Psychotropic Prescription Patterns Research Articles

Psychotropic prescription practices in child psychiatric inpatients 9 years old and younger.

We set out to examine psychotropic prescribing patterns among inner city children on public assistance admitted to a university-based inpatient service. A chart review of children 9 years old and younger admitted between 1998 and 2001 recorded demographic variables, diagnoses, and admission and discharge medications. The sample (N = 301) was 78% male, 66% African American, and averaged 7.2 years of age. Of this sample, 85% had a behavior disorder on admission and discharge; 51.8% of the patients were medicated on admission, 78.7% on discharge. Approximately 25% received polypharmacy on either admission or discharge. Stimulants were the most widely used psychotropic (38.2% on admission, 60.5% on discharge). Other medications prescribed at admission versus discharge were alpha-2 agonists (9.3% vs. 9%), atypical antipsychotics (9% vs. 12%), antidepressants (8.3% vs. 15.9%), and mood stabilizers (5.6% vs. 2.3%). Among inner city children, pharmacotherapy is more prevalent in an inpatient unit compared with the community standard. Community physicians prescribed more mood stabilizers; the academic faculty used more stimulants, atypical antipsychotics, and antidepressants. Predictors of pharmacotherapy in the community such as age, sex, race, and a behavior disorder shifted at discharge to include only length of stay and a behavior disorder diagnosis. Further research is needed to clarify whether nonadherence, treatment failure, and social factors account for lower medication utilization in the community.

Antidepressant prescribing in community cancer care.

To describe patterns of antidepressant (ADs) prescribing in community oncology practice. Data were collected using an electronic medical record on all staged breast, colon, and lung cancer patients in three community-based oncology practices. The data were analyzed retrospectively, using descriptive and bivariate analyses and multivariate logistic regression modeling. There were 850 breast, 299 colon, and 473 lung cancer patients identified in this analysis. Overall, 19.2% of breast, 11% of colon, and 13.7% of lung cancer patients had been prescribed ADs during the 2-year period. The clinic in which cancer treatment was received predicted AD prescribing. The relationship between AD administration and age proved to be nonlinear; the pattern exhibited an "inverted U" shape. Patients with comorbidities and on pain medications were more likely to be administered ADs. Colon cancer patients on pain medications were five times more likely to be administered ADs than those not on pain medications. While some predictors of AD prescribing appear to be consistent with other studies, such as being on pain medication, there is still a great amount of variability in prescribing patterns across community practices, age groups, and cancer diagnoses. This study demonstrates that prescriptions of ADs seem to be influenced by parameters other than psychopathology. Given the importance of major depression in oncology care, diagnosis of psychiatric disorders and prescription patterns of psychotropics should be part of the routine monitoring and quality management in oncology patient care.

Psychotropic Prescribing Patterns Not Impacted by Sept. 11

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessPsychotropic Prescribing Patterns Not Impacted by Sept. 11Jim RosackJim RosackSearch for more papers by this authorPublished Online:6 Sep 2002https://doi.org/10.1176/pn.37.17.0023Dispensing of antidepressants and sedatives in the New York City and Washington, D.C., areas peaked, not in the weeks following September 11, but in the two weeks preceding Christmas and the start of the new year. The holiday season, it seems, may have been more distressing than the weeks following the worst terrorist attack in our nation’s history.Data provided to Psychiatric News by NDCHealth, an independent firm that tracks and analyzes prescription drug sales and marketing activity, show that for the year-long period from May 25, 2001, to May 24, 2002, dispensing of prescription antidepressants and sedative medications—including benzodiazepines and other antianxiety drugs, as well as nonbarbiturate sedative/hypnotics—followed a pattern similar to that of the three previous years.In general, prescriptions increased over the study period, with cyclical fluctuations that follow established trends in antidepressant and sedative prescribing.The number of prescriptions dispensed, tracked on a weekly basis, rose through the fall and peaked in the weeks between Thanksgiving and Christmas. Following the new year, dispensing of both antidepressants and sedatives leveled off at a rate slightly higher than for the same period one year earlier (see charts at right).Each week of data representing a low point of dispensing represented a week containing a holiday.New York RegionIn the New York metropolitan area, the total number of antidepressant prescriptions dispensed increased 5.6 percent overall from May 2001 to May 2002. That is a small increase compared with the 18 percent growth in prescriptions for all central nervous system medications in the North American market for the same period, according to IMSHealth, an international analysis firm that tracks global prescription data and analyzes the data for both industry and government. Antidepressants were the largest component of that 18 percent increase, analysts at IMSHealth told Psychiatric News, increasing 21.7 percent during the specific yearlong period analyzed.While the increase in dispensing in the New York City area may have been smaller than the national average, the trend mirrored the national data.Dispensing of sedative prescriptions in the New York region also increased over the period, rising 10.9 percent. This closely matched the national increase of 11 percent and, again, followed a trend that was similar to that of the rest of the nation.D.C. Dispensing DataDispensing of antidepressants in the metropolitan Washington, D.C., area increased from May 2001 to May 2002 by 10.65 percent, nearly twice the rate of growth in New York, yet still below the national average of 18 percent. The same trend in dispensing was evident in the D.C. area as seen in the New York area. Dispensing increased through fall 2001, then leveled off in the spring.Prescriptions for sedatives in the D.C. metropolitan area rose 11.68 percent for the year-long period analyzed, very close to the national average. Interestingly, while antidepressant prescribing in the D.C. area increased at twice the rate for New York City, the increase in prescribing of sedatives was the same.Analysts at both NDCHealth and IMS Health agreed that the events of September 11 did not significantly impact dispensing trends for either antidepressants or sedatives. The trends seen in their data closely follow previous years’ trends, with increase in the fall, leading up to the Thanksgiving and Christmas holiday seasons.“The holidays, with inherent stressors of schedule demands, financial demands, interactions with relatives during holiday gatherings—that may or may not be good—all of these typically interact and associate with an increase in dispensing of antianxiety and sleeping medications in particular,” said Jason Patrick, an independent analyst who follows the psychotropic markets. “Of note in these particular data is the relatively low increase in dispensing of antidepressants in New York City. What that really says is anyone’s guess at this point,” he told Psychiatric News.However, the data overall do not point to any significant increase in physician prescribing for depression or anxiety disorders following September 11, the analysts agreed. That would suggest that if depression or anxiety as disorders did increase, they were treated with interventions other than medication. ▪ ISSUES NewArchived

Psychotropic drug prescription patterns among patients with bipolar I disorder.

Combination treatment, rather than monotherapy, is prevalent in the treatment of subjects with bipolar disorder, probably due to the complex and phasic nature of the illness. In general, prescription patterns may be influenced by the demographic characteristics of patients as well. We evaluated prescription patterns and the influence of demographic variables on these patterns in a voluntary registry of subjects with bipolar disorder. A subset of data from a larger voluntary registry was extracted for demographic variables and psychotropic medication use that had been reported in the month prior to registration by ambulatory, non-hospitalized subjects with bipolar I disorder in 1995/96 (n = 457). Among the thymoleptic agents, lithium was prescribed in over 50% of subjects, valproate in approximately 40%, and carbamazepine in 11% of subjects. Eighteen percent of subjects had no prescription for thymoleptic agents. Nearly one-third of all subjects were receiving antipsychotic agents, of whom two-thirds were receiving the traditional neuroleptic agents. More than half of all subjects were receiving concomitant antidepressants, of whom nearly 50% received the SSRI antidepressants and nearly 25% received buproprion. Approximately 40% of subjects received benzodiazepines. Only 18% of subjects received monotherapy, and nearly 50% received three or more psychotropic agents. In general, no associations were noted between demographic parameters including age, gender, marital or educational status, and psychotropic prescriptions. Consistent with the anecdotal reports, these data confirm that combination treatment is far more common than monotherapy. Demography appears to have a minimal impact on cross-sectional prescription patterns in subjects with bipolar disorder. Given that combination treatments are the rule rather than the exception, we should strive to achieve rational, yet pragmatic, treatment guidelines and algorithms to minimize the risks while maximizing the benefits of these combination treatments for patients with bipolar disorder.

MHC3 Factors Predicting Potentially Inappropriate Psychotropic Prescribing for the Elderly

With the widespread use of psychotropics in the elderly, issues related to the availability and appropriate use of psychotropic medications in older patients have become a concern from both therapeutic and economic viewpoints. OBJECTIVE: The purpose of this study was to examine the factors predicting potentially inappropriate psychotropic prescribing for the elderly in office-based practice. METHODS: This study utilized data from the National Ambulatory Medical Care Survey (NAMCS) 1995 to examine psychotropic agents that should be generally avoided in the elderly, based on the criteria previously developed through a consensus process. These included diazepam, chlordiazepoxide, meprobamate, flurazepam, pentobarbital, secobarbital, and amitriptyline. Psychotropic drugs considered inappropriate based on an excessive dosage or excessive duration of therapy were not examined due to the limitations of the data source. National visit estimates were derived based on the patient sampling weight provided for the NAMCS. RESULTS: Approximately 2.03 million (95% CI, 1.70–2.36 million) visits by the elderly involved potentially in appropriate psychotropic medications. Only two potentially inappropriate psychotropic medications, secobarbital and pentobarbital, were not prescribed for the elderly by office-based physicians. The remaining five potentially inappropriate medications accounted for 16.85% of the visits involving psychotropic medications, with amitriptyline alone accounting for over 10%. The most frequently prescribed potentially inappropriate psychotropic classes were antidepressants and antianxiety agents. The logistic analysis results revealed that patient characteristics (injury visit), drug characteristics (number of medications and drug classes), and physician characteristics (specialty and region) predict potentially inappropriate psychotropic prescribing. CONCLUSION: The psychotropic prescribing patterns in ambulatory settings raise concerns regarding the quality of care for the elderly with psychiatric illnesses. The predictive factors may be used to design effective educational and regulatory strategies to improve prescribing for the elderly.

Pschotropic prescribing for the elderly in office-based practice

This study employed data from the National Ambulatory Medical Care Survey (NAMCS) 1995 to (1) determine the prevalence of the prescribing of psychotropic drugs for elderly patients by office-based physicians in the United States; (2) estimate the prevalence of the prescribing of potentially inappropriate psychotropic drugs in this patient population; and (3) identify any factors that predict such prescribing. For the purposes of this study, previously developed consensus criteria were adopted defining inappropriate psychotropic drugs as those that should be avoided in the elderly. According to the NAMCS data, psychotropic medications were prescribed in an estimated 12.02 million visits by elderly patients (95% confidence interval [CI], 11.07–12.97 million). The psychotropic medications most frequently prescribed for elderly patients by office-based physicians were antidepressants and antianxiety agents. The occurrence of visits at which psychotropic medications were prescribed was greater in patients who were over 84 years of age, female, white, or from the western United States. Primary care physicians prescribed the majority of these psychotropic drugs, and most visits to psychiatrists by elderly patients resulted in the prescribing of psychotropic drugs. Office-based physicians prescribed at least one potentially inappropriate psychotropic medication in 2.03 million visits by the elderly (95% CI, 1.70–2.36 million), or 16.87% of visits by the elderly involving prescriptions for psychotropic drugs. The most frequently prescribed potentially inappropriate psychotropic drugs were amitriptyline and long-acting benzo-diazepines such as diazepam, chlor-diazepoxide, and flurazepam. Logistic regression analyses revealed that inappropriate prescribing of psychotropic drugs for elderly patients was associated with particular patient characteristics (visit due to an injury), drug characteristics (number of medications prescribed and the drug being an antidepressant or antianxiety agent), and physician characteristics (psychiatric specialty and location in the South or Northeast). The patterns of psychotropic prescribing found in the ambulatory setting raise concerns about the quality of care being received by elderly patients with psychiatric illnesses.

Sources of data for pharmacoepidemiological studies of child and adolescent psychiatric disorders.

In view of the dramatic shift to managed care models for United States health care delivery, reliable information on the prevalence and variations in psychopharmacological drug therapies for youth in community practice settings is essential. Pharmacoepidemiology, the study of medication use in large populations, aims to accomplish that challenging task. This article offers child psychopharmacologists a brief introduction to data sources for pharmacoepidemiology. Knowledge of these data sources combined with epidemiological methods for data analysis is a beginning step to assess the psychotropic medication prescribing patterns of community physicians. This review is organized in the following sequence: (1) characteristics of the "usual practice environment" according to setting, patient population, and physician characteristics; (2) validity issues related to data sources and their potential for outcomes research; (3) data sources divided into primary and secondary types that are described in terms of their features, advantages, and limitations, followed by examples of selected applied studies using such information; (4) procedures for analyzing secondary data; (5) data analytic and longitudinal approaches; and (6) access, confidentiality, and funding. A goal for future investigators in this emerging field is to develop applied research that is clinically sophisticated, methodologically sound, and public health-minded.

Potential Hazard of Serotonin Syndrome Associated With Dexfenfluramine Hydrochloride (Redux)

To the Editor. —The Food and Drug Administration recently approved labeling of dexfenfluramine hydrochloride for the long-term treatment of obesity. 1,2 Primary care physicians, not just obesity treatment specialists, will almost certainly be targets of an intense marketing campaign by the manufacturer of dexfenfluramine, since this drug purportedly represents an advance in the management of a major public health problem. However, we feel compelled to alert physicians to the hazard of serotonin syndrome 3,4 that awaits the use of dexfenfluramine within the context of contemporary psychotropic prescribing patterns. Dexfenfluramine is a nonspecific serotonin agonist that both enhances the release of serotonin from axonal terminals of presynaptic neurons and inhibits the reuptake of serotonin into these terminals, resulting in a potent increase of serotonin availability at postsynaptic receptors. 5 The potential for serotonin syndrome exists if dexfenfluramine is taken concurrently with 1 or more of the many serotoninergic drugs that are

Lithium use and discontinuation in a health maintenance organization

For decades, lithium has been prescribed to treat bipolar disorder. Its efficacy has been documented by clinical trials and by data from specialized clinics. An issue of considerable interest is the use of lithium in managed care systems. This project examined the use of lithium and its continuity of use by enrollees of a health maintenance organization (HMO). In a 6-year longitudinal cohort study, 1,594 lithium users aged 15 years and older who were enrolled in an HMO were followed from 1986-1991. Data were obtained from automated databases and from medical record review of a random 5% subsample of the group (N = 74). Bipolar disorder was the most frequent morbidity treated. Eighty-four percent (N = 62 or 74) received services from a psychiatrist. Annual prevalence of lithium use increased over the 6-year period from 1.4 to 2.3 persons per thousand HMO members. Duration of use varied widely with some long-term but many short-term users. Discontinuation of treatment was associated with evaluated rates of psychiatric hospitalization and use of psychiatric emergency services. Lithium users were much more likely to receive a variety of other psychotropic drugs than nonusers of the same sex and age. Lithium use in this population was more often sporadic than continuous. Discontinuation of lithium was associated with psychiatric hospitalization. If lithium is to be a cost-effective treatment for bipolar disorder, managed care systems will need to improve adherence to drug treatment regimens.

Impact of triplicate prescription program on psychotropic prescribing patterns in long-term care facilities.

To assess the impact of the effect of the New York state triplicate prescription program on psychotropic prescribing patterns in selected long-term care facilities over a one-year period. Retrospective study for changes in psychotropic drug use patterns before and after implementation of the triplicate prescription program. Eight private and two public long-term care facilities in the western New York area. All residents in the long-term care facilities with complete medical records for a one-year period were reviewed. Charts were reviewed for changes in psychotropic drug patterns and incidence in adverse events such as falls, hip fractures, hospital admission, signs or symptoms of benzodiazepine (BZD) withdrawal syndrome, or behavioral outburst. BZD use declined precipitously from 25 percent of psychotropic drug orders to 10 percent six months after implementation of the program. The decline in BZD use was accompanied by an increase in the number of orders for alternative psychotropic agents. Although 22 percent of the patients previously receiving BZDs were discontinued from these drugs, more than half of these patients were switched to alternative therapy, including tricyclic antidepressants and antipsychotic drugs. The majority of patients who discontinued BZDs did so without tapering of the dosage; however, few experienced minor withdrawal symptoms and no patient experienced seizures or required hospitalization following discontinuation. The risk of falls, hospital admission for any reason, or combined events was not significantly altered despite a reduction in BZD use. There was a trend, however, for a reduction in falls after implementation of the program. This study documents that psychotropic drug prescribing patterns were significantly affected by the triplicate prescription program. BZD use declined; however, use of alternative psychotropic drugs increased. Despite changes in psychotropic prescribing patterns, we found no significant risk of adverse events. Further study to evaluate the long-term effect of alternative psychotropic drugs is necessary.

Psychotropics prescribed to the US elderly in the early and mid 1980s: Prescribing patterns of primary care practitioners, psychiatrists, and other physicians

AbstractPrimary care practitioners are significant providers of mental health services to older Americans. The most common mental health service provided by primary care practitioners to this segment of the population is psychotropic drugs. A USA national data base was analyzed to compare the psychotropic prescribing patterns of primary care practitioners with psychiatrists and other office‐based specialists in both the early and mid 1980s. Prescribing patterns for six different classes of psychotropics were contrasted for patients 55 years of age and older and those 15‐54. Results indicate that primary care practioners were by far the largest prescribers of psychotropics for patients 55 and over at both time periods. This pattern held for most of the individual psychotropic drug classes. In contrast to psychiatrists, primary care practitioners infrequently included a mental disorder diagnosis when they prescribed a psychotropic drug. In addition, primary care practitioners included a mental disorder diagnosis less frequently when they prescribed for the older group than when they prescribed for the younger group. These findings may be used to benefit the training of non‐psychiatrist physicians in the diagnosing and treating of mental health disorders found among older adults.

Psychotropic Medication Prescription in U.S. Ambulatory Medical Care

Because of the pharmacologic power of psychotropic medications, the potential for adverse effects, and the changing popularity of particular psychotropic drugs, it is vital for pharmacoepidemiologists to monitor the prescribing patterns of these medications. Using data from the 1985 National Ambulatory Medical Care Survey (NAMCS), this article assesses psychotropic medication prescribing by U.S. ambulatory care physicians. Psychotropic medications are classified into three categories: minor tranquilizers (i.e., anxiolytics and sedative-hypnotics), antidepressants, and antipsychotics. The prescribing patterns of psychiatrists, primary care clinicians, and all other physicians are compared. Differences in psychotropic prescribing patterns by psychiatric diagnosis are examined as well. The excessive use of minor tranquilizers, the continuing use of first-generation psychotropic medications (particularly minor tranquilizers), and the lack of concordance between diagnoses and prescribed psychotropic medications are discussed.

Sleep disorders in the elderly

In their own practices and in consultation, requests to psychiatrists to evaluate and treat sleep disorders in the elderly are common. The five million elders in this country receive 35%-40% of the sedative-hypnotics prescribed, despite the fact that they represent only 12% of the population. Since their sleep disturbances are usually secondary to medical, psychiatric, pharmacologic, or environmental causes, they should receive a thorough evaluation and differential diagnostic approach. Before prescribing a sedative-hypnotic, one should consider nonpharmacologic interventions and education about normal sleep changes due to aging. As a foundation for the judicious prescribing of sedative-hypnotics, the pharmacokinetic changes associated with aging are discussed.

Psychotropic prescribing patterns of nonpsychiatric residents in a general hospital in 1973 and 1982.

The findings of a study of the frequency and type of psychotropic drugs that nonpsychiatric residents prescribed for nonpsychiatric patients in a teaching hospital in 1982 were compared with the findings of a similar study in the same hospital nine years earlier. The overall percentage of patients receiving psychotropic drugs remained almost the same, at less than 10 percent. However, in 1982 residents prescribed antidepressants almost four times as often as in 1973, and the use of antianxiety agents decreased. Deficiencies in chart documentation of psychotropic prescribing and the tendency to use conservative dosages remained unchanged from the earlier study.

Rural tranquility?: urban-rural differences in tranquilliser prescribing.

Literature concerning patterns of psychotropic prescribing and its causes is discussed before focusing on the relationship between geographical location and psychotropic drug prescribing. The association between tranquilliser prescribing and urban-rural location is investigated using data from general practices in two urban and two rural Family Practitioner Committee areas. Our findings indicate that in general, doctors in urban practices were more likely to prescribe tranquillisers than those in rural practices. However, the number of principals in the practices had an effect on tranquilliser prescribing which differed according to the urban-rural designation: in urban practices, tranquilliser prescribing increased with increasing number of principals, but the reverse was true in rural practices. Possible explanations for these findings are discussed and lines of further research suggested.

Justifying Psychotropic Drug Prescription Patterns in the UK

Justifying Psychotropic Drug Prescription Patterns in the UK

Psychotropic Medication Prescription Patterns in 100 Hospitalized Children and Adolescents

Patterns of prescription of medication to 50 consecutive male and 50 consecutive female patients admitted in 1976 and 1977 to a 15-bed child psychiatric facility in Canada were studied and analyzed. Data are presented with respect to the relationship of prescription of medication to age, sex, diagnosis, length of hospital stay and prescribing physician. The frequency of prescription of multiple medications is reported along with examination of the patterns in the light of Audit and Screening Criteria recommended by the American Psychiatric Association.

Psychotropic drug prescription pattern in a developing country (Nigeria). The need for an essential psychotherapeutic drug list.

Psychotropic drug prescription pattern of Nigerian psychiatrists was studied. The most widely prescribed oral antipsychotic was found to be chlorpromazine closely followed by thioridazine and trifluoperazine. Fluphenazine decanoate was the most frequently employed parenteral long-acting antipsychotic preparation. The most commonly prescribed antidepressant was amitriptyline (96.2%) closely followed by imipramine (84.6%). The two widely prescribed anxiolytics were diazepam (88.5%) and chlordiazepoxide (69.2%). This prescription pattern of Nigerian psychiatrists provides a list of what can be considered as essential psychotropic drugs in Nigeria.