Prescribing of antipsychotics in UK primary care: a cohort study.
Prescribing of antipsychotics in UK primary care: a cohort study.
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DOI：
10.1136/bmjopen-2014-006135
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发表时间：
2014-12-18
期刊：
影响因子：
2.9
通讯作者：
Osborn DP
中科院分区：
文献类型：
--
作者：
Marston L;Nazareth I;Petersen I;Walters K;Osborn DP
检查记录的适应症抗精神病药物处方在英国的初级保健。队列研究。初级护理。在2007年至2011年间，这些人服用了抗精神病药物。处方抗精神病药物的个体诊断为(1)精神病和双相情感障碍，(2)其他诊断包括抑郁、焦虑和痴呆，以及(3)没有这些诊断的比例。我们确定了47724人服用抗精神病药物。13 941人接受了第一代药物治疗，27 966人接受了第二代药物治疗。女性(发病率比（IRR） 1.092 （95% CI 1.088 ~ 1.095）、老年人（80+ vs 40-49; IRR 2.234(2.222 ~ 2.246)）和最贫困地区(最贫困地区vs最贫困地区IRR 3.487（3.567 ~ 3.606）的处方率较高。在接受第一代抗精神病药物治疗的患者中，不到50%的人被诊断为精神病/双相情感障碍。对于第二代药物，喹硫平为4824例（36%），奥氮平为7094例（62%）。在没有精神病/双相情感障碍的患者中，常见的诊断包括焦虑、抑郁、痴呆、睡眠和人格障碍。例如，在利培酮使用者中，14%的人有焦虑症状，22%的人有抑郁症，12%的人有痴呆，11%的人有睡眠障碍，4%的人有人格障碍。精神分裂症患者（如利培酮中位日剂量4mg； IQR 2-6：中位持续时间1.2年）的中位日剂量和治疗持续时间大于非精神病性/双相情感障碍（如抑郁或焦虑）患者（如利培酮1mg； IQR 1 - 2: 0.6年）。相对较大比例（6%至17%）接受单独抗精神病药物治疗的人没有上述任何诊断。在英国的初级保健中，很大一部分服用抗精神病药物的人没有精神病或双相情感障碍的记录。他们通常是患有痴呆症、非精神病性抑郁症、焦虑和睡眠障碍等疾病的老年人。
To examine the recorded indication for antipsychotic prescriptions in UK primary care. Cohort study. Primary care. Individuals prescribed antipsychotics between 2007 and 2011. The proportion of individuals prescribed antipsychotics with a diagnosis of (1) psychosis and bipolar disorder, (2) other diagnoses including depression, anxiety and dementia and (3) none of these diagnoses. We identified 47 724 individuals prescribed antipsychotic agents. 13 941 received first-generation agents and 27 966 received second-generation agents. The rates of prescribing were higher in females (incidence rate ratio (IRR) 1.092 (95% CI 1.088 to 1.095), older people (80+ vs 40–49; IRR 2.234 (2.222 to 2.246)) and in those from the most deprived areas (most deprived vs least deprived IRR 3.487 (3.567 to 3.606). Of those receiving first-generation antipsychotics, less than 50% had a diagnosis of psychosis/bipolar disorder. For the second-generation agents, the numbers ranged from 4824 (36%) for quetiapine to 7094 (62%) for olanzapine. In patients without psychosis/bipolar disorder, common diagnoses included anxiety, depression, dementia, sleep and personality disorders. For example, in risperidone users, 14% had an anxiety code, 22% depression, 12% dementia, 11% sleep disorder and 4% personality disorder. The median daily doses and duration of treatment were greater in those with schizophrenia (eg, risperidone median daily dose 4 mg; IQR 2–6: median duration 1.2 years) than in those with non-psychotic/bipolar disorders such as depression or anxiety (eg, risperidone 1 mg; IQR 1–2: 0.6 years). A relatively large proportion (between 6% and 17%) of people receiving individual antipsychotics had none of the diagnoses stated above. In UK primary care, a large proportion of people prescribed antipsychotics have no record of psychotic or bipolar disorder. They are often older people with conditions including dementia, non-psychotic depression, anxiety and sleep disorders.
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