title: [Off-label prescriptions in acute psychiatry: a practice-based evaluation].
abstract: BACKGROUND
  In acute psychiatry the prescribed medication is frequently off-label.
  
  
  OBJECTIVE
  To investigate the indications for off-label prescriptions described in the literature and to evaluate the use of off-label medication in the emergency service of Altrecht, Utrecht, The Netherlands.
  
  
  METHODS
  We performed a systematic search of the PubMed database and we evaluated all the records of patients examined by the emergency service during two assessment periods (April 2009 and November 2010).
  
  
  RESULTS
  The literature makes no mention of the prescribing of off-label medication in acute psychiatry. In general psychiatry, however, off-label medication is reported mainly for atypical antipsychotics. In the emergency service 41% of the medication prescribed during first contacts with patients was off-label. These prescriptions were most often for antipsychotics (54%) and benzodiazepines (38%) . The most important indications were aggression, agitation and sleep problems. If the term &lsquo;off-label&rsquo; is interpreted in a broader sense with respect to antipsychotics for psychosis and hypomania, then 33% of the prescriptions appeared to be off-label. If benzodiazepines prescribed for aggression/agitation were not taken into account, then the proportion of off-label prescriptions decreased to 21%.
  
  
  CONCLUSIONS
  We consider it advisable that the reason for prescribing off-label medication should be clearly documented. New medical guidelines could help by summarising current views on the use of off-label medication.
authors.affiliation: Juliana Kinderziekenhuis, Den Haag.
authors.forename: R
authors.initials: R
authors.lastname: Hoff
authors.forename: A W
authors.initials: AW
authors.lastname: Braam
mesh_terms: D004632:Emergency Medical Services / Q000639:trends*; D006801:Humans; D001523:Mental Disorders / Q000188:drug therapy*; D009426:Netherlands; D056687:Off-Label Use / Q000706:statistics & numerical data*; D011570:Psychiatry / Q000706:statistics & numerical data*; D011619:Psychotropic Drugs / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D011619:Psychotropic Drugs