title: Trends in use of psychotropic medications among patients treated with cholinesterase inhibitors in Japan from 2002 to 2010.
abstract: BACKGROUND
  We aimed to examine trends in the use of psychotropic medications among elderly outpatients with dementia in Japan between 2002 and 2010.
  
  
  METHODS
  We used data from the 2002-2010 Survey of Medical Care Activities in Public Health Insurance (SMCA-PHI), a nationally representative cross-sectional survey of claims data for the month of June in every year. We included ambulatory care visits by patients aged 65 years or older who were prescribed cholinesterase inhibitors (n = 15,591), and identified use of any psychotropic medications during the survey month.
  
  
  RESULTS
  In 2008–2010, the most prevalently prescribed psychotropic medications to patients with dementia were sedatives-hypnotics (27.3%), antipsychotics (21.3%), antidepressants (11.4%), and mood-stabilizers(2.8%). Between 2002–2004 and 2008–2010, use of second-generation antipsychotics increased from 4.9%to 11.2%, while use of first-generation antipsychotics decreased from 17.4% to 12.1% [corrected].These numbers resulted in a 1.1-fold increase in the adjusted prevalence of the overall use of antipsychotics. Quetiapine and risperidone use showed a 4.8- and 1.8-fold increase, respectively, while haloperidol use showed a 2.3-fold decrease.
  
  
  CONCLUSIONS
  Despite safety warnings against the use of antipsychotics for patients with dementia in several countries, our study revealed a slight increase in the extensive use of off-label antipsychotics over time in Japan. This finding indicates an urgent need for evaluation of the efficacy of antipsychotics for the approved treatment of severe agitation, aggression, and psychosis associated with dementia. Moreover, psychosocial interventions and antipsychotic withdrawal strategies are needed in order to reduce the overall prevalence of antipsychotic use.
authors.affiliation: Research Department,Institute for Health Economics and Policy,Association for Health Economics Research and Social Insurance and Welfare,Tokyo,Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Okumura
authors.affiliation: Inaho Clinic,Kanagawa,Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Togo
authors.affiliation: Department of Child and Adolescent Psychiatry,Kanagawa Children's Medical Center,Kanagawa,Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Fujita
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D003704:Dementia / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007564:Japan; D008297:Male; D056687:Off-Label Use; D011595:Psychomotor Agitation / Q000188:drug therapy*; D011600:Psychopharmacology; D011619:Psychotropic Drugs / Q000627:therapeutic use*
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D002800:Cholinesterase Inhibitors; D006993:Hypnotics and Sedatives; D011619:Psychotropic Drugs
keywords: mental health policy