Patterns of prescription of four major antipsychotics: a retrospective study based on medical records of psychiatric inpatients

Jul 15, 2005Pharmacoepidemiology and drug safety

Prescription Patterns of Four Common Antipsychotic Drugs in Psychiatric Hospital Patients

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Abstract

Among 421 antipsychotic prescriptions, 39.4% were for olanzapine.

Younger patients were more likely to receive amisulpride and olanzapine compared to older patients.
Affective disorders were associated with a higher prescription rate of olanzapine and risperidone.
Haloperidol was more frequently prescribed for patients hospitalized under constraint.
Co-prescription rates for antidepressants and anxiolytics were lower with haloperidol than with atypical antipsychotics.
Mood-stabilizer co-prescriptions were more common with olanzapine and risperidone compared to haloperidol and amisulpride.
Higher rates of anticholinergic co-prescription were observed with haloperidol than with atypical medications.

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PURPOSE: (1) To identify factors associated with the choice among the three atypical antipsychotics available in France (amisulpride, olanzapine, risperidone) and the typical antipsychotic of reference: (haloperidol), (2) to compare psychotropic co-prescription rates according to antipsychotic.

METHODS: All antipsychotic prescriptions including at least one of the four antipsychotics (n=421) for all inpatients (n=372) hospitalized 24 hours or more in the 6 months previous to the start of the study were included (2003). Data were obtained from medical records and psychiatrist interviews. Of the prescriptions, 13.3% included amisulpride, 39.4% olanzapine, 27.3% risperidone, and 20.0% haloperidol. Mean dosages were 142 mg (amisulpride), 15 mg (olanzapine), 4.5 mg (risperidone), and 19.5 mg (haloperidol).

RESULTS: Differences between antipsychotics were observed in relation to patients' age (younger patients prescribed amisulpride and olanzapine, p=0.04), diagnoses (affective disorders more frequently prescribed olanzapine and risperidone, p=0.005), and mode of hospitalization (admissions under constraint more frequently prescribed haloperidol, p<0.001). Antidepressant and anxiolytic-hypnotic co-prescription rates were lower with haloperidol than with atypicals. Mood-stabilizer co-prescription rates were higher for olanzapine and risperidone than for haloperidol and amisulpride. Anticholinergic co-prescription was higher with haloperidol than with atypicals (p<0.001).

CONCLUSIONS: Haloperidol was prescribed to a minority and targeted male patients hospitalized under constraint, using high dosages. Type and rate of co-prescriptions varied considerably between haloperidol and atypicals.

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Patterns of prescription of four major antipsychotics: a retrospective study based on medical records of psychiatric inpatients

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