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Ying J, Chew QH, Wang Y, Sim K. Global Neuropsychopharmacological Prescription Trends in Adults with Schizophrenia, Clinical Correlates and Implications for Practice: A Scoping Review. Brain Sci 2023; 14:6. [PMID: 38275511 PMCID: PMC10813099 DOI: 10.3390/brainsci14010006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024] Open
Abstract
It is important to examine the psychotropic prescription practices in schizophrenia, as it can inform regarding changing treatment choices and related patient profiles. No recent reviews have evaluated the global neuropsychopharmacological prescription patterns in adults with schizophrenia. A systematic search of the literature published from 2002 to 2023 found 88 empirical papers pertinent to the utilization of psychotropic agents. Globally, there were wide inter-country and inter-regional variations in the prescription of psychotropic agents. Overall, over time there was an absolute increase in the prescription rate of second-generation antipsychotics (up to 50%), mood stabilizers (up to 15%), and antidepressants (up to 17%), with an observed absolute decrease in the rate of antipsychotic polypharmacy (up to 15%), use of high dose antipsychotic (up to 12% in Asia), clozapine (up to 9%) and antipsychotic long-acting injectables (up to 10%). Prescription patterns were mainly associated with specific socio-demographic (such as age), illness (such as illness duration), and treatment factors (such as adherence). Further work, including more evidence in adjunctive neuropsychopharmacological treatments, pharmaco-economic considerations, and examination of cohorts in prospective studies, can proffer insights into changing prescription trends relevant to different treatment settings and predictors of such trends for enhancement of clinical management in schizophrenia.
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Affiliation(s)
- Jiangbo Ying
- East Region, Institute of Mental Health, Singapore 539747, Singapore
| | - Qian Hui Chew
- Research Division, Institute of Mental Health, Singapore 539747, Singapore
| | - Yuxi Wang
- East Region, Institute of Mental Health, Singapore 539747, Singapore
| | - Kang Sim
- West Region, Institute of Mental Health, Singapore 539747, Singapore
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Wang J, Jiang F, Yang Y, Zhang Y, Liu Z, Qin X, Tao X, Liu T, Liu Y, Tang YL, Liu H, Cotes RO. Off-label use of antipsychotic medications in psychiatric inpatients in China: a national real-world survey. BMC Psychiatry 2021; 21:375. [PMID: 34315410 PMCID: PMC8314470 DOI: 10.1186/s12888-021-03374-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/08/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The off-label use of antipsychotic medications is common in many countries, and the extent of such use in psychiatric inpatients in China has not been sufficiently studied. The purpose of this study was to survey the incidence and examine the correlates of off-label antipsychotic use in a large, nationally-representative sample in China. METHODS This study included discharged psychiatric patients between March 19 and 31, 2019 from 41 tertiary psychiatric hospitals across 29 provinces in China. Their socio-demographic and clinical data were collected and analyzed. RESULTS After excluding patients with schizophrenia spectrum disorder or bipolar disorder, 981 patients were included in the analysis. Overall, antipsychotics were prescribed to 63.2% (95%CI 60.2-66.2%) of the sample. Antipsychotics were used in a wide spectrum of psychiatric disorders, with the rate being the highest among patients with dissociative (conversion) disorders (89.9, 95%CI 83.0-94.8%), organic mental disorders (81.7, 95%CI 73.1-88.7%), dementia (79.0,95%CI 67.8-87.9%), obsessive-compulsive disorder (77.8, 95%CI 55.7-92.5%), mental disorders due to psychoactive substances (75.3,95%CI 64.7-84.2%), behavioural and emotional disorders with onset usually occurring in childhood and adolescence (71.4, 95%CI 45.5-90.1%), somatoform disorders (63.2, 95%CI 40.8%-82..2%), major depression disorder (53.7,95%CI 48.8-58.6%), anxiety disorder (38.8,95%CI 30.5-47.7%), and insomnia (25.0, 95%CI 8.5-28.9%). The top three most commonly used antipsychotics were olanzapine (29.1%), quetiapine (20.3%) and risperidone (6.8%), and their corresponding average doses were 9.04 ± 5.80 mg/day, 185.13 ± 174.72 mg/day, and 2.98 ± 1.71 mg/day, respectively. A binary logistic regression showed that younger age, having the Employee Health Insurance or Residents Health Insurance, having psychotic symptoms and requiring restraint during hospitalization were significantly associated with off-label use of antipsychotics. CONCLUSION Off-label use of antipsychotics is very common in psychiatric inpatients in China, mainly with moderate-dose use of single agents. However, the efficacy and safety of this practice is uncertain for many diagnoses and for the elderly. Clinicians should be cautious about this practice while waiting for more research data.
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Affiliation(s)
- Juan Wang
- grid.54549.390000 0004 0369 4060The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China ,The Fourth People’s Hospital of Chengdu, Chengdu Mental Health Center, 8 Hulixiyixiang, Jinniu District, Chengdu, China
| | - Feng Jiang
- grid.16821.3c0000 0004 0368 8293Institute of Health Yangtze River Delta, Shanghai Jiao Tong University, 1954 Huashan road, Xuhui district, Shanghai, China
| | - Yating Yang
- grid.459419.4Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 Chaohu North Road, Chaohu District, Hefei, China ,Department of Psychiatry, Anhui Psychiatric Center, 64 Chaohu North Road, Chaohu District, Hefei, China
| | - Yulong Zhang
- grid.459419.4Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 Chaohu North Road, Chaohu District, Hefei, China ,Department of Psychiatry, Anhui Psychiatric Center, 64 Chaohu North Road, Chaohu District, Hefei, China
| | - Zhiwei Liu
- Department of Psychiatry, Fuyang Third People’s Hospital, Fuyang, Anhui China
| | - Xiaorong Qin
- grid.54549.390000 0004 0369 4060The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China ,The Fourth People’s Hospital of Chengdu, Chengdu Mental Health Center, 8 Hulixiyixiang, Jinniu District, Chengdu, China
| | - Xueqin Tao
- grid.54549.390000 0004 0369 4060The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China ,The Fourth People’s Hospital of Chengdu, Chengdu Mental Health Center, 8 Hulixiyixiang, Jinniu District, Chengdu, China
| | - Tingfang Liu
- grid.12527.330000 0001 0662 3178Institute for Hospital Management of Tsinghua University, K308 Tsinghuayuan District, Shenzhen, China
| | - Yuanli Liu
- grid.506261.60000 0001 0706 7839School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, 5 Dongdansantiao, Dongcheng District, Beijing, 100730 China
| | - Yi-lang Tang
- grid.189967.80000 0001 0941 6502Department of Psychiatry and Behavioural Sciences, Emory University School of Medicine, 12 Executive Park Drive NE, Suite 150, Atlanta, GA 30329 USA ,grid.414026.50000 0004 0419 4084Mental Health Service Line, Atlanta VA Medical Center, Decatur, GA 30033 USA
| | - Huanzhong Liu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 Chaohu North Road, Chaohu District, Hefei, China. .,Department of Psychiatry, Anhui Psychiatric Center, 64 Chaohu North Road, Chaohu District, Hefei, China.
| | - Robert O. Cotes
- grid.189967.80000 0001 0941 6502Department of Psychiatry and Behavioural Sciences, Emory University School of Medicine, 12 Executive Park Drive NE, Suite 150, Atlanta, GA 30329 USA
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Riffer F, Farkas M, Streibl L, Kaiser E, Sprung M. Psychopharmacological treatment of patients with borderline personality disorder: comparing data from routine clinical care with recommended guidelines. Int J Psychiatry Clin Pract 2019; 23:178-188. [PMID: 31140337 DOI: 10.1080/13651501.2019.1576904] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objectives: Borderline personality disorder (BPD) is a life-threatening mental disorder. Guideline recommendations for pharmacological treatment of patients with BPD vary widely. The objective of the present study was to investigate pharmacotherapy of BPD patients in a routine clinical care setting. Methods: Data on the pharmacological treatment of 110 patients (90% female) with BPD (F- 60.3), treated in an inpatient psychiatric-psychosomatic clinic in Austria were assessed. Results: Results show that clinicians frequently prescribe psychotropic medications to patients with BPD, in many cases multiple medications. The most commonly prescribed substance groups were antipsychotics, mood stabilisers and antidepressants. The most commonly prescribed individual drugs were Quetiapine, Lamotrigine and Setraline. There was no significant difference in the different types or overall number of medications prescribed to BPD patients with vs. without comorbid diagnoses. Pharmacotherapy was not related to comorbidity. Conclusions: The present study shows that in routine clinical care settings psychotropic medications are frequently prescribed to patients with BPD, very often resulting in polypharmacy. A positive association between the number of medications and the effectiveness of the inpatient treatment program, as well as the absence of a relationship between number of medications and comorbidity contradicts the often suggested iatrogenic effect of polypharmacy. Key points Guidelines for pharmacotherapy of borderline personality disorders lack consensus Yet, clinicians frequently prescribe psychotropic medications to BPD patients Types/number of medications prescribed to patients with vs. without comorbidities are similar Larger treatment effects are observed for patients with greater numbers of medications Further knowledge is needed about how and why clinicians prescribe medications.
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Affiliation(s)
- Friedrich Riffer
- Psychosomatisches Zentrum Waldviertel (PSZW), Kliniken Eggenburg und Gars, Universitätsklinik für Psychosomatische Medizin der Karl Landsteiner Privatuniversität , Eggenburg , Austria
| | - Marta Farkas
- Psychosomatisches Zentrum Waldviertel (PSZW), Kliniken Eggenburg und Gars, Universitätsklinik für Psychosomatische Medizin der Karl Landsteiner Privatuniversität , Eggenburg , Austria
| | - Lore Streibl
- Psychosomatisches Zentrum Waldviertel (PSZW), Kliniken Eggenburg und Gars, Universitätsklinik für Psychosomatische Medizin der Karl Landsteiner Privatuniversität , Eggenburg , Austria
| | - Elmar Kaiser
- Psychosomatisches Zentrum Waldviertel (PSZW), Kliniken Eggenburg und Gars, Universitätsklinik für Psychosomatische Medizin der Karl Landsteiner Privatuniversität , Eggenburg , Austria
| | - Manuel Sprung
- Psychosomatisches Zentrum Waldviertel (PSZW), Kliniken Eggenburg und Gars, Universitätsklinik für Psychosomatische Medizin der Karl Landsteiner Privatuniversität , Eggenburg , Austria
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Alosaimi FD, Alhabbad A, Abalhassan MF, Fallata EO, Alzain NM, Alassiry MZ, Haddad BA. Patterns of psychotropic medication use in inpatient and outpatient psychiatric settings in Saudi Arabia. Neuropsychiatr Dis Treat 2016; 12:897-907. [PMID: 27143891 PMCID: PMC4844432 DOI: 10.2147/ndt.s100405] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To study the pattern of psychotropic medication use and compare this pattern between inpatient and outpatient psychiatric settings in Saudi Arabia. METHOD This 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. RESULTS Several 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. CONCLUSION Based 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.
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Affiliation(s)
- Fahad D Alosaimi
- Department of Psychiatry, King Saud University, Riyadh, Saudi Arabia
| | - Abdulhadi Alhabbad
- Department of Psychiatry, Prince Mohammed Medical City, Aljouf, Saudi Arabia
| | - Mohammed F Abalhassan
- Department of Medicine, Prince Sattam Bin Abdulaz University, Al-Kharj, Saudi Arabia
| | - Ebtihaj O Fallata
- Department of Psychiatry, Mental Health Hospital, Jeddah, Saudi Arabia
| | - Nasser M Alzain
- Department of Psychiatry, Al-Amal complex for Mental health, Dammam, Saudi Arabia
| | | | - Bander Abdullah Haddad
- Department of Medicine, King Abdulaziz Medical City, Ministry of National Guard, Riyadh, Saudi Arabia
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Abstract
Background Off-label use of a drug not according to its regulatory labeling has become common in medicine, especially in the field of psychiatry. Mood stabilizers are intended to be used to attenuate mood fluctuations in bipolar disorder, but their use has spread to patients with schizophrenia, as it provides greater control of impulsivity and aggressiveness. Sodium valproate is one of the most frequently used mood stabilizers in psychiatry. This study determined the prevalence of off-label use of sodium valproate for schizophrenia and schizoaffective disorder in Abarbanel Psychiatric Hospital and the demographic and clinical characteristics associated with its use. Methods Retrospective study of patients hospitalized in 2011–2012 with a diagnosis of schizophrenia or schizoaffective disorder in one of three general psychiatric wards. Results Valproate use was significantly lower in the geriatric group (11.6% vs. 20.1%, chi square = 4.7, p = .03), in patients with schizophrenia (14.1% vs. schizoaffective disorder (35.2%), chi square = 29, p<.001) and in patients receiving both atypical and typical antipsychotics (23.3% vs. 16.4%, p = .04). In multivariate logistic regression analysis, diagnosis and the combination of atypical and typical antipsychotics predicted the use of sodium valproate. The number of other medications prescribed did not predict sodium valproate use. Conclusions Off-label use of sodium valproate in psychiatric patients with schizophrenia or schizoaffective disorder is extensive, especially in younger patients and those with schizoaffective disorder. More research is needed to determine whether it is being prescribed appropriately.
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Citrome L. Adjunctive lithium and anticonvulsants for the treatment of schizophrenia: what is the evidence? Expert Rev Neurother 2014; 9:55-71. [DOI: 10.1586/14737175.9.1.55] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Mundt AP, Aichberger MC, Fakhriddinov S, Fayzirahmanova M, Grohmann R, Heinz A, Ivens S, Magzumova S, Sartorius N, Ströhle A. Prescription patterns of patients diagnosed with schizophrenia in mental hospitals in Tashkent/Uzbekistan and in four German cities. Pharmacoepidemiol Drug Saf 2011; 21:145-51. [DOI: 10.1002/pds.2166] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2010] [Revised: 04/07/2011] [Accepted: 04/11/2011] [Indexed: 11/06/2022]
Affiliation(s)
- Adrian P. Mundt
- Department of Psychiatry and Psychotherapy; Charité Campus Mitte Universitätsmedizin Berlin; Germany
| | - Marion C. Aichberger
- Department of Psychiatry and Psychotherapy; Charité Campus Mitte Universitätsmedizin Berlin; Germany
| | - Sardor Fakhriddinov
- Department of Psychiatry and Medical Psychology; Tashkent Medical Academy; Tashkent City; 100109; Uzbekistan
| | - Maria Fayzirahmanova
- Department of Psychiatry and Medical Psychology; Tashkent Medical Academy; Tashkent City; 100109; Uzbekistan
| | - Renate Grohmann
- Department of Psychiatry and Psychotherapy; Ludwig-Maximilian-Universität; Munich; Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy; Charité Campus Mitte Universitätsmedizin Berlin; Germany
| | - Sebastian Ivens
- Department of Psychiatry and Psychotherapy; Charité Campus Mitte Universitätsmedizin Berlin; Germany
| | - Shakhnoza Magzumova
- Department of Psychiatry and Medical Psychology; Tashkent Medical Academy; Tashkent City; 100109; Uzbekistan
| | - Norman Sartorius
- Association for the Improvement of Mental Health programmes, AMH; Geneva; Switzerland
| | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy; Charité Campus Mitte Universitätsmedizin Berlin; Germany
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Adjuvant use of nutritional and herbal medicines with antidepressants, mood stabilizers and benzodiazepines. J Psychiatr Res 2010; 44:32-41. [PMID: 19616220 DOI: 10.1016/j.jpsychires.2009.06.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Revised: 05/31/2009] [Accepted: 06/15/2009] [Indexed: 11/20/2022]
Abstract
Adjuvant use of nutritional and herbal medicines has potential to increase the efficacy of synthetic pharmaceuticals, and perhaps also decrease their side-effects by allowing lower doses to be prescribed. We evaluated current evidence for adjuvant use of nutritional and herbal medicines with antidepressants, mood stabilizers and benzodiazepines; and explored novel future areas of research. The paper also critiques current evidence for co-administration of St. John's wort with synthetic antidepressants. We performed a systematic search of MEDLINE, CINAHL, PsycINFO, The Cochrane database, China National Knowledge Infrastructure and the Chinese Science Citation Database. Search results were supplemented by a review of reference lists and a forward search using the Web of Science. Where possible we calculated effect sizes. Encouraging evidence exists for the use of omega-3 fatty acids, SAMe, folic acid and l-tryptophan adjuvantly with antidepressants to enhance response and improve efficacy. Various nutrients also have emerging evidence as effective adjuncts with antipsychotics and mood stabilizers. While some evidence supports nutritional adjuvancy with various psychopharmacotherapies, adjuvant use of herbal therapies has not been sufficiently studied to warrant standard clinical application. This remains a promising area of research via robust, safety-conscious studies.
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Preti A, Rucci P, Gigantesco A, Santone G, Picardi A, Miglio R, de Girolamo G. Patterns of care in patients discharged from acute psychiatric inpatient facilities: a national survey in Italy. Soc Psychiatry Psychiatr Epidemiol 2009; 44:767-76. [PMID: 19212696 DOI: 10.1007/s00127-009-0498-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Revised: 01/13/2009] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To analyze the characteristics of patients scheduled for discharge from acute psychiatric inpatient facilities in Italy, and their pattern of care. METHODS Socio-demographic and clinical characteristics, and patterns of care of 1,330 patients discharged from public and private inpatient facilities in Italy were assessed with a standardized methodology during an index period in the year 2004. RESULTS About one half of the sample had schizophrenia or bipolar disorder. However, the case-mix differed between public and private facilities, where in-patients had more frequently mood and anxiety disorders. The use of two or more drugs was very common, involving more than 90% of patients and including typically benzodiazepines and antipsychotics. Structured psychosocial treatments were rarely initiated during the hospital stay. Increasing age, male gender, long stay in the facility (>60 days), personality disorder and type of facility were associated with a higher likelihood of being discharged to a community residential facility. Predictors of discharge to another psychiatric facility were increasing age, being single, schizophrenia, personality disorder and organic mental disorder. Families were not involved in decisions about patients' discharge in a significant proportion of cases. University psychiatric clinics and private facilities were less coordinated with the community system of care than General Hospital Psychiatric Units. Referral of patients with substance use disorder to drug addiction services occurred in just 30% of subjects. CONCLUSIONS This study provides information on the characteristics and the pattern of care of patients discharged from inpatient facilities in a country that has closed down all its mental hospitals. This information may be relevant for those countries that are affording now the downsizing of MHs, and the expansion of community-based models of care.
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Affiliation(s)
- Antonio Preti
- Dept. of Psychology, University of Cagliari, Cagliari, Italy
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Changes in outpatient lithium treatment in the Netherlands during 1996-2005. J Affect Disord 2008; 111:94-9. [PMID: 18342951 DOI: 10.1016/j.jad.2008.01.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 01/20/2008] [Accepted: 01/20/2008] [Indexed: 11/21/2022]
Abstract
BACKGROUND The objectives of the present study were to investigate in outpatients in the Netherlands between 1996 and 2005, changes in 1) the incidence and prevalence of lithium use and 2) lithium use patterns (discontinuation, add-on, and switch). METHODS Incidence and prevalence of lithium use were determined for each year between 1996 and 2005. In addition, we determined cumulative changes in lithium use (discontinuation, add-on, and switching) at three, six, 12 and 24 months for three separate time-cohorts (1998-1999, 2000-2001 and 2002-2003). Lastly, concomitant use of other drugs used in the treatment of bipolar disorders next to lithium during the 24 months after the first lithium prescription was determined for the three time-cohorts. RESULTS Incidence of lithium use was constant at approximately 0.2 per 1000 person-years, prevalence increased with 26% from 0.95 to 1.2 per 1000 persons. The percentage of patients receiving an add-on drug used in the treatment of bipolar disorders was constant over the three time-cohorts, with a significant decrease in use of tricyclic antidepressants. Within the patient group that stopped using lithium, more patients switched from lithium to another agent used in the treatment of bipolar disorders over calendar time, and fewer patients discontinued lithium. There was a significant increase in the use of atypical antipsychotics and valproic acid next to lithium. LIMITATIONS We did not know the specific diagnosis for which lithium treatment was instituted. CONCLUSION The changes were in line with the increase in alternatives during the last decade and in line with Dutch guidelines.
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Wessels T, Grünler D, Bunk C, Specka M, Gastpar M, Scherbaum N, Davids E. Changes in the treatment of acute psychosis in a German public hospital from 1998 to 2004. Psychiatr Q 2007; 78:91-9. [PMID: 17351755 DOI: 10.1007/s11126-006-9030-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The aim of our study was to investigate antipsychotic treatment strategies in acute schizophrenic episodes in a German university hospital. METHODS Documented pharmacological procedures in the first six weeks of acute episodes of schizophrenia in the years 1998 (n = 108), 2001 (n = 92), and 2004 (n = 94) were analyzed. Inclusion criteria were: admission voluntary and involuntary as inpatient to our acute ward with a diagnosis of F20x according to ICD 10. RESULTS Atypical antipsychotics (AAP) were significant more frequently used in the first week of treatment in 2001 and 2004 compared to the year 1998. Switching to AAP occurred significantly earlier in 2001 and 2004 (after 7.6 +/- 7 days in 1998, 3.5 +/- 5 days in 2001 and 2.3 +/- 5 days in 2004; P < 0.002). In all three years prescription of high potent typical antipsychotics decreased during the first six weeks of treatment. Involuntary treatment (P < 0.001) and age (P = 0.001) were significantly correlated to initial prescription of AAP. Involuntary admitted patients received more often a combination of high-potent conventional high potent typical neuroleptics and AAP (48% vs. 24%, P = 0.007). CONCLUSION Second generation atypicals are used more frequently according to current guidelines and switching from conventional medications occurs earlier.
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Affiliation(s)
- Tiemo Wessels
- Rhine Clinics Essen, Department of Psychiatry and Psychotherapy, University of Duisburg-Essen, Virchowstr. 174, Essen 45147, Germany.
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