Prescribing Second-Generation Antipsychotics and the Evolving Standard of Care in Italy

Abstract

The present study was carried out to investigate the routine use of second-generation antipsychotic drugs in the Italian psychiatric care system. Seven outpatient psychiatric services enrolled a consecutive case series of patients who were being treated, or had started treatment, with clozapine, olanzapine, risperidone, or quetiapine. Information on sociodemographic and clinical variables, current psychotropic drug use, side-effects and past use of typical drugs was collected. In addition, patient symptoms and functional status were evaluated by the Health of the Nation Outcome Scale. Patients receiving off-label prescribing of second-generation antipsychotics were identified. A total of 209 patients were collected. In comparison with patients receiving other second-generation antipsychotics, living in residential facilities, unemployment, long psychiatric histories, and problems with activities of daily living and living conditions were more common in clozapine-treated patients. Nearly 80 % of patients receiving clozapine had schizophrenia compared to less than 50 % of those receiving other second-generation antipsychotics. Overall, 109 patients (52 %) received off-label prescriptions of second-generation antipsychotic drugs. This survey indicates that clozapine was mostly reserved for severe cases and poor responders; the high rate of off-label prescriptions highlights the gap existing between recommendations derived from randomised clinical trials and the current use of drugs.

U.S. National Trends in the Use of Antipsychotics During Office Visits, 1998–2002

“…The literature suggests that clinicians often use secondgeneration agents for indications not approved by the Food and Drug Administration (13)(14)(15)(16). For example, a study in veterans found that although a majority (57%) of patients (n = 73,981) were prescribed antipsychotic drugs for schizophrenia in a 4-month period, nearly 43% had diagnoses other than schizophrenia (13).…”

Off-label Prescribing in a German Psychiatric Hospital

“…studies have been done in Germany [1, 2, 9, 10, 18, 20, 21, 25, 29 -32, 35] . Therefore, the aim of this retrospective study was to determine (1) how common off-label use is in one German psychiatric hospital, (2) whether there has been a difference in the frequency of off-label prescribing since the FSC decision, and (3) how off-label use varies by patient characteristics.…”

Off-label prescribing in psychiatric practice

“…A prospective evaluation of prescribing involving 209 outpatients in Italy found that over half of them were given offlabel prescriptions of atypical antipsychotics (Barbui et al, 2002). A similar situation was found in a prescription review of 173 patients attending pharmacies in Austria, which revealed that twothirds of them were receiving antipsychotics for unlicensed indications (Weiss et al, 2000).…”