Prescribing second-generation antipsychotics and the evolving standard of care in Italy.
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.
Barbui
C
C
Laboratory of Epidemiology and Social Psychiatry, Mario Negri Institute for Pharmacological Research, Milan, Italy. corrado.barbui@univr.it
Danese
A
A
Guaiana
G
G
Mapelli
L
L
Miele
L
L
Monzani
E
E
Percudani
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D001569:Benzodiazepines; D010054:Brief Psychiatric Rating Scale; D003024:Clozapine / Q000627:therapeutic use; D003156:Community Mental Health Services / Q000639:trends*; D003987:Dibenzothiazepines / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004363:Drug Utilization / Q000639:trends; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D000077152:Olanzapine; D010045:Outpatients; D017891:Pharmacoepidemiology; D010890:Pirenzepine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011569:Psychiatric Status Rating Scales; D000069348:Quetiapine Fumarate; D018967:Risperidone / Q000627:therapeutic use; D012559:Schizophrenia / Q000175:diagnosis / Q000188:drug therapy*; D016896:Treatment Outcome
D018687:Antidepressive Agents, Second-Generation; D003987:Dibenzothiazepines; D001569:Benzodiazepines; D000069348:Quetiapine Fumarate; D010890:Pirenzepine; D003024:Clozapine; D018967:Risperidone; D000077152:Olanzapine