Prescribing of antipsychotics among people with recorded personality disorder in primary care: a retrospective nationwide cohort study using The Health Improvement Network primary care database.
Prescribing of antipsychotics among people with recorded personality disorder in primary care: a retrospective nationwide cohort study using The Health Improvement Network primary care database.
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DOI：
10.1136/bmjopen-2021-053943
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发表时间：
2022-03-09
期刊：
影响因子：
2.9
通讯作者：
Osborn D
中科院分区：
文献类型：
--
作者：
Hardoon S;Hayes J;Viding E;McCrory E;Walters K;Osborn D
调查英国初级保健中对记录的人格障碍（PD）患者开抗精神病药的程度以及与此类处方相关的因素。回顾性队列研究。一般做法有助于健康改善网络英国范围内的初级保健数据库，2000年1月1日至2016年12月31日。46210人在参与的全科诊所登记，他们的全科诊所记录中有PD记录。1358人（2.9%）缺失剥夺信息被排除在回归分析之外;没有其他缺失数据。全科医疗记录中的抗精神病药物处方和接受抗精神病药物处方的时间长度。在46210例记录在案的PD患者中，15562例（34%）曾接受过抗精神病药物治疗。在36875名记录有PD但没有记录有严重精神疾病（SMI）的人的亚组中，9208人（25%）被开了抗精神病药;在贫困程度较低的地区，开药率较低（调整后的比率（aRR）比较最少与最贫穷的五分之一：0.56，95% CI 0.48至0.66，p<0.001），女性较高，（aRR：1.25，95% CI 1.16至1.34，p<0.001）和有不良童年经历史（aRR：1.44，95% CI 1.28至1.56，p<0.001）。抗精神病药物处方的中位时间为605天（IQR 197-1639天）。处方频率随着时间的推移而增加。与目前英国的指南相反，抗精神病药物经常被越来越多地用于记录PD但没有SMI病史的人。有必要对临床实践进行紧急审查，包括这种处方的有效性以及监测代谢并发症等不良反应的必要性。
To investigate the extent of antipsychotic prescribing to people with recorded personality disorder (PD) in UK primary care and factors associated with such prescribing. Retrospective cohort study. General practices contributing to The Health Improvement Network UK-wide primary care database, 1 January 2000–31 December 2016. 46 210 people registered with participating general practices who had a record of PD in their general practice notes. 1358 (2.9%) people with missing deprivation information were excluded from regression analyses; no other missing data. Prescriptions for antipsychotics in general practice records and length of time in receipt of antipsychotic prescriptions. Of 46 210 people with recorded PD, 15 562 (34%) were ever prescribed antipsychotics. Among the subgroup of 36 875 people with recorded PD, but no recorded severe mental illness (SMI), 9208 (25%) were prescribed antipsychotics; prescribing was lower in less deprived areas (adjusted rate ratio (aRR) comparing least to most deprived quintile: 0.56, 95% CI 0.48 to 0.66, p<0.001), was higher in females (aRR:1.25, 95% CI 1.16 to 1.34, p<0.001) and with a history of adverse childhood experiences (aRR:1.44, 95% CI 1.28 to 1.56, p<0.001). Median time prescribed antipsychotics was 605 days (IQR 197–1639 days). Prescribing frequency has increased over time. Contrary to current UK guidelines, antipsychotics are frequently and increasingly prescribed for extended periods to people with recorded PD, but with no history of SMI. An urgent review of clinical practice is warranted, including the effectiveness of such prescribing and the need to monitor for adverse effects, including metabolic complications.
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