title: Factors associated with the prescribing of olanzapine, quetiapine, and risperidone in patients with bipolar and related affective disorders.
abstract: OBJECTIVE
  To identify the factors associated with newly prescribed, first-line, second-generation antipsychotics (SgAs) associated with weight gain-olanzapine, risperidone, and quetiapine.
  
  
  METHODS
  Retrospective medical record review.
  
  
  METHODS
  Outpatient and inpatient psychiatry services at a tertiary care, academic medical center.
  
  
  METHODS
  Three hundred forty consecutive adults who had major depressive disorder with psychotic features, bipolar I, bipolar II, bipolar not otherwise specified, or schizoaffective disorder over two time periods (August 30-October 30, 2009, and April 1-May 31, 2010).
  
  
  RESULTS
  Clinical and sociodemographic variables associated with newly prescribed olanzapine, risperidone, and quetiapine were identified by using univariate and multivariate logistic regression. Several clinical factors were individually associated with initiation of these SgAs: mania (odds ratio [OR] 3.6, 95% confidence interval [CI] 1.2-10.8, p=0.02), psychosis (OR 3.3, 95% CI 1.5-6.9, p=0.002), and inpatient treatment (OR 3.8, 95% CI 1.8-7.9, p=0.0005). Prevalent use of lithium (OR 0.3, 95% CI 0.1-0.9, p=0.03) and being married (OR 0.3, 95% CI 0.1-0.8, p=0.02) were inversely associated with new use of an SgA. Mania, psychosis, married status, and lithium use remained independently associated on multivariate analysis. Factors related to metabolic or vascular risk were not associated with SgA initiation.
  
  
  CONCLUSIONS
  Psychiatric clinicians were influenced heavily by clinical features related to mental status and acuity when determining whether to prescribe SgAs. However, factors related to vascular risk were not associated. Future observational studies should consider current clinical status as an important factor in determining propensity to receive antipsychotics or other short-term treatments for bipolar and related disorders.
authors.affiliation: Department of Psychiatry, Carver College of Medicine, College of Public Health, University of Iowa, Iowa City, USA.
authors.forename: Maithri
authors.initials: M
authors.lastname: Prabhakar
authors.forename: William G
authors.initials: WG
authors.lastname: Haynes
authors.forename: William H
authors.initials: WH
authors.lastname: Coryell
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Chrischilles
authors.forename: Del D
authors.initials: del D
authors.lastname: Miller
authors.forename: Stephan
authors.initials: S
authors.lastname: Arndt
authors.forename: Vicki L
authors.initials: VL
authors.lastname: Ellingrod
authors.forename: Lois
authors.initials: L
authors.lastname: Warren
authors.forename: Jess G
authors.initials: JG
authors.lastname: Fiedorowicz
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000009:adverse effects / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy; D003865:Major Depressive Disorder / Q000188:drug therapy; D003987:Dibenzothiazepines / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D000077152:Olanzapine; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011618:Psychotic Disorders / Q000188:drug therapy; D000069348:Quetiapine Fumarate; D012189:Retrospective Studies; D018967:Risperidone / Q000009:adverse effects / Q000627:therapeutic use*; D015430:Weight Gain / Q000187:drug effects
chemical_list: D014150:Antipsychotic Agents; D003987:Dibenzothiazepines; D001569:Benzodiazepines; D000069348:Quetiapine Fumarate; D018967:Risperidone; D000077152:Olanzapine