Browse > Article

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

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)
Publication Information
Korean Journal of Biological Psychiatry / v.22, no.4, 2015 , pp. 195-204 More about this Journal
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
Prescription pattern; Psychotropic; Open psychiatric ward;
Citations & Related Records
Times Cited By KSCI : 1  (Citation Analysis)
연도 인용수 순위
1 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.   DOI
2 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.   DOI
3 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.   DOI
4 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.   DOI
5 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.
6 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.
7 Medco Health Solutions. America's State of Mind Report. Franklin Lakes: Medco Health Solutions;2011.
8 Batstra L, Frances A. Holding the line against diagnostic inflation in psychiatry. Psychother Psychosom 2012;81:5-10.   DOI
9 Olfson M, Marcus SC. National patterns in antidepressant medication treatment. Arch Gen Psychiatry 2009;66:848-856.   DOI
10 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.   DOI
11 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.   DOI
12 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.   DOI
13 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.   DOI
14 Mojtabai R, Olfson M. National trends in psychotropic medication polypharmacy in office-based psychiatry. Arch Gen Psychiatry 2010;67:26-36.   DOI
15 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.   DOI
16 Fleischhacker WW, Uchida H. Critical review of antipsychotic polypharmacy in the treatment of schizophrenia. Int J Neuropsychopharmacol 2014;17:1083-1093.   DOI
17 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.
18 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.
19 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.   DOI
20 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.   DOI
21 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.
22 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.
23 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.
24 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.
25 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.
26 Fava M, Davidson KG. Definition and epidemiology of treatmentresistant depression. Psychiatr Clin North Am 1996;19:179-200.   DOI
27 Rush AJ, Thase ME, Dube S. Research issues in the study of difficult- to-treat depression. Biol Psychiatry 2003;53:743-753.   DOI
28 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.   DOI
29 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.   DOI
30 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.   DOI
31 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.   DOI
32 Thase ME. What role do atypical antipsychotic drugs have in treatment- resistant depression? J Clin Psychiatry 2002;63:95-103.   DOI
33 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.   DOI
34 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.   DOI
35 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.   DOI