Characteristics and predictors of off‐label use of antipsychotics in general population sample

Abstract

Objective: Increasing number of people have been prescribed antipsychotics (APs) off-label in recent decades. This study aimed to identify the characteristics and predictors of receiving prescription of antipsychotics off-label. Methods: The study sample was part of the Northern Finland Birth Cohort 1966 (n = 7071). Data included questionnaires and national register data.Information on prescribed medications was extracted from the national register. The sample was divided into three groups: Persons who had been prescribed APs off-label (n = 137), individuals with non-psychotic mental disorders without APs off label (n = 1478) and individuals who had been diagnosed with psychosis or bipolar disorder and who had been prescribed APs (n = 151). We compared sociodemographic, lifestyle and clinical characteristics between the off-label and the comparison groups using logistic regression. Results:The most common diagnoses in the off-label group were depression (n = 96, 70.1%) and anxiety (n = 55, 40.1%). Compared with individuals with non-psychotic mental disorders who were not prescribed APs off-label, individuals with prescribed off-label APs had a lower level of education, lower socioeconomic status, were less often married, had a higher level of somatic and psychiatric morbidity, were more often smokers and more often had a substance abuse disorder and heavy alcohol consumption. When comparing the off-label group to individuals with psychosis or bipolar disorder who used APs, there were less differences, though individuals with psychosis or bipolar disorder had more markers of morbidity and a lower level of education. Conclusion:Individuals who had been prescribed APs off label had a higher level of mental and somatic morbidity and poorer socioeconomic status than individuals with non-psychotic mental disorders who did not use APs.

Neurological Perspectives Should Be Integrated Into the Management of Tardive Dyskinesia—Expert Opinions and Proposed Educational Initiatives in Asia

“…Several non-APD drug classes also seem to have an association with the development of TD-like syndromes including some antiemetics and calcium channel blockers, and more rarely anticholinergics and anticonvulsants [9,10].Unsurprisingly, Focus Group advisers' experiences reflected these global literature reports.The calcium channel blocker, flunarizine, and the combination therapy of flupentixol, an APD, plus melitracen, a tricyclic antidepressant, which is used in some countries for the treatment of mood disorders,werereported to be common causes of TD in Asia.Responsesconfirmed some of the literature reports that female gender (40% of respondents) and older age (60% of respondents) areassociated with a higher risk of developing of TD [11,12], The number of comorbid conditions seem to increase TD risk, including previous stroke, small vessel disease, psychiatric disorders, brain damage, dementia, drug addiction and gastrointestinal motility disorders.Experts' experiences reflected both Western literature [8,13] and observations fromstudies in Asia [14], that off-label use of APD is common and likely impacts TD prevalence. It was suggested that any observedincrease in TD prevalence may be due to animproved awareness among neurologists, availability of newer drugs, and more patients seeking treatment.…”