Analysis of prescription patterns of antipsychotics agents in psychiatry

Abstract

Introduction. Wed describe the different diseases in which conventional and second generation antipsychotic (APS) prescriptions are made.

Method. Observational, retrospective, multicenter study based on the review of 300 clinical records of public and private sites, hospital and out-patient clinics, located in Salamanca, Vigo, Bilbao, Barcelona, Valencia, Oviedo and Malaga.

Results. The mean age of the population studied was 42±17 years; 56.6% were men. Atypical drugs (67%) were used basically versus classical ones (33 %). Classical APS are basically prescribed in bipolar disorder with/without psychotic symptoms (20.6%), schizophrenia (18.3%) and delusional disorder (11.5%). Atypical APS are fundamentally prescribed in schizophrenia (31.5 %), bipolar disorders with/without psychotic symptoms (12.5 %) and other psychotic disorders (8.9 %). When the psychotic disorders are considered by groups (schizophrenia, bipolar disorder with psychotic symptoms, delusional disorder and other psychotic disorders), classical APS are used in 47.4% and atypical APS in 62.5%. APS were used «outside the indication» (off-label) in 32.8%, including resistant depressions, serious obsessive-compulsive disorder and borderline personality disorder, with similar percentages for both conventional and atypical ones. In dementia, atypical APS were used in 5.1% versus 1.5% of the conventional ones. The most frequent reasons for prescription of classical APS were control of psychotic symptoms (33.6 %), aggressiveness-agitation (31.3 %), severe insomnia (16%), impulsivity (6.9%) and severe anxiety (6.1%). Atypical APS were preferably used in the control of psychotic symptoms (58.8%) and aggressiveness-agitation (25.5%).

Conclusions. The use of APS basically occurs within their authorized indications (67.2 %). The off-label use (32.8%) occurs both for the classical as well as atypical APS and occurs in serious diseases in which there are no alternative treatments.