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. 2014 Dec 18;4(12):e006135.
doi: 10.1136/bmjopen-2014-006135.

Prescribing of antipsychotics in UK primary care: a cohort study

Louise Marston  1 , Irwin Nazareth  1 , Irene Petersen  1 , Kate Walters  1 , David P J Osborn  2
Affiliations

Prescribing of antipsychotics in UK primary care: a cohort study

Louise Marston et al. BMJ Open. .

Abstract

Objective: To examine the recorded indication for antipsychotic prescriptions in UK primary care.

Design: Cohort study.

Setting: Primary care.

Participants: Individuals prescribed antipsychotics between 2007 and 2011.

Measures: 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.

Results: 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.

Conclusions: 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.

Keywords: EPIDEMIOLOGY; MENTAL HEALTH; STATISTICS & RESEARCH METHODS.

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Figures

Figure 1
Figure 1
Flow of individuals through the study. FGA, first generation antipsychotics; SGA, second generation antipsychotics.
See this image and copyright information in PMC

Comment in

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