title: National Trends in Psychiatric Not Otherwise Specified (NOS) Diagnosis and Medication Use Among Adults in Outpatient Treatment.
abstract: OBJECTIVE
  This study examined national trends between 1999 and 2010 in not otherwise specified (NOS) DSM-IV psychiatric diagnoses and in related medication treatment patterns reported for adults during outpatient physician office visits.
  
  
  METHODS
  Data on physician office visits by adults (ages 18-64) with a psychiatric diagnosis were from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey (1999-2010) (N=52,026). Trends for visits with full-criteria diagnoses compared with visits with NOS diagnoses were analyzed for major psychiatric diagnostic groups, physician specialty, and prescribed medications. Population weighted chi square and logistic regression analyses were utilized.
  
  
  RESULTS
  Between 1999-2002 and 2007-2010, the proportion of all mental health visits by adults to office-based physicians that involved an NOS diagnosis increased significantly, from 42% to 50% (p<.001). Significant proportional increases in NOS diagnoses included bipolar disorders NOS (5% to 55%), anxiety disorders NOS (50% to 62%), and mood disorders NOS (.4% to 1.8%). In 2007-2010, NOS visits accounted for a greater proportion of visits to nonpsychiatrists than to psychiatrists (61% and 35%, respectively). Psychotropic medications prescribed during visits increased over time for both full-criteria and NOS diagnoses, but the increase was greater for NOS visits, specifically for antipsychotics, anticonvulsants-mood stabilizers, and lithium. By 2007-2010, psychotropic monotherapy and multidrug regimens were comparable for full-criteria and NOS diagnoses.
  
  
  CONCLUSIONS
  The proportion of U.S. physician visits with an NOS psychiatric diagnosis increased to nearly 50% in 2007-2010. The increase raises concerns about the precision of psychiatric diagnoses in community care and about the impact on concomitant medication regimens.
authors.affiliation: Dr. Rajakannan, Mr. Burcu, and Dr. Zito are with the Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore. Dr. Zito is also with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Dr. Safer is with the Department of Psychiatry and Pediatrics, Johns Hopkins University School of Medicine, Baltimore. Send correspondence to Dr. Safer (e-mail: dsafer@jhmi.edu ).
authors.forename: Thiyagu
authors.initials: T
authors.lastname: Rajakannan
authors.affiliation: Dr. Rajakannan, Mr. Burcu, and Dr. Zito are with the Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore. Dr. Zito is also with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Dr. Safer is with the Department of Psychiatry and Pediatrics, Johns Hopkins University School of Medicine, Baltimore. Send correspondence to Dr. Safer (e-mail: dsafer@jhmi.edu ).
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Safer
authors.affiliation: Dr. Rajakannan, Mr. Burcu, and Dr. Zito are with the Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore. Dr. Zito is also with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Dr. Safer is with the Department of Psychiatry and Pediatrics, Johns Hopkins University School of Medicine, Baltimore. Send correspondence to Dr. Safer (e-mail: dsafer@jhmi.edu ).
authors.forename: Mehmet
authors.initials: M
authors.lastname: Burcu
authors.affiliation: Dr. Rajakannan, Mr. Burcu, and Dr. Zito are with the Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore. Dr. Zito is also with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Dr. Safer is with the Department of Psychiatry and Pediatrics, Johns Hopkins University School of Medicine, Baltimore. Send correspondence to Dr. Safer (e-mail: dsafer@jhmi.edu ).
authors.forename: Julie Magno
authors.initials: JM
authors.lastname: Zito
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data; D000927:Anticonvulsants / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000188:drug therapy*; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data / Q000639:trends*; D010045:Outpatients / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D011619:Psychotropic Drugs