Prescribing of antipsychotics in UK primary care: a cohort study
Louise Marston, Irwin Nazareth, Irene Petersen, Kate Walters, David P J Osborn.
Antipsychotics are first line treatment for schizophrenia and other psychoses and increasingly prescribed for bipolar affective disorder. They are not routinely recommended for other mental health conditions such as depression, anxiety and especially dementia. Antipsychotics may be associated with a range of side effects; so people taking them should have their weight, cholesterol and glucose monitored regularly. We looked at anonymised general practice records of people prescribed antipsychotics between 2007 and 2011. One percent of people registered with a general practice received an antipsychotic. These medications were more likely to be prescribed to females, older people and people from poorer areas. Most took the newer types of (second generation) antipsychotics, but almost a third was prescribed the older (first generation) antipsychotics. More than half of those receiving first generation antipsychotics did not have a diagnosis schizophrenia, other psychotic conditions or bipolar affective disorder, in their records. Many people had other diagnoses in their notes. For example in those taking the newer antipsychotic risperidone 14% had anxiety recorded, 22% had depression, 12% dementia. People with schizophrenia tended to be on higher doses and for longer periods of time than those with other diagnoses. We conclude that many people are prescribed antipsychotics without having a diagnosis of psychoses or bipolar disorder. They should be monitored for side effects including weight gain, poor glucose control, and increased cholesterol. There should also be more effort to decrease antipsychotic prescribing in people with dementia, since this is not recommended by guidelines.