title: Prescribing of antipsychotics in UK primary care: a cohort study.
abstract: OBJECTIVE
  To examine the recorded indication for antipsychotic prescriptions in UK primary care.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  Primary care.
  
  
  METHODS
  Individuals prescribed antipsychotics between 2007 and 2011.
  
  
  METHODS
  The proportion of individuals prescribed antipsychotics with a diagnosis of (1) psychosis and bipolar disorder, (2) other diagnoses including depression, anxiety and dementia and (3) none of these diagnoses.
  
  
  RESULTS
  We identified 47,724 individuals prescribed antipsychotic agents. 13,941 received first-generation agents and 27,966 received second-generation agents. The rates of prescribing were higher in females (incidence rate ratio (IRR) 1.092 (95% CI 1.088 to 1.095), older people (80+ vs 40-49; IRR 2.234 (2.222 to 2.246)) and in those from the most deprived areas (most deprived vs least deprived IRR 3.487 (3.567 to 3.606). Of those receiving first-generation antipsychotics, less than 50% had a diagnosis of psychosis/bipolar disorder. For the second-generation agents, the numbers ranged from 4824 (36%) for quetiapine to 7094 (62%) for olanzapine. In patients without psychosis/bipolar disorder, common diagnoses included anxiety, depression, dementia, sleep and personality disorders. For example, in risperidone users, 14% had an anxiety code, 22% depression, 12% dementia, 11% sleep disorder and 4% personality disorder. The median daily doses and duration of treatment were greater in those with schizophrenia (eg, risperidone median daily dose 4 mg; IQR 2-6: median duration 1.2 years) than in those with non-psychotic/bipolar disorders such as depression or anxiety (eg, risperidone 1 mg; IQR 1-2: 0.6 years). A relatively large proportion (between 6% and 17%) of people receiving individual antipsychotics had none of the diagnoses stated above.
  
  
  CONCLUSIONS
  In UK primary care, a large proportion of people prescribed antipsychotics have no record of psychotic or bipolar disorder. They are often older people with conditions including dementia, non-psychotic depression, anxiety and sleep disorders.
authors.affiliation: Research Department of Primary Care and Population Health, University College London, London, UK.
authors.forename: Louise
authors.initials: L
authors.lastname: Marston
authors.affiliation: Research Department of Primary Care and Population Health, University College London, London, UK.
authors.forename: Irwin
authors.initials: I
authors.lastname: Nazareth
authors.affiliation: Research Department of Primary Care and Population Health, University College London, London, UK.
authors.forename: Irene
authors.initials: I
authors.lastname: Petersen
authors.affiliation: Research Department of Primary Care and Population Health, University College London, London, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Walters
authors.affiliation: Division of Psychiatry, University College London, London, UK Camden and Islington NHS Foundation Trust, London, UK.
authors.forename: David P J
authors.initials: DP
authors.lastname: Osborn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy; D002648:Child; D015331:Cohort Studies; D003704:Dementia / Q000188:drug therapy; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy*; D008875:Middle Aged; D019964:Mood Disorders / Q000188:drug therapy; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011320:Primary Health Care; D011618:Psychotic Disorders / Q000188:drug therapy; D018967:Risperidone / Q000627:therapeutic use; D012559:Schizophrenia / Q000188:drug therapy; D012720:Severity of Illness Index; D006113:United Kingdom; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D018967:Risperidone
keywords: EPIDEMIOLOGY; MENTAL HEALTH; STATISTICS & RESEARCH METHODS