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Trends in use of psychotropic medications among patients treated with cholinesterase inhibitors in Japan from 2002 to 2010

Published online by Cambridge University Press:  12 September 2014

Yasuyuki Okumura ,
Takashi Togo  and
Junichi Fujita
Yasuyuki Okumura*
Affiliation:
Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan
Takashi Togo
Affiliation:
Inaho Clinic, Kanagawa, Japan
Junichi Fujita
Affiliation:
Department of Child and Adolescent Psychiatry, Kanagawa Children's Medical Center, Kanagawa, Japan
*
Correspondence should be addressed to: Yasuyuki Okumura, PhD, Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, 1-5-11 Nishi-Shinbashi, Minato-ku 105-0003, Tokyo, Japan. Phone: +81-3-3506-8529; Fax: +81-3-3506-8528. Email: [email protected].
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Abstract

Background:

We aimed to examine trends in the use of psychotropic medications among elderly outpatients with dementia in Japan between 2002 and 2010.

Methods:

We used data from the 2002–2010 Survey of Medical Care Activities in Public Health Insurance (SMCA-PHI), a nationally representative cross-sectional survey of claims data for the month of June in every year. We included ambulatory care visits by patients aged 65 years or older who were prescribed cholinesterase inhibitors (n = 15,591), and identified use of any psychotropic medications during the survey month.

Results:

In 2008–2010, the most prevalently prescribed psychotropic medications to patients with dementia were sedatives-hypnotics (37.5%), antipsychotics (24.9%), antidepressants (13.0%), and mood-stabilizers (2.9%). Between 2002–2004 and 2008–2010, use of second-generation antipsychotics (SGAs) increased from 5.0% to 12.0%, while use of first-generation antipsychotics (FGAs) decreased from 20.6% to 12.9%. These numbers resulted in a 1.1-fold increase in the adjusted prevalence of the overall use of antipsychotics. Quetiapine and risperidone use showed a 4.8- and 1.8-fold increase, respectively, while haloperidol use showed a 2.3-fold decrease.

Conclusions:

Despite safety warnings against the use of antipsychotics for patients with dementia in several countries, our study revealed a slight increase in the extensive use of off-label antipsychotics over time in Japan. This finding indicates an urgent need for evaluation of the efficacy of antipsychotics for the approved treatment of severe agitation, aggression, and psychosis associated with dementia. Moreover, psychosocial interventions and antipsychotic withdrawal strategies are needed in order to reduce the overall prevalence of antipsychotic use.

Keywords

dementiabehavioral and psychological symptoms of dementia (BPSD)psychopharmacologymental health policy
Type
Research Article
Information
International Psychogeriatrics , Volume 27 , Issue 3 , March 2015 , pp. 407 - 415
Copyright
Copyright © International Psychogeriatric Association 2014 

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References

Agenzia Italiana del Farmaco (2005). Il Trattamento Farmacologico dei Disturbi Psicotici in Pazienti Affetti da Demenza. Available at: http://www.agenziafarmaco.gov.it/it/content/il-trattamento-farmacologico-dei-disturbi-psicotici-pazienti-affetti-da-demenza; last accessed 12 May 2014.Google Scholar
Banerjee, S. (2009). The Use of Antipsychotic Medication for People with Dementia: Time for Action. London: Institute of Psychiatry, King's College London.Google Scholar
Carrasco-Garrido, P., Lopez de Andres, A., Hernandez Barrera, V., Jimenez-Trujillo, I. and Jimenez-Garcia, R. (2013). National trends (2003–2009) and factors related to psychotropic medication use in community-dwelling elderly population. International Psychogeriatrics, 25, 328–338.Google Scholar
Cipriani, A. et al. (2009). Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis. Lancet, 373, 746–758.Google Scholar
Declercq, T. et al. (2013). Withdrawal versus continuation of chronic antipsychotic drugs for behavioral and psychological symptoms in older people with dementia. Cochrane Database of Systematic Reviews, 3, CD007726.Google Scholar
Franchi, C. et al. (2012). Changes in trend of antipsychotics prescription in patients treated with cholinesterase inhibitors after warnings from Italian medicines agency: results from the EPIFARM-elderly project. European Neuropsychopharmacology, 22, 569–577.Google Scholar
Gallini, A., Andrieu, S., Donohue, J. M., Oumouhou, N., Lapeyre-Mestre, M. and Gardette, V. (2014). Trends in use of antipsychotics in elderly patients with dementia: impact of national safety warnings. European Neuropsychopharmacology, 24, 95–104.CrossRefGoogle ScholarPubMed
Gareri, P., De Fazio, P., Manfredi, V. G. and De Sarro, G. (2014). Use and safety of antipsychotics in behavioral disorders in elderly people with dementia. Journal of Clinical Psychopharmacology, 34, 109–123.Google Scholar
Gill, S. S. et al. (2007). Antipsychotic drug use and mortality in older adults with dementia. Annals of Internal Medicine, 146, 775–786.Google Scholar
Herrmann, N., Lanctot, K. L. and Hogan, D. B. (2013). Pharmacological recommendations for the symptomatic treatment of dementia: the Canadian consensus conference on the diagnosis and treatment of dementia 2012. Alzheimer's Research and Therapy, 5, S5.CrossRefGoogle ScholarPubMed
Hoffmann, F. (2013). Perceptions of German GPs on benefits and risks of benzodiazepines and Z-drugs. Swiss Medical Weekly, 143, w13745.Google ScholarPubMed
Kales, H. C. et al. (2011). Trends in antipsychotic use in dementia 1999–2007. Archives of General Psychiatry, 68, 190–197.Google Scholar
Levy, H. B. (2014). Non-benzodiazepine hypnotics and older adults: what are we learning about zolpidem? Expert Review of Clinical Pharmacology, 7, 5–8.Google Scholar
Lyketsos, C. G., Lopez, O., Jones, B., Fitzpatrick, A. L., Breitner, J. and DeKosky, S. (2002). Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the cardiovascular health study. Journal of the American Medical Association, 288, 1475–1483.Google Scholar
Maglione, M. et al. (2011). Off-Label Use of Atypical Antipsychotics: an Update. Rockville, MD: AHRQ Publication.Google Scholar
Martinez, C., Jones, R. W. and Rietbrock, S. (2013). Trends in the prevalence of antipsychotic drug use among patients with Alzheimer's disease and other dementias including those treated with antidementia drugs in the community in the UK: a cohort study. BMJ Open, 3, e002080.CrossRefGoogle ScholarPubMed
McCleery, J., Cohen, D. A. and Sharpley, A. L. (2014). Pharmacotherapies for sleep disturbances in Alzheimer's disease. Cochrane Database of Systematic Reviews, 3, CD009178.Google Scholar
Medicines and Healthcare Products Regulatory Agency (2009). Antipsychotics: use in elderly people with dementia. Drug Safety Update, 1, 5.Google Scholar
Mizushima, Y. (2002). Todays Drug Therapy in 2002. Tokyo: Nankodo.Google Scholar
Nakanishi, M., Hattori, K., Nakashima, T. and Sawamura, K. (2012). Priority for elderly persons with behavioral and psychological symptoms of dementia on waiting lists for placement in nursing homes in Japan: do nursing homes change priorities based on their own guidelines? Journal of the American Medical Directors Association, 13, 794–799.Google Scholar
National Institute for Health and Clinical Excellence (2006). Dementia: Supporting People with Dementia and their Carers in Health and Social Care. Manchester: National Institute for Health and Clinical Excellence.Google Scholar
National Institute of Population and Social Security Research (2014). Social Security in Japan. Available at: http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm124830.htm; last accessed 16 August 2014.Google Scholar
Rabins, P. V. et al. (2007). American Psychiatric Association practice guideline for the treatment of patients with Alzheimer's disease and other dementias. American Journal of Psychiatry, 164, 5–56.Google Scholar
Richter, T., Meyer, G., Mohler, R. and Kopke, S. (2012). Psychosocial interventions for reducing antipsychotic medication in care home residents. Cochrane Database of Systematic Reviews, 12, CD008634.Google Scholar
Ruths, S. et al. (2013). Trends in psychotropic drug prescribing in Norwegian nursing homes from 1997 to 2009: a comparison of six cohorts. International Journal of Geriatric Psychiatry, 28, 868–876.CrossRefGoogle ScholarPubMed
Schneider, L. S., Dagerman, K. S. and Insel, P. (2005). Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials. Journal of the American Medical Association, 294, 1934–1943.Google Scholar
Schulze, J., van den Bussche, H., Glaeske, G., Kaduszkiewicz, H., Wiese, B. and Hoffmann, F. (2013). Impact of safety warnings on antipsychotic prescriptions in dementia: nothing has changed but the years and the substances. European Neuropsychopharmacology, 23, 1034–1042.CrossRefGoogle ScholarPubMed
Seitz, D. P., Adunuri, N., Gill, S. S., Gruneir, A., Herrmann, N. and Rochon, P. (2011). Antidepressants for agitation and psychosis in dementia. Cochrane Database of Systematic Reviews, CD008191.Google Scholar
Statistics and Information Department, Minister's Secretariat, Ministry of Health, Labor and Welfare (2011). Survey of Medical Care Activities in Public Health Insurance 2010. Tokyo: Japan: Health and Welfare Association.Google Scholar
Tampi, R. R. and Tampi, D. J. (2014). Efficacy and tolerability of benzodiazepines for the treatment of behavioral and psychological symptoms of dementia: a systematic review of randomized controlled trials. American Journal of Alzheimer's Disease and Other Dementias. Epublished ahead of print.Google Scholar
Tannenbaum, C., Martin, P., Tamblyn, R., Benedetti, A. and Ahmed, S. (2014). Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the empower cluster randomized trial. Journal of the American Medical Association Internal Medicine, 174, 890–898.Google ScholarPubMed
U.S. Food and Drug Administration (2005). Public Health Advisory: Deaths with Antipsychotics in Elderly Patients with Behavioral Disturbances. Available at: http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/PublicHealthAdvisories/ucm053171.htm; last accessed 5 May 2014.Google Scholar
U.S. Food and Drug Administration (2008). Information for Healthcare Professionals: Conventional Antipsychotics. Available at: http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm124830.htm; last accessed 5 May 2014.Google Scholar
Yeh, Y. C. and Ouyang, W. C. (2012). Mood stabilizers for the treatment of behavioral and psychological symptoms of dementia: an update review. Kaohsiung Journal of Medical Sciences, 28, 185–193.Google Scholar
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