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Hefner G, Wolff J, Toto S, Reißner P, Klimke A. Off-label use of antidepressants, antipsychotics, and mood-stabilizers in psychiatry. J Neural Transm (Vienna) 2022; 129:1353-1365. [PMID: 36070009 DOI: 10.1007/s00702-022-02542-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/30/2022] [Indexed: 10/14/2022]
Abstract
Off-label drug prescribing in psychiatry is increasing. Many psychotropic drugs are approved for psychopathologic syndromes rather than based on international standard diagnostic classification systems which might facilitate the clinical decision for off-label prescriptions. The objective of this study was to analyze the prevalence and category of off-label use of psychotropic drugs. The study was conducted in 10 psychiatric hospitals in Germany over a period of 2 years. Prescription data of all patients were retrospectively analyzed after identification of antidepressants, antipsychotics, and mood-stabilizers, which were classified as off-label according to the German prescribing information and diagnostic classification according to ICD-10. In total, 53,909 patient cases (46% female) with a mean age of 46.8 (SD: 18) years were included in the study. 30.2% of the cases received at least one off-label prescription of a psychotropic drug during hospital stay. Off-label prevalence rates differed markedly between different diagnostic groups (ICD-10 F0/G3: 47%, F1: 33%, F2: 25%, F3: 21%, F4: 27%, F6: 46%, F7: 84%). The most often off-label prescribed drugs were quetiapine and mirtazapine for organic mental disorders (F0/G3), valproate and quetiapine in patients with disorders due to psychoactive substance use (F1), valproate in patients with psychotic disorders (F2), and risperidone and olanzapine in patients with affective disorders (F3). The prevalence rate of psychotropic off-label prescriptions is high if restricted to product description and ICD-10 diagnosis. Therefore, current psychiatric guidelines should drug-specifically issue this problem by defining psychiatric off-label indications based on a clear benefit-risk assessment.
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Affiliation(s)
- Gudrun Hefner
- Psychiatric Hospital, Vitos Clinic for Forensic Psychiatry, Kloster-Eberbach-Straße 4, 65346, Eltville, Germany.
| | - Jan Wolff
- Peter L. Reichertz Institute for Medical Informatics, Hannover Medical School, Hannover, Germany
| | - Sermin Toto
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Pamela Reißner
- Department of Psychiatry and Psychotherapy, Vitos Klinikum Hochtaunus, Friedrichsdorf, Germany
| | - Ansgar Klimke
- Department of Psychiatry and Psychotherapy, Vitos Klinikum Hochtaunus, Friedrichsdorf, Germany.,Heinrich-Heine-University, Duesseldorf, Germany
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Kim N, Cho SJ, Kim H, Kim SH, Lee HJ, Park CHK, Rhee SJ, Kim D, Yang BR, Choi SH, Choi G, Koh M, Ahn YM. Epidemiology of pharmaceutically treated depression and treatment resistant depression in South Korea. PLoS One 2019; 14:e0221552. [PMID: 31442296 PMCID: PMC6707549 DOI: 10.1371/journal.pone.0221552] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 08/09/2019] [Indexed: 12/28/2022] Open
Abstract
Background The epidemiology of pharmaceutically treated depression (PTD) and treatment resistant depression (TRD) is largely unknown in South Korea. The aim of this study was to develop a greater understanding of the characteristics of PTD and TRD in nearly the entire adult population in South Korea using the Health Insurance Review and Assessment Service (HIRA). Method Diagnostic codes and prescription data for South Korean adults were extracted from the HIRA. Subjects were included in the PTD cohort if they received at least one prescription for antidepressants and were diagnosed with depression. TRD was defined as PTD having two or more regimen failures of antidepressants or antipsychotics. Results In 2012, there were 41,256,396 adults in South Korea with 834,694 meeting the criteria for PTD (2.0%). Among subjects with PTD, 57% stopped treatment in less than 28 days of antidepressant supply. Tricyclic and tetracyclic antidepressants were the most frequently used antidepressants as a first-line regimen for PTD (44.3% of PTD) followed by selective serotonin reuptake inhibitors (32.1% of PTD). Results also indicated that 34,812 subjects developed TRD (4.2% of PTD). Median PTD and TRD durations were 28 and 623 days respectively. Proportions of psychiatric and non-psychiatric comorbidities were higher in TRD cases than in PTD cases that were not treatment resistant. Conclusions Despite a small proportion of patients with TRD, the prolonged duration of illness and higher comorbidity implies the need for better treatment.
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Affiliation(s)
- Namwoo Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sung Joon Cho
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyeyoung Kim
- Department of Psychiatry, Inha University Hospital, Incheon, Republic of Korea
- Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Se Hyun Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun Jeong Lee
- Mental Health Clinic, National Cancer Center, Goyang-si, Republic of Korea
| | - C. Hyung Keun Park
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang Jin Rhee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Daewook Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Bo Ram Yang
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - So-Hyun Choi
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - GumJee Choi
- Medical Affairs, Janssen Korea, Seoul, Republic of Korea
| | - MinJung Koh
- Medical Affairs, Janssen Korea, Seoul, Republic of Korea
| | - Yong Min Ahn
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Republic of Korea
- * E-mail:
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López-Muñoz F, Tracy DK, Povedano-Montero FJ, Breedvelt J, García-Pacios J, Fernández-Martín MP, Rubio G, Álamo C. Trends in the scientific literature on atypical antipsychotic drugs in the United Kingdom: a bibliometric study. Ther Adv Psychopharmacol 2019; 9:2045125318820207. [PMID: 30800284 PMCID: PMC6378637 DOI: 10.1177/2045125318820207] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 11/13/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE A bibliometric study was undertaken of peer-reviewed publications on atypical antipsychotic drugs (AADs) from the United Kingdom and the findings are presented herein. METHODS We selected the documents from the Scopus database. We applied several production and dispersion bibliometric indicators, including Price's law on the growth of the scientific literature, and Bradford's law. We also calculated a so-called 'participation index' across different countries. The bibliometric data were thereafter correlated with social and health data from the UK, including total per capita expenditure on health and gross domestic expenditure. RESULTS A total of 4156 original manuscripts were published within the timeframe 1967-2015. Our results are in accord with Price's law, with scientific output demonstrating exponential growth (r = 0.9227, as against an r = 0.8766 after adjustment). The drugs most widely evaluated were clozapine (465 documents), olanzapine (263) and risperidone (248). Stratification into Bradford zones produced a nucleus represented by the Journal of Psychopharmacology (168 articles) and British Journal of Psychiatry (159 articles). A total of 1250 different journals were evaluated. CONCLUSIONS Publications on AADs in the UK have shown exponential growth across the studied period, which is in line with the progressively burgeoning novel AAD releases. No evidence of a saturation point was observed.
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Affiliation(s)
- Francisco López-Muñoz
- Faculty of Health Sciences, Camilo José Cela University, C/ Alarcón 49, 28692 Villanueva de la Cañada, Madrid, Spain Neuropsychophar-macology Unit, Hospital 12 de Octubre Research Institute (i+12), Madrid, Spain Portucalense Institute of Neuropsychology and Cognitive and Behavioural Neurosciences (INPP), Portucalense University, Porto, Portugal
- Thematic Network for Cooperative Health Research (RETICS), Addictive Disorders Network, Health Institute Carlos III, MICINN and FEDER, Madrid, Spain
| | - Derek K. Tracy
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
- Oxleas National Health Service (NHS) Trust, London, UK
| | - F. Javier Povedano-Montero
- Faculty of Health Sciences, Camilo José Cela University, Madrid, Spain Faculty of Biomedical Sciences and Health, European University of Madrid, Spain
| | | | - Javier García-Pacios
- Faculty of Health Sciences, Camilo José Cela University, Madrid, Spain Laboratory of Cognitive and Computational Neuroscience, Center for Biomedical Technology, Technical University of Madrid and Complutense University of Madrid, Spain
| | | | - Gabriel Rubio
- Neuropsychophar-macology Unit, Hospital 12 de Octubre Research Institute (i+12), Madrid, Spain
- Thematic Network for Cooperative Health Research (RETICS), Addictive Disorders Network, Health Institute Carlos III, MICINN and FEDER, Madrid, Spain Department of Psychiatry, ‘Doce de Octubre’ University Hospital, Complutense University, Madrid, Spain
| | - Cecilio Álamo
- Department of Biomedical Sciences (Pharmacology Area), Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
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López-Muñoz F, Povedano-Montero FJ, Chee KY, Shen WW, Fernández-Martín P, García-Pacios J, Rubio G, Álamo C. A Bibliometric Analysis of Scientific Production on Second-Generation Anti-Psychotic Drugs in Malaysia. Malays J Med Sci 2018; 25:40-55. [PMID: 30899186 PMCID: PMC6422559 DOI: 10.21315/mjms2018.25.3.5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 04/24/2018] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE We carried out a bibliometric study on the scientific papers related to second-generation antipsychotic drugs (SGAs) in Malaysia. METHODS With the SCOPUS database, we selected those documents made in Malaysia whose title included descriptors related to SGAs. We applied bibliometric indicators of production and dispersion, as Price's law and Bradford's law, respectively. We also calculated the participation index of the different countries. The bibliometric data were also been correlated with some social and health data from Malaysia (total per capita expenditure on health and gross domestic expenditure on R&D). RESULTS We found 105 original documents published between 2004 and 2016. Our results fulfilled Price's law, with scientific production on SGAs showing exponential growth (r = 0.401, vs. r = 0.260 after linear adjustment). The drugs most studied are olanzapine (9 documents), clozapine (7), and risperidone (7). Division into Bradford zones yields a nucleus occupied by the Medical Journal of Malaysia, Singapore Medical Journal, Australian and New Zealand Journal of Psychiatry, and Pharmacogenomics. Totally, 63 different journals were used, but only one in the top four journals had an impact factor being greater than 3. CONCLUSION The publications on SGAs in Malaysia have undergone exponential growth, without evidence a saturation point.
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Affiliation(s)
- Francisco López-Muñoz
- Faculty of Health Sciences, University Camilo José Cela, Madrid, Spain
- Neuropsychopharmacology Unit, Hospital 12 de Octubre Research Institute (i+12), Madrid, Spain
- Portucalense Institute of Neuropsychology and Cognitive and Behavioural Neurosciences (INPP), Portucalense University, Porto, Portugal
- Thematic Network for Cooperative Health Research (RETICS), Addictive Disorders Network, Health Institute Carlos III, MICINN and FEDER, Madrid, Spain
| | - Francisco J Povedano-Montero
- Faculty of Health Sciences, University Camilo José Cela, Madrid, Spain
- Faculty of Biomedical Sciences and Health, European University of Madrid, Spain
| | - Kok-Yoon Chee
- Department of Psychiatry & Mental Health, Tunku Abdul Rahman Institute of Neuroscience, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - Winston W Shen
- Departments of Psychiatry, Wan Fang Medical Center and School of Medicine, Taipei Medical University, Taipei, Taiwan
| | | | - Javier García-Pacios
- Faculty of Health Sciences, University Camilo José Cela, Madrid, Spain
- Laboratory of Cognitive and Computational Neuroscience, Center for Biomedical Technology, Technical University of Madrid and Complutense University of Madrid, Spain
| | - Gabriel Rubio
- Neuropsychopharmacology Unit, Hospital 12 de Octubre Research Institute (i+12), Madrid, Spain
- Thematic Network for Cooperative Health Research (RETICS), Addictive Disorders Network, Health Institute Carlos III, MICINN and FEDER, Madrid, Spain
- Department of Psychiatry, “Doce de Octubre” University Hospital, Complutense University, Madrid, Spain
| | - Cecilio Álamo
- Department of Biomedical Sciences (Pharmacology Area), Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
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Wang SM, Han C, Lee SJ, Jun TY, Patkar AA, Masand PS, Pae CU. Second Generation Antipsychotics in the Treatment of Major Depressive Disorder: An Update. Chonnam Med J 2016; 52:159-72. [PMID: 27689026 PMCID: PMC5040765 DOI: 10.4068/cmj.2016.52.3.159] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 06/15/2016] [Accepted: 06/16/2016] [Indexed: 12/23/2022] Open
Abstract
Less than one third of patients who suffer from major depressive disorder (MDD) report remission following antidepressant treatments requiring more diverse treatment approaches. Augmentation of second generation antipsychotics (SGAs) has been increasingly recognized as an important treatment option. The authors have previously provided a comprehensive review of SGAs for the treatment of MDD in 2013. Since then, numerous additional clinical trials have been conducted to investigate diverse issues regarding the utility of SGAs in MDD. Moreover, a new SGA, brexpiprazole, was recently approved by the Food and Drug Administration in July 2015 for the treatment of MDD as an augmentation agent to antidepressants. Thus, the aim of this study was to provide a concise update of all the available SGAs for the treatment of MDD, in particular on the additional clinical trials which have been published since 2013.
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Affiliation(s)
- Sheng-Min Wang
- Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Korea.; International Health Care Center, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Changsu Han
- Department of Psychiatry, College of Medicine, Korea University, Korea
| | - Soo-Jung Lee
- Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Tae-Youn Jun
- Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ashwin A Patkar
- Department of Psychiatry and Behavioural Sciences, Duke University Medical Center, Durham, NC, USA
| | | | - Chi-Un Pae
- Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Korea.; Department of Psychiatry and Behavioural Sciences, Duke University Medical Center, Durham, NC, USA
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López-Muñoz F, Sanz-Fuentenebro J, Rubio G, García-García P, Álamo C. Quo Vadis Clozapine? A Bibliometric Study of 45 Years of Research in International Context. Int J Mol Sci 2015; 16:23012-34. [PMID: 26404263 PMCID: PMC4613349 DOI: 10.3390/ijms160923012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 09/04/2015] [Accepted: 09/13/2015] [Indexed: 12/26/2022] Open
Abstract
We have carried out a bibliometric study about the international scientific publications on clozapine. We have used the EMBASE and MEDLINE databases, and we applied bibliometric indicators of production, as Price's Law on the increase of scientific literature. We also calculated the participation index (PI) of the different countries. The bibliometric data have also been correlated with some social and health data from the 12 most productive countries in biomedicine and health sciences. In addition, 5607 original documents dealing with clozapine, published between 1970 and 2013, were downloaded. Our results state non-fulfilment of Price's Law, with scientific production on clozapine showing linear growth (r=0.8691, vs. r=0.8478 after exponential adjustment). Seven of the 12 journals with the highest numbers of publications on clozapine have an Impact Factor>2. Among the countries generating clozapine research, the most prominent is the USA (PI=24.32), followed by the UK (PI=6.27) and Germany (PI=5.40). The differences among countries on clozapine research are significantly related to economic variables linked to research. The scientific interest in clozapine remains remarkable, although after the application of bibliometric indicators of production, a saturation point is evident in the growth of scientific literature on this topic.
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Affiliation(s)
- Francisco López-Muñoz
- Faculty of Health Sciences and Chair of Genomic Medicine, Camilo José Cela University, C/Castillo de Alarcón, 49, Urb. Villafranca del Castillo, 28692 Villanueva de la Cañada, Madrid, Spain.
- Department of Biomedical Sciences (Pharmacology Area), Faculty of Medicine and Health Sciences, University of Alcalá, Campus Universitario-C/19, Ctra. Madrid-Barcelona, Km. 33,600, 28871 Alcalá de Henares, Madrid, Spain.
- Neuropsychopharmacology Unit, "Hospital 12 de Octubre" Research Institute, Avda. Córdoba, s/n, Madrid 28041, Spain.
| | - Javier Sanz-Fuentenebro
- Neuropsychopharmacology Unit, "Hospital 12 de Octubre" Research Institute, Avda. Córdoba, s/n, Madrid 28041, Spain.
- Department of Psychiatry, 12 de Octubre University Hospital, Avda. Córdoba, s/n, Madrid 28041, Spain.
- Biomedical Research Center Network for Mental Health (CIBERSAM), Madrid 28029, Spain.
| | - Gabriel Rubio
- Neuropsychopharmacology Unit, "Hospital 12 de Octubre" Research Institute, Avda. Córdoba, s/n, Madrid 28041, Spain.
- Department of Psychiatry, 12 de Octubre University Hospital, Avda. Córdoba, s/n, Madrid 28041, Spain.
- Department of Psychiatry, Complutense University, Plaza de Ramón y Cajal, s/n, Ciudad Universitaria, Madrid 28040, Spain.
- Networks for Cooperative Research in Health (RETICS-Addictive Disorder Network), Institute of Health Carlos III (ISCIII), MICINN and FEDER, Madrid 28029, Spain.
| | - Pilar García-García
- Department of Biomedical Sciences (Pharmacology Area), Faculty of Medicine and Health Sciences, University of Alcalá, Campus Universitario-C/19, Ctra. Madrid-Barcelona, Km. 33,600, 28871 Alcalá de Henares, Madrid, Spain.
| | - Cecilio Álamo
- Department of Biomedical Sciences (Pharmacology Area), Faculty of Medicine and Health Sciences, University of Alcalá, Campus Universitario-C/19, Ctra. Madrid-Barcelona, Km. 33,600, 28871 Alcalá de Henares, Madrid, Spain.
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López-Muñoz F, Shen WW, Shinfuku N, Pae CU, Castle DJ, Chung AK, Sim K, Álamo C. A Bibliometric Study on Second-generation Antipsychotic Drugs in the Asia–Pacific Region. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.jecm.2014.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hamner MB, Robert S. Emerging roles for atypical antipsychotics in chronic post-traumatic stress disorder. Expert Rev Neurother 2014; 5:267-75. [PMID: 15853496 DOI: 10.1586/14737175.5.2.267] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Post-traumatic stress disorder is an anxiety disorder that may occur after the individual is exposed to severe psychologic trauma such as combat, sexual assault, or childhood physical or sexual abuse. Chronic post-traumatic stress disorder may result in considerable psychologic pain and suffering for the individual in addition to significant functional impairment. In addition to the heterogeneity of symptoms that occur in post-traumatic stress disorder, there may also be extensive comorbidity with other anxiety disorders, mood disorders, psychotic disorders, and other psychiatric disorders. This complicates the treatment picture. Currently, accepted treatments for post-traumatic stress disorder include psychotherapy, in particular cognitive behavioral-based approaches and antidepressant medication. However, many patients are refractory to these initial treatments or have only a partial response. In light of this, may clinicians combine additional classes of psychotropic agents and different psychotherapeutic approaches to enhance treatment response. This article reviews the literature on the use of atypical antipsychotics in the treatment of post-traumatic stress disorder. Most of the research to date has involved combat veterans partially responsive or refractory to treatment, namely with antidepressants. Studies have shown improvement across post-traumatic stress disorder symptom clusters, as well as improvement in comorbid psychotic symptoms or disorders. More research is needed to confirm these recent findings and further delineate the role of atypical antipsychotics in the treatment of post-traumatic stress disorder. Currently, possible indications for their use include treatment-resistant post-traumatic stress disorder and post-traumatic stress disorder with comorbid psychotic features.
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Affiliation(s)
- Mark B Hamner
- Department of Psychiatry, Ralph H Johnson Department of Veterans Affairs Medical Center and Medical University of South Carolina, Charleston, SC 29401, USA.
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López-Muñoz F, Sim K, Shen WW, Huelves L, Moreno R, Molina JDD, Rubio G, Noriega C, Pérez-Nieto MÁ, Alamo C. A bibliometric study of scientific research conducted on second-generation antipsychotic drugs in Singapore. Singapore Med J 2014; 55:24-33. [PMID: 24452974 PMCID: PMC4291907 DOI: 10.11622/smedj.2014006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION A bibliometric study was carried out to ascertain the volume and impact of scientific literature published on second-generation antipsychotic drugs (SGAs) in Singapore from 1997 to 2011. METHODS A search of the EMBASE and MEDLINE databases was performed to identify articles originating from Singapore that included the descriptors 'atypic* antipsychotic*', 'second-generation antipsychotic*', 'clozapine', 'risperidone', 'olanzapine', 'ziprasidone', 'quetiapine', 'sertindole', 'aripiprazole', 'paliperidone', 'amisulpride', 'zotepine', 'asenapine', 'iloperidone', 'lurasidone', 'perospirone' and 'blonanserin' in the article titles. Certain bibliometric indicators of production and dispersion (e.g. Price's Law on the increase of scientific literature, and Bradford's Law) were applied, and the participation index of various countries was calculated. The bibliometric data was also correlated with some social and health data from Singapore, such as the total per capita expenditure on health and gross domestic expenditure on research and development. RESULTS From 1997 to 2011, a total of 51 articles on SGAs in Singapore were published. Our results suggested non-fulfilment of Price's Law (r = 0.0648 after exponential adjustment vs. r = 0.2140 after linear adjustment). The most widely studied drugs were clozapine (21 articles), risperidone (16 articles) and olanzapine (8 articles). Division into Bradford zones yielded a nucleus occupied by the Journal of Clinical Psychopharmacology (6 articles) and the Singapore Medical Journal(4 articles). The analysed material was published in a total of 30 journals, with the majority from six journals. Four of these six journals have an impact factor greater than 2. CONCLUSION Publications on SGAs in Singapore are still too few to confirm an exponential growth of scientific literature.
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Affiliation(s)
- Francisco López-Muñoz
- Faculty of Health Sciences, Camilo José Cela University, C/ Castillo de Alarcón, 49, Urb Villafranca del Castillo, Villanueva de la Cañada, 28692 Madrid, Spain.
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López-Muñoz F, Castle D, Shen W, Moreno R, Huelves L, Pérez-Nieto M, Noriega C, Rubio G, Molina J, Álamo C. The Australian contribution to the literature on atypical antipsychotic drugs: a bibliometric study. Australas Psychiatry 2013; 21:343-5. [PMID: 23804115 DOI: 10.1177/1039856213492352] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We performed a bibliometric study on scientific publications on atypical antipsychotic drugs (AADs) from Australia. METHODS Using the EMBASE and MEDLINE databases, we chose those documents produced in Australia between 1993 and 2011, whose title included the descriptors atypic* (atypical*), antipsychotic*, second-generation antipsychotic*, clozapine, risperidone, olanzapine, ziprasidone, quetiapine, sertindole, aripiprazole, paliperidone, amisulpride, zotepine, asenapine, iloperidone, lurasidone, perospirone and blonanserin. We applied bibliometric indicators of production as well as dispersion. RESULTS We identified 438 relevant publications. The most widely studied AADs were clozapine (162 documents), olanzapine (103), risperidone (77) and quetiapine (42). There was a lack of exponential growth in publications over time, indicated by non-fulfilment of Price's Law (correlation coefficient r=0.9195 after exponential adjustment vs. r=0.9253 after linear adjustment). Publications appeared in 148 different journals, with four of the top nine journals having an impact factor greater than 3; 84 of the articles appeared in the Australian and New Zealand Journal of Psychiatry. CONCLUSION Despite Australian publications on AADs appearing in reasonably high impact journals, most were confined to a single Australian psychiatry journal and overall publications did not show exponential growth over the period studied. This might reflect, inter alia, the relative paucity of medication trials being performed in Australia.
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Affiliation(s)
- Francisco López-Muñoz
- Faculty of Health Sciences, and Director of International Doctoral School, Camilo José Cela University, Madrid, Spain.
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Moritz S, Andreou C, Klingberg S, Thoering T, Peters MJV. Assessment of subjective cognitive and emotional effects of antipsychotic drugs. Effect by defect? Neuropharmacology 2013; 72:179-86. [PMID: 23643756 DOI: 10.1016/j.neuropharm.2013.04.039] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 03/11/2013] [Accepted: 04/23/2013] [Indexed: 11/29/2022]
Abstract
Antipsychotic medication represents the first-line treatment for schizophrenia. While it is undisputed that antipsychotics ameliorate positive symptoms, the exact cognitive and emotional pathways through which the effect is exerted has remained unclear. The present study investigated the subjective effects of antipsychotics across various domains of cognition and emotion in both patients with psychotic symptoms and patients with other psychiatric diagnoses. A total of 69 patients with a probable history of psychosis or psychotic symptoms and 26 patients with psychiatric diagnoses other than psychosis participated in a survey conducted over the Internet. Multiple control measures aimed to secure response validity. All patients were currently or had previously been treated with antipsychotic agents. A questionnaire comprising 49 items and measuring possible effects of antipsychotics on cognition and emotion was administered. For 30 out of 49 items a clear response pattern emerged, which was similar for patients with psychotic disorders and patients with other diagnoses. Factor analysis of these items revealed three main effects of antipsychotic medication related to doubt and self-doubt, cognitive and emotional numbing, and social withdrawal. Antipsychotic treatment appears to be connected to a number of negative subjective effects on cognition and emotion. Further studies are warranted to assess how these effects impact on the patients' subjective well-being and quality of life, as well as their association with antipsychotic efficacy on one hand, and adherence rates on the other. Induction of doubt and dampening of emotion may be one reason why antipsychotics work and at the same time offer an explanation why they are experienced as rather unpleasant and are eventually discontinued by many patients.
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Affiliation(s)
- Steffen Moritz
- University Medical Center Hamburg Eppendorf, Department of Psychiatry and Psychotherapy, Martinistrasse 52, 20246 Hamburg, Germany.
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López-Muñoz F, Shen WW, Pae CU, Moreno R, Rubio G, Molina JD, Noriega C, Pérez-Nieto MA, Huelves L, Álamo C. Trends in scientific literature on atypical antipsychotics in South Korea: a bibliometric study. Psychiatry Investig 2013; 10:8-16. [PMID: 23482954 PMCID: PMC3590435 DOI: 10.4306/pi.2013.10.1.8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 07/30/2012] [Accepted: 08/01/2012] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE We have carried out a bibliometric study on the scientific publications in relation to atypical or second-generation antipsychotic drugs (SGAs) in South Korea. METHODS With the EMBASE and MEDLINE databases, we selected those publications made in South Korea whose title included the descriptors atypic(*) (atypical(*)) antipsychotic(*), second-generation antipsychotic(*), clozapine, risperidone, olanzapine, ziprasidone, quetiapine, sertindole, aripiprazole, paliperidone, amisulpride, zotepine, asenapine, iloperidone, lurasidone, perospirone and blonanserin. We applied some bibliometric indicators of paper production and dispersion with Price's law and Bradford's law, respectively. We also calculated the participation index (PI) of the different countries, and correlated the bibliometric data with some social and health data from Korea (such as total per capita expenditure on health and gross domestic expenditure on research and development). RESULTS We collected 326 original papers published between 1993 and 2011. Our results state fulfilment of fulfilled Price's law, with scientific production on SGAs showing exponential growth (correlation coefficient r=0.8978, as against an r=0.8149 after linear adjustment). The most widely studied drugs were risperidone (91 papers), aripiprazole (77), olanzapine (53), and clozapine (43). Division into Bradford zones yielded a nucleus occupied by the Progress in Neuro-Psychopharmacology and Biological Psychiatry (36 articles). A total of 86 different journals were published, with 4 of the first 10 used journals having an impact factor being greater than 4. CONCLUSION The publications on SGAs in South Korea have undergone exponential growth over the studied period, without evidence of reaching a saturation point.
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Affiliation(s)
- Francisco López-Muñoz
- Faculty of Health Sciences, Camilo José Cela University, Madrid, Spain
- Department of Pharmacology, University of Alcalá, Madrid, Spain
| | - Winston W. Shen
- Department of Psychiatry, Wan Fang Medical Center and School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chi-Un Pae
- Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
- Department of Psychiatry and Behavioral Science, Duke University Medical Center, Durham, NC, USA
| | - Raquel Moreno
- Faculty of Health Sciences, Camilo José Cela University, Madrid, Spain
| | - Gabriel Rubio
- Department of Psychiatry, "Doce de Octubre" University Hospital, Complutense University, Madrid, Spain
| | - Juan D. Molina
- Faculty of Health Sciences, Camilo José Cela University, Madrid, Spain
- Acute Inpatients Unit, Dr. R. Lafora Psychiatric Hospital, Madrid, Spain
| | - Concha Noriega
- Faculty of Health Sciences, Camilo José Cela University, Madrid, Spain
| | | | - Lorena Huelves
- Faculty of Health Sciences, Camilo José Cela University, Madrid, Spain
| | - Cecilio Álamo
- Department of Pharmacology, University of Alcalá, Madrid, Spain
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Rissanen I, Jääskeläinen E, Isohanni M, Koponen H, Joukamaa M, Alaräisänen A, Miettunen J. Use of antipsychotic medication and suicidality--the Northern Finland Birth Cohort 1966. Hum Psychopharmacol 2012; 27:476-85. [PMID: 22886816 DOI: 10.1002/hup.2250] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 07/05/2012] [Indexed: 11/11/2022]
Abstract
In addition to psychoses, antipsychotic drugs are nowadays also prescribed for other psychiatric disturbances, such as mood disorders. We wanted to find out whether there is any association between the use of antipsychotic drugs and suicidality in cases of psychotic and non-psychotic disorders. Our sample was the population-based Northern Finland 1966 Birth Cohort. Information on the use of prescribed drugs was collected in 1997 from the nationwide medication register and with a postal questionnaire (N = 8218). The presence of suicidal ideation was assessed cross-sectionally using the Symptom Check List-25 questionnaire. We studied associations between suicidal ideation, adjusted for symptoms of depression and anxiety, and antipsychotic medication in different diagnostic groups (schizophrenia, other psychosis and no psychosis). Individuals receiving antipsychotic medication (n = 70, 0.9%) had in general more suicidal ideation regardless of diagnostic group, although the associations diminished when taking other symptoms into account. There were no statistically significant differences between those taking typical and atypical antipsychotics. In the non-psychotic group, higher antipsychotic doses were associated with more suicidal ideation even when adjusted for symptoms of depression and anxiety (p < 0.05). In the cases of schizophrenia or other forms of psychosis, no such associations were observed. Our results suggest that one should take suicidal ideation into account when prescribing antipsychotic medication, especially for off-label use.
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Affiliation(s)
- Ina Rissanen
- Department of Psychiatry, Institute of Clinical Medicine, University of Oulu, Oulu, Finland.
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Gao K, Kemp DE, Fein E, Wang Z, Fang Y, Ganocy SJ, Calabrese JR. Number needed to treat to harm for discontinuation due to adverse events in the treatment of bipolar depression, major depressive disorder, and generalized anxiety disorder with atypical antipsychotics. J Clin Psychiatry 2011; 72:1063-71. [PMID: 21034695 PMCID: PMC3457049 DOI: 10.4088/jcp.09r05535gre] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Accepted: 01/07/2010] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To estimate the number needed to treat to harm (NNTH) for discontinuation due to adverse events with atypical antipsychotics relative to placebo during the treatment of bipolar depression, major depressive disorder (MDD), and generalized anxiety disorder (GAD). DATA SOURCES English-language literature published and cited in MEDLINE from January 1966 to May 2009 was searched with the terms antipsychotic, atypical antipsychotic, generic and brand names of atypical antipsychotics, safety, tolerability, discontinuation due to adverse events, somnolence, sedation, weight gain, akathisia, or extrapyramidal side effect; and bipolar depression, major depressive disorder, or generalized anxiety disorder; and randomized, placebo-controlled clinical trial. This search was augmented with a manual search. STUDY SELECTION Studies with a cumulative sample of ≥ 100 patients were included. DATA EXTRACTION The NNTHs for discontinuation due to adverse events, somnolence, sedation, ≥ 7% weight gain, and akathisia relative to placebo were estimated with 95% confidence intervals to reflect the magnitude of variance. DATA SYNTHESIS Five studies in bipolar depression, 10 studies in MDD, and 4 studies in GAD were identified. Aripiprazole and olanzapine have been studied in bipolar depression and refractory MDD. Only quetiapine extended release (quetiapine-XR) has been studied in 3 psychiatric conditions with different fixed dosing schedules. For aripiprazole, the mean NNTH for discontinuation due to adverse events was 14 in bipolar depression, but was not significantly different from placebo in MDD. For olanzapine, the mean NNTHs were 24 in bipolar depression and 9 in MDD. The risk for discontinuation due to adverse events during quetiapine-XR treatment appeared to be associated with dose. For quetiapine-XR 300 mg/d, the NNTHs for discontinuation due to adverse events were 9 for bipolar depression, 8 for refractory MDD, 9 for MDD, and 5 for GAD. CONCLUSIONS At the same dose of quetiapine-XR, patients with GAD appeared to have a lower tolerability than those with bipolar depression or MDD. Due to flexible dosing, the risk for discontinuation due to adverse events in the treatment of bipolar depression, MDD, or GAD with other atypical antipsychotics could not be compared.
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Affiliation(s)
- Keming Gao
- Department of Psychiatry, Mood and Anxiety Clinic in the Mood Disorders Program, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
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Vulink NCC, Figee M, Denys D. Review of atypical antipsychotics in anxiety. Eur Neuropsychopharmacol 2011; 21:429-49. [PMID: 21345655 DOI: 10.1016/j.euroneuro.2010.12.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 11/30/2010] [Accepted: 12/27/2010] [Indexed: 10/18/2022]
Abstract
Atypical antipsychotics are increasingly used for treatment of anxiety disorders, either in mono- or combination therapy. This is the first review reporting on the use of atypical antipsychotics in monotherapy or augmentation in patients with primary anxiety disorders or anxiety (disorders) comorbid to schizophrenia, bipolar disorder (BPD) and major depressive disorder (MDD). We included 49 open-label trials, 32 randomized, placebo-controlled trials (RCTpls) and five randomized controlled trials without placebo arm with almost 6000 patients (open-label: 1710, randomized: 4145). An increasing number of RCTpls show promising results in 27-71% of patients with primary or comorbid anxiety disorders who were treated with monotherapy atypical antipsychotics or augmentation therapy. However, methodological flaws of included studies may limit conclusions of this review and larger placebo-controlled trials are warranted comparing standard treatment with monotherapy and augmentation therapy of atypical antipsychotics and placebo. In addition, higher dropout rates and side effects from treatment with atypical antipsychotics may limit the use of atypical antipsychotics in patients with anxiety disorders.
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Affiliation(s)
- Nienke C C Vulink
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands.
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Mustafa FA. Test of treatment in psychiatric practice. PSYCHOPHARMACOLOGY BULLETIN 2011; 44:61-64. [PMID: 22506439 PMCID: PMC5044557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Due to lack of laboratorial investigations in psychiatric practice, tests of treatment are often used to aid diagnosis. This article provides examples of test of treatment in psychiatric practice and outlines their limitations.
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Martin CM. Off-label use of medications: innovative prescribing or risky business? THE CONSULTANT PHARMACIST : THE JOURNAL OF THE AMERICAN SOCIETY OF CONSULTANT PHARMACISTS 2010; 25:806-814. [PMID: 21172761 DOI: 10.4140/tcp.n.2010.806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Off-label use of medication is common and can lead to innovations in the use of medicine to treat patients in unconventional ways. However, issues of increased health care costs, decreased reimbursement, and lack of clinical data to support off-label use, are concerns of practitioners and patients alike. By using their knowledge of medications and carefully examining the existing research, pharmacists can aid prescribers in appropriate off-label medication use.
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Atypical antipsychotic medications are independently associated with severe obstructive sleep apnea. Clin Neuropharmacol 2010; 33:109-13. [PMID: 20502129 DOI: 10.1097/wnf.0b013e3181db8040] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Atypical antipsychotic (AA) medications are widely prescribed for their Food and Drug Administration-approved uses (acute mania, bipolar mania, psychotic agitation, bipolar maintenance, etc) and off-label indications. Although AA medications are associated with substantial weight gain, their tranquilizing effects may independently contribute to risk of obstructive sleep apnea (OSA) perhaps, by a reduction in activity of hypoglossal or recurrent activity of laryngeal nerve on the upper motor airway musculature. METHODS We hypothesized that AA medications are associated with more severe OSA independent of weight and neck circumference. Medical intake data and polysomnographic studies of patients referred to community hospital sleep disorders center were analyzed retrospectively. RESULTS Mean age of patients was 49.1 years, 55.1% were male, and mean body mass index (BMI) was 33.8 kg/m. Sixty-eight patients (8.1%) were taking AA at the time of polysomnography. There were no differences in age, sex, neck circumference and BMI of AA versus non-AA patients. The mean (SE) apnea-hypopnea index values were 29.2 (3.5)/h in AA patients and 21.3 (0.8)/h in non-AA patients (P = 0.03). Thirty-four percent of AA patients had severe OSA (apnea-hypopnea index > 30/h) compared with 23% of non-AA patients (P = 0.04). When adjusted for BMI, sex, and use of benzodiazepines and sleeping aids, the odds ratios of severe OSA in AA patients were 1.9 times in non-AA patients (95% confidence interval, 1.1-3.3). CONCLUSIONS Atypical antipsychotic medication use may increase the risk of more severe OSA independent of weight and neck circumference.
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Pollack TM, McCoy C, Stead W. Clinically significant adverse events from a drug interaction between quetiapine and atazanavir-ritonavir in two patients. Pharmacotherapy 2010; 29:1386-91. [PMID: 19857154 DOI: 10.1592/phco.29.11.1386] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Clinicians caring for patients infected with the human immunodeficiency virus (HIV) and diagnosed with psychiatric comorbidities must be aware of potential drug-drug interactions, particularly with protease inhibitor-based antiretroviral therapy. Although possible interactions can be predicted based on a drug's pharmacokinetic parameters, the clinical significance is often unknown. We describe two patients who experienced serious quetiapine adverse effects potentially mediated through an interaction with ritonavir-boosted atazanavir. The first patient was a 57-year-old man with HIV and bipolar disease who developed rapid and severe weight gain when quetiapine was added to a stable atazanavir-ritonavir-based antiretroviral regimen. After the patient discontinued both quetiapine and ritonavir, his weight returned to its baseline value. The second patient was a 32-year-old woman with HIV, anxiety disorder, and a history of intravenous drug abuse who developed increased sedation and mental confusion when an atazanavir-ritonavir-based antiretroviral regimen was added to her stable antianxiety drug regimen, which included quetiapine. Her symptoms resolved promptly after discontinuation of the quetiapine. Use of the Naranjo adverse drug reaction probability scale indicated that the adverse effects experienced by the two patients were possibly related and probably related, respectively, to an interaction between quetiapine and atazanavir-ritonavir. Quetiapine is primarily metabolized by cytochrome P450 (CYP) 3A4, and ritonavir is a potent inhibitor of CYP3A4. Thus, it is reasonable to theorize that quetiapine concentrations will increase when these drugs are used concurrently, which would be the likely cause of the toxicities in these two patients. To our knowledge, these are the first published reports of a clinically significant interaction between atazanavir-ritonavir and quetiapine. Clinicians should be aware of the potential for this interaction, and extreme caution should be used when prescribing quetiapine and other atypical antipsychotic agents in HIV-positive patients who are receiving antiretroviral therapy.
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Affiliation(s)
- Todd M Pollack
- Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA
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Fountoulakis KN, Gonda X, Vieta E, Schmidt F. Treatment of psychotic symptoms in bipolar disorder with aripiprazole monotherapy: a meta-analysis. Ann Gen Psychiatry 2009; 8:27. [PMID: 20043829 PMCID: PMC2812439 DOI: 10.1186/1744-859x-8-27] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Accepted: 12/31/2009] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND We present a systematic review and meta-analysis of the available clinical trials concerning the usefulness of aripiprazole in the treatment of the psychotic symptoms in bipolar disorder. METHODS A systematic MEDLINE and repository search concerning clinical trials for aripiprazole in bipolar disorder was conducted. RESULTS The meta-analysis of four randomised controlled trials (RCTs) on acute mania suggests that the effect size of aripiprazole versus placebo was equal to 0.14 but a more reliable and accurate estimation is 0.18 for the total Positive and Negative Syndrome Scale (PANSS) score. The effect was higher for the PANSS-positive subscale (0.28), PANSS-hostility subscale (0.24) and PANSS-cognitive subscale (0.20), and lower for the PANSS-negative subscale (0.12). No data on the depressive phase of bipolar illness exist, while there are some data in favour of aripiprazole concerning the maintenance phase, where at week 26 all except the total PANSS score showed a significant superiority of aripiprazole over placebo (d = 0.28 for positive, d = 0.38 for the cognitive and d = 0.71 for the hostility subscales) and at week 100 the results were similar (d = 0.42, 0.63 and 0.48, respectively). CONCLUSION The data analysed for the current study support the usefulness of aripiprazole against psychotic symptoms during the acute manic and maintenance phases of bipolar illness.
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Moritz S, Peters MJV, Karow A, Deljkovic A, Tonn P, Naber D. Cure or curse? Ambivalent attitudes towards neuroleptic medication in schizophrenia and non-schizophrenia patients. Ment Illn 2009; 1:e2. [PMID: 25478082 PMCID: PMC4253341 DOI: 10.4081/mi.2009.e2] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 11/12/2009] [Accepted: 11/13/2009] [Indexed: 11/29/2022] Open
Abstract
Neuroleptic non-compliance remains a serious challenge for the treatment of psychosis. Non-compliance is predominantly attributed to side effects, lack of illness insight, reduced well-being or poor therapeutic alliance. However, other still neglected factors may also play a role. Further, little is known about whether psychiatric patients without psychosis who are increasingly prescribed neuroleptics differ in terms of medication compliance or about reasons for non-compliance by psychosis patients. As direct questioning is notoriously prone to social desirability biases, we conducted an anonymous survey. After a strict selection process blind to results, 95 psychiatric patients were retained for the final analyses (69 participants with a presumed diagnosis of schizophrenia psychosis, 26 without psychosis). Self-reported neuroleptic non-compliance was more prevalent in psychosis patients than non-psychosis patients. Apart from side effects and illness insight, main reasons for non-compliance in both groups were forgetfulness, distrust in therapist, and no subjective need for treatment. Other notable reasons were stigma and advice of relatives/acquaintances against neuroleptic medication. Gain from illness was a reason for non-compliance in 11-18% of the psychosis patients. Only 9% of all patients reported no side effects and full compliance and at the same time acknowledged that neuroleptics worked well for them. While pills were preferred over depot injections by the majority of patients, depot was judged as an alternative by a substantial subgroup. Although many patients acknowledge the need and benefits of neuroleptic medication, non-compliance was the norm rather than the exception in our samples.
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Affiliation(s)
- Steffen Moritz
- University Medical Center Hamburg Eppendorf , Department of Psychiatry and Psychotherapy, Hamburg, Germany
| | - Maarten J V Peters
- Faculty of Psychology and Neuroscience, Maastricht University , Maastricht, The Netherlands
| | - Anne Karow
- University Medical Center Hamburg Eppendorf , Department of Psychiatry and Psychotherapy, Hamburg, Germany
| | - Azra Deljkovic
- University Medical Center Hamburg Eppendorf , Department of Psychiatry and Psychotherapy, Hamburg, Germany
| | - Peter Tonn
- University Medical Center Hamburg Eppendorf , Department of Psychiatry and Psychotherapy, Hamburg, Germany
| | - Dieter Naber
- University Medical Center Hamburg Eppendorf , Department of Psychiatry and Psychotherapy, Hamburg, Germany
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Patterns and predictors of antipsychotic medication use among the U.S. population: findings from the Medical Expenditure Panel Survey. Res Social Adm Pharm 2009; 9:263-75. [PMID: 21272525 DOI: 10.1016/j.sapharm.2009.07.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Revised: 07/01/2009] [Accepted: 07/02/2009] [Indexed: 11/21/2022]
Abstract
BACKGROUND Given the importance of pharmacological treatment in mental disorders, it is important to have a thorough understanding of predictors and variations in antipsychotic use. OBJECTIVE To provide a description of patient characteristics associated with antipsychotic use and to examine predictors of atypical antipsychotic use among antipsychotic users. METHODS Data were obtained from the 2004 and 2005 Medical Expenditure Panel Survey. Dependent variables were annual, self-reported, atypical and typical antipsychotic use. Independent variables included predisposing, enabling, and need characteristics according to Andersen's Behavioral Model. In addition to descriptive statistics, logistic regression analyses were performed to examine the determinants of antipsychotic use. RESULTS Patients aged 65 and older were 0.63 times as likely to use antipsychotics as patients aged 26-45. Poor and near-poor patients were 1.55 and 1.37 times as likely to use antipsychotics as middle- to high-income patients, respectively. The odds of antipsychotic use were 2.95 and 1.99 times for patients with public and prescription insurance coverage, respectively. Patients with a usual source of health care were 1.51 times as likely to use antipsychotics as those without. Compared with typical antipsychotic use, patients aged 25 and younger were 3.88 times as likely to use atypical antipsychotics as patients aged between 26 and 45. Urban residents were 1.87 times as likely as rural residents to use atypical antipsychotics. The odds of antipsychotic and atypical antipsychotic use for the poor mental health population were 8.73 and 3.87 times as patients with good to excellent mental health status. CONCLUSIONS Predisposing and need factors play important roles in determining the use of antipsychotics. However, among antipsychotic users, the use of atypical versus typical antipsychotics appears to have been influenced primarily by need. These findings should be useful to clinicians and policy makers in directing antipsychotic treatments to patients in need.
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Devulapalli KK, Nasrallah HA. An analysis of the high psychotropic off-label use in psychiatric disorders The majority of psychiatric diagnoses have no approved drug. Asian J Psychiatr 2009; 2:29-36. [PMID: 23051015 DOI: 10.1016/j.ajp.2009.01.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Accepted: 01/07/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The authors' goals were to determine the extent of unapproved indications in the DSM-IV-TR, to highlight common off-label uses of psychotropic medications and offer insights into the rationale of the widespread off-label prescribing in psychiatry. METHOD Indications for approved psychotropic agents, obtained from the Physicians Desk Reference and the Drug Information Handbook, Clinical Handbook of Psychotropic Drugs, 15th edition, and the Drugs@FDA online database were analyzed in the context of the DSM-IV-TR to determine the percent of DSM-IV-TR disorders that are indications for psychotropic agents. A literature search was performed to determine common off-label uses of major classes of psychotropic medications. RESULTS 88.5% of all DSM-IV-TR categorized disorders lack an approved medication for their treatment. Atypical Antipsychotics had the most extensive off-label use for DSM-IV-TR categorized disorder, whereas Mood Stabilizers showed the greatest off-label use with regards to disorders and symptoms that are not DSM-IV classified. For each class of medications, more off-label uses exist than FDA-approved uses. CONCLUSIONS The vast majority of DSM-IV-TR categorized disorders lack approved medications for their treatment. The large unmet need for approved psychiatric indications may explain the widespread off-label use of psychotropic medications in clinical practice.
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Han C, Lee MS, Pae CU, Ko YH, Patkar AA, Jung IK. Usefulness of long-acting injectable risperidone during 12-month maintenance therapy of bipolar disorder. Prog Neuropsychopharmacol Biol Psychiatry 2007; 31:1219-23. [PMID: 17532106 DOI: 10.1016/j.pnpbp.2007.04.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2007] [Revised: 04/13/2007] [Accepted: 04/24/2007] [Indexed: 11/17/2022]
Abstract
This study aimed to assess the safety, tolerability, efficacy, and compliance of a risperidone long-acting injection (RLAI) formulation for the maintenance treatment of stabilized bipolar patients. A prospective, open-label trial of RLAI was conducted for 12 months. Stable bipolar patients (n=11) were switched from their existing oral antipsychotic agents to RLAI, and injections were given every 2 weeks. The assessments were performed at baseline and at 6 and 12 months of treatment by using the Young Mania Rating Scale (YMRS), Clinical Global Impressions-Severity of Illness (CGI-S) scale, 17-item Hamilton Rating Scale for Depression (HAM-D), Brief Psychiatric Rating Scale (BPRS), and Extrapyramidal Symptom Rating Scale (ESRS). The satisfaction levels of subjects were evaluated at the end of the study period using a 10-point visual analog scale. Ten patients (90.9%) completed the trial, and no significant changes were seen in the YMRS, HAM-D, and BPRS scores throughout the study. CGI-S and ESRS scores were significantly decreased from the baseline to the post-12-month treatment score. Relapses were not reported by any of the participants. This result indicates that RLAI may be beneficial in the maintenance therapy of stable bipolar patients; however, an adequately powered, randomized, placebo-controlled trial is necessary to draw a definite conclusion about the role of RLAI in the maintenance treatment of bipolar patients.
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Affiliation(s)
- Changsu Han
- Department of Psychiatry, Korea University, College of Medicine, Seoul, South Korea
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Sankaranarayanan J, Puumala SE. Antipsychotic use at adult ambulatory care visits by patients with mental health disorders in the United States, 1996-2003: national estimates and associated factors. Clin Ther 2007; 29:723-41. [PMID: 17617297 DOI: 10.1016/j.clinthera.2007.04.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This retrospective analysis was conducted to derive national estimates of typical, atypical, and combination (typical-atypical) antipsychotic use and to examine factors associated with their use at adult (age >>-18 years) ambulatory care visits by patients with mental health disorders in the United States. METHODS Data on adult visits with an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code for a mental health disorder were extracted from the office-based National Ambulatory Medical Care Survey and the outpatient facilitybased National Hospital Ambulatory Medical Care Survey from 1996 through 2003. The visits were categorized according to whether use of a typical, atypical, or combination antipsychotic was mentioned (either prescribed, supplied, administered, ordered, or continued at the visits). Total weighted visit estimates, weighted visit percentages, and 95% CIs were calculated across the 3 types of visit groups. Bivariate analysis was performed on the association between selected characteristics and the 3 visit groups. Multivariate logistic regression was performed on factors associated with atypical versus typical antipsychotic use. RESULTS During the 8-year period, there were an estimated 47.7 million adult ambulatory care visits involving a mental health disorder and mention of an antipsychotic (weighted percent: 0.83%; 95% CI, 0.73-0.93). From 1996/1997 to 2002/2003, visits involving atypical and combination antipsychotics increased by 195% and 149%, respectively, and visits involving typical antipsychotics decreased by 71%. Men, blacks, and those with public insurance made more visits in which combination antipsychotics rather than typical or atypical antipsychotics were mentioned. Relative to typical or combination antipsychotic visits, more atypical antipsychotic visits involved antide-pressants (weighted percent: 61.23% atypical, 37.29% typical, and 38.32% combination). Fewer atypical antipsychotic visits compared with typical or combination antipsychotic visits involved psychotic disorders (weighted percent: 32.94%, 51.23%, and 69.93%, respectively) and medications for extrapyramidal symptoms (weighted percent: 6.69%, 29.95%, and 36.64%). In multivariate analyses controlling for sex, race, diagnosis of schizophrenia, region, diagnosis of anxiety, and recent years, atypical versus typical antipsychotic use was significantly less likely at visits by those aged 41 to 64 years compared with those aged 18 to 40 years (adjusted odds ratio [OR] = 0.63; 95% CI, 0.47-0.84; P = 0.002); significantly less likely at visits by those with public compared with private insurance (Medicare OR = 0.59 [95% CI, 0.40-0.88], P = 0.010; Medicaid OR = 0.44 [95% CI, 0.28-0.69], P < 0.001); and significantly more likely at visits associated with depression compared with those not associated with depression (OR = 1.92; 95% CI, 1.26-2.93; P = 0.003) and those associated with bipolar disorder compared with those not associated with bipolar disorder (OR = 2.10; 95% CI, 1.32-3.36; P = 0.002). CONCLUSIONS This retrospective analysis found more atypical than typical or combination antipsychotic use at US ambulatory care visits by adults with mental health disorders other than schizophrenia or psychoses in the period studied. Atypical versus typical antipsychotic use was significantly less likely at visits by adults aged 41 to 64 years and those with public insurance, but significantly more likely at visits by those with depression or bipolar disorder.
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Affiliation(s)
- Jayashri Sankaranarayanan
- Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska 68198-6045, USA.
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Kroenke K, Rosmalen JGM. Symptoms, syndromes, and the value of psychiatric diagnostics in patients who have functional somatic disorders. Med Clin North Am 2006; 90:603-26. [PMID: 16843765 DOI: 10.1016/j.mcna.2006.04.003] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Half of all outpatient encounters are precipitated by physical complaints, of which one third to one half are medically unexplained symptoms, and 20% to 25% are chronic or recurrent. Many of the patients suffer from one or more discrete symptoms, whereas others have functional somatic syndromes. Individual symptoms and somatic syndromes are associated with impaired quality of life, increased health care use, and diminished patient and provider satisfaction. This article provides an overview of (1) unexplained symptoms and somatization; (2) limitations of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition in classifying somatoform disorders; (3) predictors of psychiatric comorbidity in patients who have physical symptoms; and (4) measurement and management of symptoms.
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Affiliation(s)
- Kurt Kroenke
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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Lewin AB, Storch EA, Geffken GR, Goodman WK, Murphy TK. A neuropsychiatric review of pediatric obsessive-compulsive disorder: etiology and efficacious treatments. Neuropsychiatr Dis Treat 2006; 2:21-31. [PMID: 19412443 PMCID: PMC2671737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Pediatric obsessive-compulsive disorder (OCD) is a chronic neuropsychiatric condition associated with broad impairments in functioning. This paper outlines current etiological theories of OCD, providing a review of neuroanatomical, neurochemical, neuroimmunological, and cognitive-behavioral explanations. Subsequently, first-line treatment modalities are discussed (serotonin reuptake inhibitors [SRIs] and cognitive-behavioral therapy [CBT] with exposure and response prevention [E/RP]) in the context of recent pharmacological, CBT, and combined trials.
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Affiliation(s)
- Adam B Lewin
- Department of Psychiatry, University of Florida, Gainesville, FL, USA.
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Engelhardt E, Brucki SMT, Cavalcanti JLS, Forlenza OV, Laks J, Vale FAC. [Treatment of Alzheimer's disease: recommendations and suggestions of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology]. ARQUIVOS DE NEURO-PSIQUIATRIA 2005; 63:1104-12. [PMID: 16400437 DOI: 10.1590/s0004-282x2005000600035] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The present recommendations and suggestions on "Treatment of Alzheimer's Disease" were elaborated by a work group constituted by participants of the IV Meeting of Researchers on Alzheimer's Disease and Related Disorders, sponsored by the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology. They comprise topics on pharmacological and non-pharmacological treatment of cognitive impairment and functional decline, as well as of behavioral and psychological symptoms of this dementing disease. Several levels of evidence and of recommendations and suggestions are used for the various proposed drugs, as well as for non-pharmacological treatment, underpinned by a wide national and international bibliographical review.
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Affiliation(s)
- Eliasz Engelhardt
- Setor de Neurologia Cognitiva e do Comportamento, Instituto de Neurologia Deolindo Couto, Universidade Federal do Rio de Janeiro, RJ, Brasil.
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Bhatara VS, López-Muñoz F, Gupta S. Guest editorial: celebrating the 50TH anniversary of the introduction of chlorpromazine in North America and the advent of the psychopharmacology revolution. Ann Clin Psychiatry 2005; 17:109-11. [PMID: 16433052 DOI: 10.1080/10401230591001986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Aparasu RR, Bhatara V, Gupta S. U.S. national trends in the use of antipsychotics during office visits, 1998-2002. Ann Clin Psychiatry 2005; 17:147-52. [PMID: 16433056 DOI: 10.1080/10401230591002084] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND There is a paucity of studies on U.S. national trends in the use of antipsychotic medications in the 21st century. This study examined national trends in the prescribing of antipsychotic drugs in office-based physician practices. METHODS National probability sample survey data from 1998-2002 National Ambulatory Medical Surveys were used to analyze the prescribing trends. The weighted visit estimates and percentages were compared across the years using z-test. RESULTS The number of antipsychotic-related visits was found to increase significantly and nearly two-fold, from 4.6 million in 1998 to 8.6 million in 2002. During the same period, the number of visits for second-generation antipsychotic drugs nearly tripled. The proportion of visits for the second-generation agents, as a percentage of visits for all antipsychotic drugs, rose sharply from about 48% in 1998 to 84% in 2002. Correspondingly, the percentage of visits involving first-generation antipsychotic drugs declined. The growth in the number of visits involving antipsychotic drugs over the 5-year period was substantial (120%) in visits with non-psychiatrist physicians, but not in visits involving psychiatrists. CONCLUSIONS The trend of growth in prescription of antipsychotic drugs in office visits, accounted by increased use of second-generation antipsychotics, has persisted into the 21st century. Increased prescribing of these agents by non-psychiatrists is also apparently fueling this trend. This trend of shift from first-to-second generation antipsychotic agents, though not unambiguously supported by extant safety and efficacy data, is endorsed by guidelines based on expert-consensus and limited data. Given the high-level use of second-generation drugs, more practical studies of these drugs, focusing on effectiveness or long-term outcomes, are needed.
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Affiliation(s)
- Rajender R Aparasu
- Department of Pharmaceutical Sciences, College of Pharmacy, South Dakota State University, Brookings, SD 57007, USA.
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