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Understanding antipsychotic non-classical prescriptions: a quantitative and qualitative approach

Published online by Cambridge University Press:  11 April 2011

Antonio Veronese ,
Valerio Vivenza ,
Michela Nosè ,
Andrea Cipriani ,
Michele Tansella  and
Corrado Barbui
Antonio Veronese*
Affiliation:
Section of Psychiatry and Clinical Psychology, Department of Medicine and Public Health, University of Verona, Verona (Italy)
Valerio Vivenza
Affiliation:
Section of Psychiatry and Clinical Psychology, Department of Medicine and Public Health, University of Verona, Verona (Italy)
Michela Nosè
Affiliation:
Section of Psychiatry and Clinical Psychology, Department of Medicine and Public Health, University of Verona, Verona (Italy)
Andrea Cipriani
Affiliation:
Section of Psychiatry and Clinical Psychology, Department of Medicine and Public Health, University of Verona, Verona (Italy)
Michele Tansella
Affiliation:
Section of Psychiatry and Clinical Psychology, Department of Medicine and Public Health, University of Verona, Verona (Italy)
Corrado Barbui
Affiliation:
Section of Psychiatry and Clinical Psychology, Department of Medicine and Public Health, University of Verona, Verona (Italy)
*
Dr. A. Veronese, Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona (Italy). Fax: +39-045-585871 E-mail: [email protected]
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Summary

Aims – To date only a few studies investigated the clinical reasons supporting and explaining non-classical antipsychotic prescriptions. The present study was carried out to develop concepts which help understand this phenomenon in a natural setting, giving emphasis to views of clinicians according to quali – quantitative research methodologies. Subjects – From the South-Verona Psychiatric Case Register all antipsychotic prescriptions issued during 2005 were extracted. Concurrent prescribing of two or more antipsychotics, prescribing antipsychotic drugs outside the licensed indications, and outside the licensed ranges of doses reported in the Italian National Formulary, were considered non-classical prescriptions. Reasons for non-classical prescriptions were collected by means of brainstorming sessions with clinicians. Non-classical prescriptions and the corresponding reasons were grouped according to whether they were “clinically sound” or “clinically not sound”. Results – During 2005 a total of 259 patients received 376 non-classical prescriptions. The most frequently reported reasons for non-classical prescribing were that prescriptions were inherited from another clinician with or without benefit, and that prescriptions were motivated by the need of reducing psychotic symptoms. More than 60% of these non-classical prescriptions were categorised as “clinically sound”. Clinically not sound prescriptions were related with negative clinicians’ views and opinions about the patient/clinician relationship. Conclusion – Clinically not sound prescriptions appeared just a reflection of a problematic doctor/patient relationship, where no individual treatment plan existed and psychiatric visits had the only goal of monitoring ongoing prescriptions.

Declaration of Interest: This study received no funding. We have no conflicts of interest.

Keywords

antipsychoticsepidemiologycommunity psychiatric servicesirrational prescriptions
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 17 , Issue 3 , September 2008 , pp. 236 - 241
Copyright
Copyright © Cambridge University Press 2008

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References

Amaddeo, F., Beecham, J., Bonizzato, P., Fenyo, A., Knapp, M. & Tansella, M. (1997). The use of a case register to evaluate the costs of psychiatric care. Acta Psychiatrica Scandinavica 95,189–198.CrossRefGoogle ScholarPubMed
Ananth, J. (2005). Long term antipsychotic polypharmacy is common among Medicaid recipients with schizophrenia. Evidence-Based Mental Health 8,55.CrossRefGoogle Scholar
Barbui, C. (2005). Evidence-based medicine and medicine-based evidence. Neurological Sciences 26, 145–146.CrossRefGoogle ScholarPubMed
Barbui, C., Ciuna, A., Nosè, M., Patten, S.B., Stegagno, M., Burti, L., Amaddeo, F. & Tansella, M. (2004). Off-label and non-classical prescriptions of antipsychotic agents in ordinary in-patient practice. Acta Psychiatrica Scandinavica 109, 275–278.CrossRefGoogle ScholarPubMed
Barbui, C., Nosè, M., Rambaldelli, G., Bonetto, C., Levi, D., Patten, S. & Tansella, M. (2005). Development of a registry for monitoring psychotropic drug prescriptions: aims, methods and implications for ordinary practice and research. International Journal of Methods in Psychiatric Research 14, 151–157.CrossRefGoogle ScholarPubMed
Barbui, C., Nosè, M., Mazzi, M.A., Thornicroft, G., Schene, A., Becker, T., Bindman, J., Leese, M., Helm, H., Koeter, M., Weinmann, S. & Tansella, M. (2006). Persistence with polypharmacy and excessive dosing in patients with schizophrenia treated in four European countries. International Clinical Psychopharmacology 21, 355–362.CrossRefGoogle ScholarPubMed
Barbui, C., Veronese, A. & Cipriani, A. (2007). Explanatory and Pragmatic Trials. Epidemiologia e Psichiatria Sociale 16(2), 124–125.CrossRefGoogle ScholarPubMed
Biancosino, B., Barbui, C., Marmai, L., Dona, S. & Grassi, L. (2005). Determinants of antipsychotic polypharmacy in psychiatric inpatients: a prospective study. International Clinical Psychopharmacology 20, 305–309.CrossRefGoogle ScholarPubMed
Bonetto, C., Nosè, M., & Barbui, C. (2006). Generating drug exposure data from computer-based medical records. Computer Methods and Programs in Biomedicine 83,120–124.CrossRefGoogle ScholarPubMed
Centorrino, F., Fogarty, K.V., Sani, G., Salvatore, P., Cincotta, S.L., Hennen, J., Guzzetta, F., Talamo, A., Saadeh, M.G. & Baldessarini, R.J. (2005). Use of combinations of antipsychotics: McLean Hospital inpatients, 2002. Human Psychopharmacology 20, 485–492.CrossRefGoogle ScholarPubMed
Ganguly, R., Kotzan, J.A., Miller, L.S., Kennedy, K. & Martin, B.C. (2004). Prevalence, trends, and factors associated with antipsychotic polypharmacy among Medicaid-eligible schizophrenia patients, 1998–2000. Journal of Clinical Psychiatry 65, 1377–1388.CrossRefGoogle ScholarPubMed
Kingsbury, S., Yi, D. & Simpson, G. (2001). Rational and irrational polypharmacy. Psychiatric Services 52, 1033–1036.CrossRefGoogle ScholarPubMed
Kogut, S.J., Yam, F. & Dufresne, R. (2005). Prescribing of antipsychotic medication in a medicaid population: use of polytherapy and offlabel dosages. Journal of Managed Care Pharmacy 11, 17–24.CrossRefGoogle Scholar
March, J.S., Silva, S.G., Compton, S., Shapiro, M., Califf, R. & Krishnan, R. (2005). The case for practical clinical trials in psychiatry. American Journal of Psychiatry 162, 836–846.CrossRefGoogle ScholarPubMed
Mays, N. & Pope, C. (2000). Assessing quality in qualitative research. British Medical Journal 320,50–52.CrossRefGoogle ScholarPubMed
National Institute for Clinical Excellence (2002). Guidance on the use of newer (atypical) antipsychotic drugs for the treatment of schizophrenia. NICE ed.Google Scholar
Percudani, M., Barbui, C., Fortino, I., Tansella, M., Petrovich, L. (2006). Antidepressant and antipsychotic drug prescribing in Lombardy. Epidemiologia e Psichiatria Sociale 15(1), 58–69.CrossRefGoogle ScholarPubMed
Pope, C. & Mays, N. (1995). Qualitative research: reaching the parts other methods cannot reach: an introduction to qualitative methods in health and health services research. British Medical Journal 311, 42–45.CrossRefGoogle ScholarPubMed
Rijcken, C., Boelema, G.J., Slooff, C., Beuger, P., Tanja, T. & De Jong-van den Berg, L.T. (2003). Off-label use of antipsychotics in the community pharmacy: the sex differences. Pharmacopsychiatry 36,186–191.Google ScholarPubMed
Schumacher, J., Makela, E. & Griffin, H. (2003). Multiple antipsychotic medication prescribing pattern. Annals of Pharmacotherapy 37, 951–955.CrossRefGoogle Scholar
Sernyak, M.J. & Rosenheck, R. (2004). Clinicians' reasons for antipsychotic coprescribing. Journal of Clinical Psychiatry 65, 1597–1600.CrossRefGoogle ScholarPubMed
Stiles, W. (1999). Evaluating qualitative research. Evidence-Based Mental Health 2, 99–101.CrossRefGoogle Scholar
Tansella, M. & Burti, L. (2003). Integrating evaluative research and community- based mental health care in Verona, Italy. British Journal of Psychiatry 183, 167–169.CrossRefGoogle ScholarPubMed
Tansella, M., Amaddeo, F., Burti, L., Lasalvia, A. & Ruggeri, M. (2006a). Evaluating a community-based mental health service focusing on severe mental illness. The Verona experience. Acta Psychiatrica Scandinavica. Supplementum 429, 90–94.CrossRefGoogle Scholar
Tansella, M., Thornicroft, G., Barbui, C., Cipriani, A. & Saraceno, B. (2006b). Seven criteria for improving effectiveness trials in psychiatry. Psychological Medicine, 36, 711–720.CrossRefGoogle ScholarPubMed
Tapp, A., Wood, A.E., Secrest, L., Erdmann, J., Cubberley, L. & Kilzieh, N. (2003). Combination antipsychotic therapy in clinical practice. Psychiatric Services 54, 55–59.CrossRefGoogle ScholarPubMed
Treweek, S., McCormack, K., Abalos, E., Campbell, M., Ramsay, C. & Zwarenstein, M. (2006). The Trial Protocol Tool: The PRACTIHC software tool that supported the writing of protocols for pragmatic randomized controlled trials. Journal of Clinical Epidemiology 59, 1127–1133.CrossRefGoogle Scholar
Weiss, E., Hummer, M., Koller, D., Pharmd, Ulmer H. & Fleischhacker, W.W. (2000). Off-label use of antipsychotic drugs. Journal of Clinical Psychopharmacology 20, 695–698.CrossRefGoogle ScholarPubMed