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. 2024 Dec 26;75(750):e68-e79.
doi: 10.3399/BJGP.2024.0367. Print 2025 Jan.

Antipsychotic management in general practice: serial cross-sectional study (2011-2020)

Alan Woodall  1 , Alex Gampel  2 , Lauren E Walker  3 , Frances S Mair  4 , Sally Sheard  5 , Pyers Symon  6 , Iain Buchan  7
Affiliations

Antipsychotic management in general practice: serial cross-sectional study (2011-2020)

Alan Woodall et al. Br J Gen Pract. .

Abstract

Background: Long-term use of antipsychotics confers increased risk of cardiometabolic disease. Ongoing need should be reviewed regularly by psychiatrists.

Aim: To explore trends in antipsychotic management in general practice, and the proportions of patients prescribed antipsychotics receiving psychiatrist review.

Design and setting: Serial cross-sectional study using linked general practice and hospital data in Wales (2011-2020).

Method: Participants were adults (aged ≥18 years) registered with general practices in Wales. Outcome measures were prevalence of patients receiving ≥6 antipsychotic prescriptions annually, the proportion of patients prescribed antipsychotics receiving annual psychiatrist review, and the proportion of patients prescribed antipsychotics who were registered on the UK serious mental illness, depression, and/or dementia registers, or not on any of these registers.

Results: Prevalence of adults prescribed long-term antipsychotics increased from 1.055% (95% confidence interval [CI] = 1.041 to 1.069) in 2011 to 1.448% (95% CI = 1.432 to 1.464) in 2020. The proportion receiving annual psychiatrist review decreased from 59.6% (95% CI = 58.9 to 60.4) in 2011 to 52.0% (95% CI = 51.4 to 52.7) in 2020. The proportion of overall antipsychotic use prescribed to patients on the serious mental illness register decreased from 50.0% (95% CI = 49.4 to 50.7) in 2011 to 43.6% (95% CI = 43.0 to 44.1) by 2020.

Conclusion: Prevalence of long-term antipsychotic use is increasing. More patients are managed by GPs without psychiatrist review and are not on monitored disease registers; they thus may be less likely to undergo cardiometabolic monitoring and miss opportunities to optimise or deprescribe antipsychotics. These trends pose risks for patients and need to be addressed urgently.

Keywords: antipsychotics; cardiometabolic risk factors; cross-sectional studies; general practice; medication review; psychiatry.

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Conflict of interest statement

Alan Woodall, Lauren E Walker, Iain Buchan, and Frances S Mair receive funding from the NIHR DynAIRx project (reference: NIHR 203986) investigating the use of artificial intelligence to optimise prescribing. Iain Buchan has acted as an advisor to AstraZeneca plc, on behalf of the University of Liverpool. The other authors have declared no competing interests.

References

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