Korean Journal of Biological Psychiatry (생물정신의학)

The Korean Society of Biological Psychiatry (대한생물정신의학회)
권호 표지

Changes in Psychotropic Prescription Patterns in Patients Admitted to an Open Psychiatric Ward : Eleven-Year Comparison in a University Hospital in Gyeonggi-Do

정신건강의학과 개방병동 입원 환자의 진단군별 약물 처방 경향 변화 : 경기도 소재 일 대학병원에서의 11년 비교 연구

  • Byun, Seonjeong (Department of Neuropsychiatry, Seoul National University Hospital) ;
  • Kim, Euitae (Department of Neuropsychiatry, Seoul National University Bundang Hospital) ;
  • Yoo, Hee Jeong (Department of Neuropsychiatry, Seoul National University Bundang Hospital) ;
  • Ha, Tae Hyon (Department of Neuropsychiatry, Seoul National University Bundang Hospital) ;
  • Yoon, In-Young (Department of Neuropsychiatry, Seoul National University Bundang Hospital) ;
  • Kim, Ki Woong (Department of Neuropsychiatry, Seoul National University Bundang Hospital)
  • 변선정 (서울대학교병원 정신건강의학과) ;
  • 김의태 (분당서울대학교병원 정신건강의학과) ;
  • 유희정 (분당서울대학교병원 정신건강의학과) ;
  • 하태현 (분당서울대학교병원 정신건강의학과) ;
  • 윤인영 (분당서울대학교병원 정신건강의학과) ;
  • 김기웅 (분당서울대학교병원 정신건강의학과)
  • Received : 2015.08.28
  • Accepted : 2015.10.02
  • Published : 2015.11.30
Download PDF
⟨ Previous Next ⟩

Abstract

Objectives This study investigated the patterns of psychotropic medications prescribed to patients admitted to an open psychiatric ward. Methods We reviewed 4282 medical records of patients who were discharged from an open psychiatric ward from May 2003 through April 2014. Data were collected on each patient's age, sex, length of hospital stay, number of past admissions, discharge diagnosis, and kinds and dosages of psychotropic medications at discharge. Results Among the 1384 male and 2898 female patients, 3.56 psychotropic medications were prescribed on average, with the number increasing across years, from 3.30 in 2003-2008 to 3.76 in 2009-2014. Prescription rates of antipsychotics, anxiolytics, and hypnotics significantly increased in patients with depressive disorders, bipolar disorders, anxiety disorders, delirium, dementia, and amnestic and other cognitive disorders. Only lithium prescription rates decreased significantly. Prescriptions for two or more anxiolytics and antipsychotics increased during the survey years, while antidepressant polypharmacy rates decreased. Conclusions Recently, there has been a significant increase in the number of psychotropic medications prescribed, including antipsychotics, anxiolytics, and hypnotics. Caution should be exercised when prescribing medications to avoid cost increases and the risk of side effects, with uncertain gains in the quality of care.

Keywords

References

  1. Medco Health Solutions. America's State of Mind Report. Franklin Lakes: Medco Health Solutions;2011.
  2. Batstra L, Frances A. Holding the line against diagnostic inflation in psychiatry. Psychother Psychosom 2012;81:5-10. https://doi.org/10.1159/000331565
  3. Olfson M, Marcus SC. National patterns in antidepressant medication treatment. Arch Gen Psychiatry 2009;66:848-856. https://doi.org/10.1001/archgenpsychiatry.2009.81
  4. Stephenson CP, Karanges E, McGregor IS. Trends in the utilisation of psychotropic medications in Australia from 2000 to 2011. Aust N Z J Psychiatry 2013;47:74-87. https://doi.org/10.1177/0004867412466595
  5. Mond J, Morice R, Owen C, Korten A. Use of antipsychotic medications in Australia between July 1995 and December 2001. Aust N Z J Psychiatry 2003;37:55-61. https://doi.org/10.1046/j.1440-1614.2003.01110.x
  6. Konstantinidis A, Papageorgiou K, Grohmann R, Horvath A, Engel R, Kasper S. Increase of antipsychotic medication in depressive inpatients from 2000 to 2007: results from the AMSP International Pharmacovigilance Program. Int J Neuropsychopharmacol 2012;15:449-457. https://doi.org/10.1017/S1461145711000745
  7. Mojtabai R, Olfson M. National trends in psychotropic medication polypharmacy in office-based psychiatry. Arch Gen Psychiatry 2010;67:26-36. https://doi.org/10.1001/archgenpsychiatry.2009.175
  8. Correll CU, Shaikh L, Gallego JA, Nachbar J, Olshanskiy V, Kishimoto T, et al. Antipsychotic polypharmacy: a survey study of prescriber attitudes, knowledge and behavior. Schizophr Res 2011;131:58-62. https://doi.org/10.1016/j.schres.2011.02.016
  9. Alexander GC, Gallagher SA, Mascola A, Moloney RM, Stafford RS. Increasing off-label use of antipsychotic medications in the United States, 1995-2008. Pharmacoepidemiol Drug Saf 2011;20:177-184. https://doi.org/10.1002/pds.2082
  10. Fleischhacker WW, Uchida H. Critical review of antipsychotic polypharmacy in the treatment of schizophrenia. Int J Neuropsychopharmacol 2014;17:1083-1093. https://doi.org/10.1017/S1461145712000399
  11. Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Beaulieu S, Alda M, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013. Bipolar Disord 2013;15:1-44.
  12. Bradley CP. Factors which influence the decision whether or not to prescribe: the dilemma facing general practitioners. Br J Gen Pract 1992;42:454-458.
  13. Zito JM, Safer DJ, DosReis S, Gardner JF, Magder L, Soeken K, et al. Psychotropic practice patterns for youth: a 10-year perspective. Arch Pediatr Adolesc Med 2003;157:17-25. https://doi.org/10.1001/archpedi.157.1.17
  14. Baldessarini RJ, Leahy L, Arcona S, Gause D, Zhang W, Hennen J. Patterns of psychotropic drug prescription for U.S. patients with diagnoses of bipolar disorders. Psychiatr Serv 2007;58:85-91. https://doi.org/10.1176/ps.2007.58.1.85
  15. Kwon JS, Kim ET, Ha TH, Roh KS, Choi JS, Kim YS. Drug prescribing patterns of outpatients with schizophrenia in a university hospital. J Korean Neuropsychiatr Assoc 2003;42:683-690.
  16. Seo HJ, Jung YE, Lee J, Chae JH, Jun TY, Bahk WM. Changes of medication usage in inpatients with major depressive disorder: one university hospital between year 2001 and 2006. Korean J Psychopharmacol 2007;18:399-407.
  17. Hwang IH, Kim D, Oh DY. Psychotropic Prescription Patterns for Inpatients with Schizophrenia: 10-Year Comparison in a University-Affiliated Hospital in South Korea. Korean J Biol Psychiatry 2014;21:49-56.
  18. Skrbo A, Begovic B, Skrbo S. [Classification of drugs using the ATC system (Anatomic, Therapeutic, Chemical Classification) and the latest changes]. Med Arh 2004;58(1 Suppl 2):138-141.
  19. Yoon BH, Bahk WM, Jon DI, Shin YC, Seo JS, Lee JG, et al. Korean Medication Algorithm for Bipolar Disorder 2014: Overview. Korean J Psychopharmacol 2014;25:43-56.
  20. Fava M, Davidson KG. Definition and epidemiology of treatmentresistant depression. Psychiatr Clin North Am 1996;19:179-200. https://doi.org/10.1016/S0193-953X(05)70283-5
  21. Rush AJ, Thase ME, Dube S. Research issues in the study of difficult- to-treat depression. Biol Psychiatry 2003;53:743-753. https://doi.org/10.1016/S0006-3223(03)00088-X
  22. Souery D, Amsterdam J, de Montigny C, Lecrubier Y, Montgomery S, Lipp O, et al. Treatment resistant depression: methodological overview and operational criteria. Eur Neuropsychopharmacol 1999;9:83-91. https://doi.org/10.1016/S0924-977X(98)00004-2
  23. Han KM, Park SC, Won ES, Sung SH, Lee H, Koo JW, et al. Evidence- based Korean pharmacological treatment guideline for depression, revised edition (III): dose increment, switching, combination, and augmentation strategy in antidepressant therapy. J Korean Neuropsychiatr Assoc 2013;52:386-401. https://doi.org/10.4306/jknpa.2013.52.5.386
  24. Comer JS, Mojtabai R, Olfson M. National trends in the antipsychotic treatment of psychiatric outpatients with anxiety disorders. Am J Psychiatry 2011;168:1057-1065. https://doi.org/10.1176/appi.ajp.2011.11010087
  25. Kales HC, Zivin K, Kim HM, Valenstein M, Chiang C, Ignacio RV, et al. Trends in antipsychotic use in dementia 1999-2007. Arch Gen Psychiatry 2011;68:190-197. https://doi.org/10.1001/archgenpsychiatry.2010.200
  26. Thase ME. What role do atypical antipsychotic drugs have in treatment- resistant depression? J Clin Psychiatry 2002;63:95-103. https://doi.org/10.4088/JCP.v63n0202
  27. Gill SS, Bronskill SE, Normand SL, Anderson GM, Sykora K, Lam K, et al. Antipsychotic drug use and mortality in older adults with dementia. Ann Intern Med 2007;146:775-786. https://doi.org/10.7326/0003-4819-146-11-200706050-00006
  28. Peters SM, Knauf KQ, Derbidge CM, Kimmel R, Vannoy S. Demographic and clinical factors associated with benzodiazepine prescription at discharge from psychiatric inpatient treatment. Gen Hosp Psychiatry 2015;37:595-600. https://doi.org/10.1016/j.genhosppsych.2015.06.004
  29. Bartlett G, Abrahamowicz M, Grad R, Sylvestre MP, Tamblyn R. Association between risk factors for injurious falls and new benzodiazepine prescribing in elderly persons. BMC Fam Pract 2009;10:1. https://doi.org/10.1186/1471-2296-10-1
  30. Seo JJ, Lee SH, Lee YS, Kwon BM, Ma Y, Hwang BY, et al. Anxiolytic- like effects of obovatol isolated from Magnolia obovata: involvement of GABA/benzodiazepine receptors complex. Prog Neuropsychopharmacol Biol Psychiatry 2007;31:1363-1369. https://doi.org/10.1016/j.pnpbp.2007.05.009
  31. Billioti de Gage S, Begaud B, Bazin F, Verdoux H, Dartigues JF, Peres K, et al. Benzodiazepine use and risk of dementia: prospective population based study. BMJ 2012;345:e6231. https://doi.org/10.1136/bmj.e6231
  32. Bishara D, Taylor D, Howard RJ, Abdel-Tawab R. Expert opinion on the management of behavioural and psychological symptoms of dementia (BPSD) and investigation into prescribing practices in the UK. Int J Geriatr Psychiatry 2009;24:944-954. https://doi.org/10.1002/gps.2200
  33. Cook JM, Biyanova T, Masci C, Coyne JC. Older patient perspectives on long-term anxiolytic benzodiazepine use and discontinuation: a qualitative study. J Gen Intern Med 2007;22:1094-1100. https://doi.org/10.1007/s11606-007-0205-5
  34. Kwon JW, Hwang JS, Oh SH, Park EJ, Kwak SJ, Oh KS, et al. Prescription pattern and safety of benzodiazepines. Seoul: National Evidence-based Healthcare Collaborating Agency;2013. p.1-4.
  35. Hogan DB, Maxwell CJ, Fung TS, Ebly EM. Prevalence and potential consequences of benzodiazepine use in senior citizens: results from the Canadian Study of Health and Aging. Can J Clin Pharmacol 2003;10:72-77.