title: Ecological Assessment of Clinicians' Antipsychotic Prescription Habits in Psychiatric Inpatients: A Novel Web- and Mobile Phone-Based Prototype for a Dynamic Clinical Decision Support System.
abstract: Electronic prescribing devices with clinical decision support systems (CDSSs) hold the potential to significantly improve pharmacological treatment management.
  
  
  
  The aim of our study was to develop a novel Web- and mobile phone-based application to provide a dynamic CDSS by monitoring and analyzing practitioners' antipsychotic prescription habits and simultaneously linking these data to inpatients' symptom changes.
  
  
  
  We recruited 353 psychiatric inpatients whose symptom levels and prescribed medications were inputted into the MEmind application. We standardized all medications in the MEmind database using the Anatomical Therapeutic Chemical (ATC) classification system and the defined daily dose (DDD). For each patient, MEmind calculated an average for the daily dose prescribed for antipsychotics (using the N05A ATC code), prescribed daily dose (PDD), and the PDD to DDD ratio.
  
  
  
  MEmind results found that antipsychotics were used by 61.5% (217/353) of inpatients, with the largest proportion being patients with schizophrenia spectrum disorders (33.4%, 118/353). Of the 217 patients, 137 (63.2%, 137/217) were administered pharmacological monotherapy and 80 (36.8%, 80/217) were administered polytherapy. Antipsychotics were used mostly in schizophrenia spectrum and related psychotic disorders, but they were also prescribed in other nonpsychotic diagnoses. Notably, we observed polypharmacy going against current antipsychotics guidelines.
  
  
  
  MEmind data indicated that antipsychotic polypharmacy and off-label use in inpatient units is commonly practiced. MEmind holds the potential to create a dynamic CDSS that provides real-time tracking of prescription practices and symptom change. Such feedback can help practitioners determine a maximally therapeutic drug treatment while avoiding unproductive overprescription and off-label use.
authors.affiliation: Department of Psychiatry, Brest Medical University Hospital at Brest, Brest, France.|UMR CNRS 6285 Lab-STICC, Institut Mines-Telecom, Brest, France.|ERCR SPURBO, Université de Bretagne occidentale, Brest, France.
authors.forename: Sofian
authors.identifier: 0000-0001-9148-6218
authors.initials: S
authors.lastname: Berrouiguet
authors.affiliation: Department of Psychiatry, Fundacion Jimenez Diaz Hospital, Madrid, Spain.
authors.forename: Maria Luisa
authors.identifier: 0000-0002-2497-6353
authors.initials: ML
authors.lastname: Barrigón
authors.affiliation: Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
authors.forename: Sara A
authors.identifier: 0000-0002-0653-9563
authors.initials: SA
authors.lastname: Brandt
authors.affiliation: Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
authors.forename: George C
authors.identifier: 0000-0002-6397-9661
authors.initials: GC
authors.lastname: Nitzburg
authors.affiliation: Department of Psychiatry, Fundacion Jimenez Diaz Hospital, Madrid, Spain.
authors.forename: Santiago
authors.identifier: 0000-0001-7539-724X
authors.initials: S
authors.lastname: Ovejero
authors.affiliation: Department of Psychiatry, Fundacion Jimenez Diaz Hospital, Madrid, Spain.
authors.forename: Raquel
authors.identifier: 0000-0002-1145-4425
authors.initials: R
authors.lastname: Alvarez-Garcia
authors.affiliation: Department of Psychiatry, Fundacion Jimenez Diaz Hospital, Madrid, Spain.
authors.forename: Juan
authors.identifier: 0000-0001-8446-8820
authors.initials: J
authors.lastname: Carballo
authors.affiliation: Department of Psychiatry, Brest Medical University Hospital at Brest, Brest, France.
authors.forename: Michel
authors.identifier: 0000-0002-3071-7673
authors.initials: M
authors.lastname: Walter
authors.affiliation: UMR CNRS 6285 Lab-STICC, Institut Mines-Telecom, Brest, France.
authors.forename: Romain
authors.identifier: 0000-0002-1806-0074
authors.initials: R
authors.lastname: Billot
authors.affiliation: IMT Atlantique, UMR CNRS 6285 Lab-STICC, Technopôle Brest Iroise, Brest, France.
authors.forename: Philippe
authors.identifier: 0000-0001-5014-2347
authors.initials: P
authors.lastname: Lenca
authors.affiliation: Departamento de Estadistica, Universidad Carlos III de Madrid, Madrid, Spain.
authors.forename: David
authors.identifier: 0000-0002-2976-2602
authors.initials: D
authors.lastname: Delgado-Gomez
authors.affiliation: LaTIM - INSERM UMR 1101, Brest Medical University Hospital, Brest, France.
authors.forename: Juliette
authors.identifier: 0000-0003-3948-8632
authors.initials: J
authors.lastname: Ropars
authors.affiliation: Cabaro Soluciones SA, Valladolid, Spain.
authors.forename: Ivan
authors.identifier: 0000-0002-8638-4249
authors.initials: I
authors.lastname: de la Calle Gonzalez
authors.affiliation: INSERM U1061, Université de Montpellier, Montpellier, France.
authors.forename: Philippe
authors.identifier: 0000-0002-6519-8586
authors.initials: P
authors.lastname: Courtet
authors.affiliation: Department of Psychiatry, Fundacion Jimenez Diaz Hospital, Madrid, Spain.
authors.forename: Enrique
authors.identifier: 0000-0002-6963-6555
authors.initials: E
authors.lastname: Baca-García
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D040421:Cell Phone; D020000:Decision Support Systems, Clinical; D011307:Drug Prescriptions; D055695:Electronic Prescribing; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007297:Inpatients; D020407:Internet; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D010818:Practice Patterns, Physicians'; D011618:Psychotic Disorders / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents
keywords: antipsychotic agents; clinical decision-making; mobile applications; off-label use; prescriptions; software