.0001), and inversely associated with adjunctive use of anti-Parkinson drugs (P < 0.0001). ConclusionThe association between disorganized speech and adjunctive use of mood stabilizers could perhaps be understood in the context of a relationship with impulsiveness/aggressiveness, or in terms of deconstructing the Kraepelinian dualism.

Access to Psychotropic Medication via Prescription Is Associated With Choice of Psychotropic Medication as Suicide Method

Whether physical access to psychotropic medication via prescription (ie, prescribed access) is associated with use of psychotropic medication as a means of subsequent suicide attempt remains unclear. In a population of suicide attempters, we investigated whether prescribed access to any psychotropic medication increased the likelihood of using any psychotropic drug in a suicide attempt and whether prescribed access to a specific psychotropic drug type increased the likelihood of using that specific psychotropic drug type in an attempt. Case-control study design was used. We identified individuals receiving care for a suicide attempt (fatal or nonfatal) in emergency department and inpatient settings from a US insurance claims dataset (2006-2013) using relevant ICD-9-CM codes. Cases used a psychotropic drug in their suicide attempt, while controls used another method. Exposed individuals filled a psychotropic drug prescription within 90 days prior to the attempt. Multivariable logistic regression estimated odds ratios. A population of 27,876 (cases = 10,158, controls = 17,718) was included. Anxiolytics were used most in attempts (n = 6,037, 59.4%), followed by antidepressants (n = 3,573, 35.2%), antipsychotics or mood stabilizers (n = 1,168, 11.5%), and stimulants (n = 368, 3.6%). Thirteen percent (n = 1,316) used more than 1 type of psychotropic drug in the attempt. Across all psychotropic drug groups evaluated, individuals using psychotropic medication in a suicide attempt were significantly more likely to have had prescribed access (adjusted odds ratio [aOR] = 1.7; 95% CI, 1.6-1.9), with the highest drug type-specific odds ratios for antipsychotics or mood stabilizers (aOR = 6.5; 95% CI, 5.4-7.7) and stimulants (aOR = 7.6; 95% CI, 5.5-10.5). Individuals at high risk for suicide with prescribed access to any psychotropic medication should be targeted for means safety interventions.

Association of Focused Medication Review With Optimization of Psychotropic Drug Prescribing

ImportanceMedication review has been proposed to achieve improved use of psychotropic drugs, but benefits have not been confirmed.ObjectiveTo synthesize evidence for focused psychotropic medication review in medication optimization.Data SourcesMedline, PsycINFO, EMBASE, and CINAHL Plus were searched from inception to February 2018 using the index terms “drug utilization review” and “psychotropic drugs” and synonyms. Additional articles were retrieved using citation tracking and reference checking.Study SelectionFull-length, peer-reviewed articles that reported focused psychotropic medication review were included. Inclusion was determined against prespecified criteria and assessed independently.Data Extraction and SynthesisStudy quality was assessed using National Institutes for Health appraisal tools and informed a structured synthesis of results. Meta-analysis using a random effects model was conducted.Main Outcomes and MeasuresChange in the number or dosage of psychotropic medications, change in clinical parameters, change in patient-reported outcomes, and economic data were collected.ResultsA total of 26 studies met the inclusion criteria. Four studies were randomized clinical trials (n = 712 participants), while the remainder were before-after studies (n = 7844 participants). Most studies were conducted in elderly individuals, people with dementia, and adults with intellectual disability. Focused psychotropic medication review is a complex intervention; the professional(s) involved, target drug, degree of integration with usual care, and participant involvement varied greatly among the studies. Meta-analysis included 3 studies (n = 652 participants). Psychotropic medication review was associated with a reduction in prescribing of psychotropic drugs compared with control (pooled odds ratio, 0.24; 95% CI, 0.14-0.39) in elderly participants with cognitive impairment living in nursing homes. Before-after studies consistently reported a change in psychotropic drug prescribing after medication review, regardless of the population. Studies that reported the effects of psychotropic medication review on clinical outcomes failed to demonstrate benefit. Economic implications of focused psychotropic medication review were not adequately assessed. The quality of evidence is poor and studies are at risk of bias.Conclusions and RelevanceFocused psychotropic medication review was associated with a reduction in prescribing of psychotropic drugs, but has not been shown to improve clinical outcomes or to provide economic benefit. More robust evidence is needed before programs of focused psychotropic medication review can be recommended as part of routine care for any patient group.

Initiation of new psychotropic prescriptions without a psychiatric diagnosis among US adults: Rates, correlates, and national trends from 2006 to 2015.

To estimate rates and national trends of initiation of new psychotropic medications without a psychiatric diagnosis and to identify demographic and clinical correlates independently associated with such use among US adults in outpatient settings. Data were gathered from the 2006-2015 National Ambulatory Medical Care Survey (NAMCS), a nationally representative sample of office-based U.S. outpatient care. The sample was limited to adults aged 18 or older who received a new psychotropic drug prescription (n=8618 unweighted). Using a repeated cross-sectional design with survey sampling techniques, we estimated prescription initiation rates and national trends. Multivariable-adjusted logistic regression analysis was used to identify correlates independently associated with initiation of new psychotropic prescriptions without a psychiatric diagnosis. Data were publicly available, and we extracted them from the Centers for Disease Control and Prevention website. Altogether, at 60.4% of visits at which a new psychotropic prescription was initiated, no psychiatric diagnosis was recorded for the visit. Overall, the rate increased from 59.1% in 2006-2007 to 67.7% in 2008-2009 and then decreased to 52.0% in 2014-2015. Visits to psychiatrists were associated with very low odds of having no psychiatric diagnosis when compared to primary care visits (OR=0.02; 95% CI, 0.01-0.04). Visits to non-psychiatric specialists showed 6.90 times greater odds of not having a psychiatric diagnosis when compared to primary care visits (95% CI, 5.38-8.86). New psychotropic medications are commonly initiated without any psychiatric diagnosis, especially by non-psychiatrist physicians. Non-psychiatrists should document relevant diagnoses more vigilantly to prevent potentially inappropriate use or misuse.

Psychiatric morbidity and suicidal behaviour in psoriasis: a primary care cohort study.

Psychological distress among people with psoriasis may lead to elevated risks of suicide and nonfatal self-harm. To investigate psychiatric comorbidity, psychotropic medication prescribing and risk of suicidality in people with psoriasis. A cohort of patients with psoriasis (1998-2014) was delineated using the Clinical Practice Research Datalink, with linkage to Hospital Episode Statistics and Office for National Statistics mortality records. Each patient with psoriasis was matched with up to 20 patients without psoriasis on age, sex and general practice. A stratified Cox regression model was used to estimate the hazard ratios (HRs) for suicide or nonfatal self-harm risks adjusted for socioeconomic status. At baseline, among 56 961 and 876 919 patients with and without psoriasis, higher prevalence for histories of alcohol misuse, bipolar disorder, depression, anxiety disorders, self-harm and psychotropic drug prescription were observed. The deprivation-adjusted HR indicated lower suicide risk in people with psoriasis [HR 0·59, 95% confidence interval (CI) 0·41-0·85]. The risk of suicide varied according to age: it was lower in people with psoriasis diagnosed at ≥ 40 years (HR 0·38, 95% CI 0·21-0·66), whereas there was no difference in risk of suicide in people with psoriasis diagnosed before age 40 years (HR 0·92, 95% CI 0·58-1·46). Conversely, there was a small increased risk for self-harm (HR 1·15, 95% CI 1·04-1·27) associated with psoriasis. The prevalence of mental illness was raised in people with psoriasis, and this may lead to a greater risk of self-harm. Nevertheless, having psoriasis does not appear to be associated with an increased risk of suicide. Healthcare professionals caring for patients with psoriasis should continue to monitor and tackle effectively the psychological needs of these individuals.

Mental illness in primary care: a narrative review of patient, GP and population factors that affect prescribing rates.

Mental illness poses a large and growing disease burden worldwide. Its management is increasingly provided by primary care. The prescribing of psychotropic drugs in general practice has risen in recent decades, and variation in prescribing rates has been identified by a number of studies. It is unclear which factors lead to this variation. To describe the variables that cause variation in prescribing rates for psychotropic drugs between general practices. A narrative review was conducted in January 2018 by searching electronic databases using the PRISMA statement. Studies investigating causal factors for variation in psychotropic prescribing between at least two general practice sites were eligible for inclusion. Ten studies met the inclusion criteria. Prescribing rates varied considerably between practices. Positive associations were found for many variables, including social deprivation, ethnicity, patient age and gender, urban location, co-morbidities, chronic diseases and GP demographics. However studies show conflicting findings, and no single regression model explained more than 57% of the variation in prescribing rates. There is no consensus on the factors that most predict prescribing rates. Most research was conducted in countries with central electronic databases, such as the United Kingdom; it is unclear whether these findings apply in other healthcare systems. More research is needed to determine the variables that explain prescribing rates for psychotropic medications.

Stopping over-medication of people with intellectual disability, Autism or both (STOMP) in England part 1 – history and background of STOMP

PurposeThe programme – Stopping the over-medication of people with an intellectual disability, Autism or Both (STOMP) is a three-year programme supported by NHS England. Concern about the overuse of antipsychotic drugs has been a constant theme since the 1970s. However, despite a multitude of guidelines the practice continues. The report into the events at Winterbourne View not only raised concerns about the overuse of antipsychotic drugs but of antidepressants and multiple psychotropic drug use. The purpose of this paper is twofold: Part 1 is to present the history and background to the use of psychotropic drugs in intellectual disabilities, autism or both; and Part 2 presents the progress with the STOMP programme.Design/methodology/approachThe review tracks the various concerns, guidelines and attempts to tackle the issue of over medication of people with intellectual disability autism or both.FindingsThe review identifies that despite the many studies and guidelines associated with the prescribing of psychotropic drugs for people with an intellectual disability, autism or both the practice is common. Programmes that minimise the use of psychotropic drugs involve a full use of the multidisciplinary team and an availability of alternative methods of managing challenging behaviours.Originality/valueSTOMP is part of an English national agenda – Transforming care. The English Government and leading organisations across the health and care system are committed to transforming care for people with intellectual disabilities, autism or both who have a mental illness or whose behaviour challenges services. This review identifies many studies, programmes and guidelines associated with psychotropic drug use for people with an intellectual disability, autism or both.

The Risk of Offspring Psychiatric Disorders in the Setting of Maternal Obesity and Diabetes.

Prenatal exposure to metabolic disturbances is associated with increased risk of offspring neurodevelopmental impairment and autism spectrum disorder, while little is known about the joint effect of maternal obesity and diabetes. With this study, we aim to assess the joint effect of maternal obesity and diabetes on the risk for offspring psychiatric and mild neurodevelopmental disorders. Nationwide registries were used to link data of all live births in Finland between 2004 and 2014 (n = 649 043). Cox proportional hazards modeling adjusting for potential confounders was applied to estimate the effect of maternal obesity, pregestational diabetes mellitus (PGDM), and gestational diabetes mellitus, as well as their joint effects, on the outcomes of offspring psychiatric and mild neurodevelopmental diagnoses and offspring prescription of psychotropic drugs. Among mothers without diabetes, severely obese mothers had 67% to 88% increased risk of having a child with mild neurodevelopmental disorders (hazard risk ratio [HR] = 1.69; 95% confidence interval [CI] = 1.54-1.86), attention-deficit/hyperactivity disorder or conduct disorder (HR = 1.88; 95% CI = 1.58-2.23), and psychotic, mood, and stress-related disorders (HR = 1.67; 95% CI = 1.31-2.13) compared with mothers with a normal BMI. PGDM implied a further risk increase for all groups of psychiatric diagnoses with onset in childhood or adolescence in mothers with severe obesity. Marked effects were found particularly for autism spectrum disorder (HR = 6.49; 95% CI = 3.08-13.69), attention-deficit/hyperactivity disorder and conduct disorder (HR = 6.03; 95% CI = 3.23-11.24), and mixed disorders of conduct and emotions (HR = 4.29; 95% CI = 2.14-8.60). Gestational diabetes mellitus did not increase the risk highly for these offspring disorders. Maternal PGDM combined with severe maternal obesity markedly increases the risk of several children's psychiatric and mild neurodevelopmental disorders.

Factors related to use of potentially inappropriate psychotropic drugs in 2,343 residents of 19 nursing homes

To identify factors that influence use of potentially inappropriate psychotropic drugs among elderly residents living in nursing homes (NH). Cross-sectional, multicentre study among 65+ years NH residents, based on queries performed on the PATHOS database and on prescription information from residents' medical data. Medications were coded using the Anatomical Therapeutical Chemical classification. Psychotropic agents were classed using Delay and Deniker's classification, and the Beers Criteria (Beers list 2015 update) were used to identify potentially inappropriate psychotropic drugs (PIPs). Logistic regression was performed to identify factors related to use of potentially inappropriate psychotropic drugs, and factors related to PIPs. The average number of drugs per subject (n=2,343) was 7.8±3.5. In total, 1,709 (71.6%) subjects were taking psychotropic drugs (1.8±0.9 psychotropic drugs per user). Psychotropic agents represented 17.4% of the 18,143 drugs used by the whole study population. The frequency of PIPs was 44.1%. By multivariable analysis, the use of psychotropic drug was significantly associated with behavioural disorders (OR 3.21, 95%CI [2.46-4.18]); depression (OR 8.79, 95%CI [6.64-11.6]); anxiety (OR 3.43, 95%CI [2.45-4.8]); psychosis (OR 2.05, 95%CI [1.28-3.30]), use of >4 drugs (OR 4.85, 95%CI [3.60-6.53]); and dehydration (OR 0.49, 95%CI [0.32-0.75]). PIPs was significantly associated to behavioural disorders (odds ratio (OR) 1.56, 95% confidence interval (CI) [1.89-1.29]); depression (OR 2.90, 95%CI [3.60-2.3]); anxiety (OR 1.68, 95%CI [2.32-1.22]); dementia (OR 2.43, 95%CI [2.96-1.99]); use of >4 drugs (OR 3.41, 95%CI [4.90-2.37]); dehydration (OR 0.53, 95%CI [0.76-0.37]), arthritis/arthrosis of the hip (OR 1.48, 95%CI [2.04-1.07]) and arthritis/arthrosis of the shoulder (OR 2.06, 95%CI [3.43-1.23]). Regular review of prescriptions and emphasis on non-drug therapy of behavioural disorders in elderly subjects can help to reduce the rate of prescription of psychotropic drugs and PIPs in NH residents.

The benzodiazepine nation of Croatia: an observational, comparative study of psychotropic drug utilization between Croatia and Sweden 2014–2015

ABSTRACTBackground: The consumption of psychotropic drugs (PD) is increasing worldwide with a significant variation between countries. Croatia and Sweden have similar health and pharmaceutical systems; however, Sweden is a high-income country with developed medical care, registries, and prescribing guidelines. We sought to compare the utilization of PD between Croatia and Sweden to identify areas for improvement in rational use of drugs.Methods: This was a cross-sectional study using national databases to assess utilization of PD (ATC N05, N06) in Croatia and Sweden in 2014 and 2015.Results: Prescribing of PD in Croatia increased from 127 DDD/TID (defined daily dose/1000 inhabitants) in 2014 to 131 DDD/TID in 2015. In Sweden, the total utilization was higher with an increase from 183 DDD/TID in 2014 to 188 DDD/TID in 2015. There were substantial differences. In Croatia, the utilization of benzodiazepine derivatives (N05BA) was 72.5 DDD/TID in 2014 and increased to 74.4 DDD/TID, in 2015. In Sweden, the utilization was only 11.2 DDD/TID for benzodiazepine derivatives in both years.Conclusions: There were substantial differences in utilization of PD between Croatia and Sweden. Highlighting the problem of inappropriate benzodiazepine utilization in Croatia can help to introduce measures to change prescribing habits and improve prescribing quality.

Application of the STOPP criteria in hospitalised elderly patients to detect and optimise inappropriate psychopharmaceutical prescriptions.

Psychotropic drugs are frequently used in the elderly population, but their inappropriate prescription can cause numerous adverse effects and interactions. To evaluate the impact of a multidisciplinary intervention to detect and optimise inappropriate prescriptions of psychotropic drugs in patients aged over 75years in a hospital setting. A prospective study which included every patient aged over 75years admitted to the Consorcio Hospital General in Valencia, Spain,and who had been prescribed psychotropic drugs inappropriately, carried out over 1 year. The intervention was to detect inappropriate prescriptions of psychotropic drugs using the STOPP criteria, treatment optimisation by a team of psychiatrists, readjustment of the electronic prescription register, and communication to the primary care physician. The impact of the intervention was assessed by measuring the persistence of the changes made 3 months after discharge and by quarterly assessment of inappropriate prescriptions. Of 4571 admissions, 378 inappropriate prescriptions were detected in 346 patients. The drugs most frequently used were long half-life benzodiazepines (70%), which were substituted in 62% of the cases, withdrawn in 32%, and maintained in 6%. At 3 months follow-up, the changes had been maintained by the patients' primary care physician in 67%. Evaluation of the prescriptions during the subsequent quarters of the year showed a significant decrease in the inappropriate prescriptions, especially benzodiazepines. Coordinated intervention by pharmacologists and psychiatrists in hospital settings, and communication between these professionals and primary care teams, can reduce psychotropic drugs inappropriately prescribed to the elderly.

Retrospective study of psychotropic drugs used in neurological rehabilitation (2010–2016): Impact of a collaboration between prescribers and pharmacists

The prescription of psychotropic drugs is common in neuro-rehabilitation. In our establishment it represents 16% of prescriptions. Since 2010, a collaboration between pharmacists, psychiatrists and medical specialists has led to a policy of reducing and supervising their prescriptions. The retrospective study of the psychotropic drugs’ consumption compared to the evolution of the type of patients treated with makes possible to evaluate the undertaken measures. From 2010 to 2016, in addition to its routine analysis, audits and awareness compaign of the psychotropic drug's prescriptions were regularly carried out by pharmacists to doctors and interns. Over the same period, the data of stays by psychological diagnostic code — psychotic disorders, anxiety, depressive disorders, other — were collected from the DIM (Medical informations department in France). Consumptions of psychotropic drugs (hypnotics, anxiolytics, antidepressants, antipsychotics) were extracted from pharmaceutical management software. For each drug the daily intake was calculated according to the SPC. The overall number of patients with psychological diagnosis code hospital stays increased by 321% in 6 years. +150% for depressive disorders, +287% for psychotic disorders, +443% for anxiety disorders and +488% for sleep disorders. The daily consumption of psychotropic drugs decreased by 19.9%; a decrease of 45.3% and 39.4% for hypnotics and anxiolytics respectively, antipsychotics remained stable (0.9%) and antidepressants increased by 21.1%. The Pearson correlation test shows a negative correlation with a phi coefficient −0.7 ( P = 0.06) between the number of targeted stays and the psychotropic drugs’consumption. The collaboration between prescribers and pharmacists is successful: the use of psychotropic drugs is decreasing despite a number of ever-increasing stays of patients. The involvement of pharmacists must be continued. As a reinforcement of these results, drug-free therapeutic alternatives are currently being examined such as relaxation techniques, RESC, psychiatric or psychological care.

Psychotropic medication in children and adolescents in the United States in the year 2004 vs 2014.

BackgroundThere is a global perception that psychotropic utilization in children and adolescents is increasing in the US.MethodsWe present prevalent estimates for all psychotropics prescribed in the US (using commercial claims from Medicare and Medicaid) to children and adolescents in 2004 (total population N = 6,808,453) and in 2014 (total population N = 11,082.260). Further we evaluated if there has been a statistically significant change in prevalence during this time period. Analyses were stratified for the 6 major drug classes, all individuals’ psychotropics (87 drugs), age and sex.ResultsThe prevalence of psychotropic drug prescription was 8.55% in 2004 and 9.00% in 2014 (age stratified in 2004 and 2014 toddlers: 3.08 and 2.63%, children: 8.74 and 8.73%, adolescents: 10.89% and 12.11). The prevalence for each drug class in 2004 and 2014 was: stimulants/other ADHD drugs 5.0 and 5.8%; antidepressants 2.8 and 2.7%; anxiolytic-hypnotic-sedative 2.2 and 2.3%; mood stabilizers 0.1 and 0.1%; antipsychotics 1.3 and 1.1%; and for drugs treating drug dependence 0.02 and 0.02%.ConclusionsThe perception that psychotropic utilization in children and adolescents is increasing in the US, derived from the 2 to 3 fold increase seen from the mid 80’s to the mid 90’s is not valid anymore. There has been a slowdown in the increase of prescribing psychotropics. In the last 10 years, in toddlers there was a decrease in the prescription; in children there was no change; and in adolescents there was a slight increase. The prescription of antidepressants, antipsychotics and mood stabilizers has decreased overall. Graphical abstractIn the last 10 years there has been a slowdown in the increase of prescribing psychotropics. In toddlers there was a decrease in the prescription (3.08 and 2.63%); in children (8.74 and 8.73%) there was no change; and in adolescents there was a slight increase (10.89% and 12.11). The prescription of antidepressants, antipsychotics and mood stabilizers has decreased overall. Electronic supplementary materialThe online version of this article (10.1007/s40199-018-0204-6) contains supplementary material, which is available to authorized users.

Prescription of Psychotropic Drugs with Potentially Restraining Effect: An Analysis of Care Need Assessment Data by MDK Bayern

Physical restraints in home care and residential care settings in the form of restraining devices have been reduced in the last years. Now psychotropic drugs with sedating and thus potentially restraining effect are of increasing interest. The objective of this study was to describe prescription of psychotropic drugs for insurants in need of care and factors influencing such prescription. On the "Annual Word Elder Abuse Awareness Day", the Medical Service of the Statutory Health Insurance undertook a reference day analysis. During the regular assessment of care needs, distribution of psychotropic drugs according to relevant aspects of care were analyzed. Additionally, prescribed drugs were rated with respect to inappropriateness for elder people according to the Priscus list. Data on 706 insured people were analyzed; 43% of them received at least one psychotropic drug as a regular medication, 22% of them at least one potentially sedating drug. According to the Priscus list, 16% of prescribed drugs were identified as potentially inappropriate for elder people. Significant correlation was shown between prescription of psychotropic drugs and location of assessment, care need, diagnosis and the degree of limitation in daily living skills. This paper supports results in literature and emphasizes the discrepancy between restraint in the prescription of psychotropic drugs as advised by experts and distribution of these drugs in reality. Further studies analyzing the quality of prescriptions taking into consideration the individual circumstances of patients are desirable.

HU3 - Initiation of Psychotropic Prescriptions without a Psychiatric Diagnosis in US Adults

Prescribing psychotropic medications without a psychiatric diagnosis may pose inappropriate use, misuse, or a risk of developing significant adverse drug events. This study estimates prevalence and national trends of initiation of psychotropic medications without a psychiatric diagnosis, and identify correlates independently associated with such use among US adults in outpatient visits. Data were gathered from the 2006-2015 National Ambulatory Medical Care Survey (NAMCS), a nationally representative sample of office-based U.S. outpatient care. The sample was limited to adults aged 18 or older who received a new psychotropic drug prescription (n=9,426 unweighted). Psychotropic prescriptions were classified into one of five groups using generic names (antipsychotics, antidepressants, anxiolytics, sleep-specific anxiolytics, or others). Using a repeated cross-sectional design with survey sampling techniques, we estimated prevalence rates and national trends. Multivariable-adjusted logistic regression analysis was used to identify demographic and clinical correlates independently associated with initiation of psychotropic prescriptions without a psychiatric diagnosis. Altogether, at 62.1% of visits at which a psychotropic prescription was initiated, no psychiatric diagnosis was recorded for the visit. Overall, the rate increased from 61% in 2006-2007 to 69.5% in 2008-2009, and then decreased to 53.3% in 2014-2015. Visits to psychiatrists were associated with very low odds of having no psychiatric diagnosis when compared to primary care visits (OR=0.02; 95% CI, 0.01-0.04). Visits to non-psychiatric specialists showed 6.89 times greater odds of not having a psychiatric diagnosis when compared to primary care visits (95% CI, 5.34-8.82). Among psychotropic drug classes, sleep-specific anxiolytics was associated with 3.29 times greater odds of not having a psychiatric diagnosis, when compared to antipsychotic prescriptions (95% CI, 2.03-5.34). Psychotropic medications are commonly initiated without any psychiatric diagnosis, especially among non-psychiatrist physicians. Non-psychiatrists should document relevant diagnoses more vigilantly to prevent potentially inappropriate use or misuse.

Psychotropic drug prescribing in residential aged care homes.

Psychotropic drug prescribing in residential aged care homes.

Older Adults with Autism Spectrum Disorders in Sweden: A Register Study of Diagnoses, Psychiatric Care Utilization and Psychotropic Medication of 601 Individuals

In a Swedish sample of persons eligible for disability services and aged 55 years or older in 2012, persons (n = 601) with autism spectrum disorder diagnoses registered in specialist care were identified. Register data concerning diagnoses of other psychiatric disorders, psychiatric care, and psychiatric medication were reviewed. More than 60% had been in contact with psychiatric care. The majority had no intellectual disability (ID) diagnosis recorded during the study period. Apart from ID, affective disorders, anxiety and psychotic disorders were most commonly registered; alcohol/substance abuse disorders were uncommon. Psychotropic drug prescriptions were very common, especially in the ID group. Professionals need awareness of this vulnerable group; studies concerning their life circumstances and service requirements should be conducted.