scholarly journals Quetiapine: off-label prescribing in a community mental health team

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S63-S64
Author(s):  
Ala Abdelgadir ◽  
Richard Walsh ◽  
Elizabeth Walsh ◽  
Sonn Patel
Keyword(s):  
Mental Health ◽  
Psychotic Disorders ◽  
Prescribing Patterns ◽  
Low Doses ◽  
Off Label Use ◽  
Mental Health Team ◽  
Off Label ◽  
Health Team ◽  
Icd 10 ◽  
Label Use

AimsQuetiapine is an atypical anti-psychotic medication licensed for the treatment of schizophrenia, bipolar disorder and adjunctive use in major depressive disorder. It's off-label use in low doses is increasing, possibly due to its sedative qualities, tolerability, low risk of extrapyramidal symptoms and to limit the unnecessary use of benzodiazepines. However, previous research highlights the risk of metabolic consequences even in low doses. Our aim is to establish the prescribing patterns and off-label use of quetiapine within a complete comminity mental health team population (CMHT).MethodThe GR1 CMHT provides care to a population of 25,000 people in a mixed urban and rural area. Multi-disciplinary case notes for all registered patients were reviewed for a one-year period. A database was created to include sociodemographic details, diagnosis, and medication. The proportion of patients prescribed quetiapine was identified and the dosage divided into multiple increments. The team's consultant reviewed and verified all ICD-10 diagnoses. Quetiapine dose by diagnosis was examined using descriptive statistics.ResultOf 246 registered patients, 62 (25% of CMHT caseload) were prescribed Quetiapine. Quetiapine was prescribed across a range of disorders including psychotic 17 (27%), mood 18 (29%), anxiety 14 (22 %), personality disorders 11 (18%) and others 2 (3%). Doses spanned between 25 mg – 800 mg daily. 19 patients (31%) were prescribed less than 25 mg, 20 patients (32%) between 25 mg and 100 mg and 23 patients (37%) above 100 mg. In psychotic and mood disorders, dosage varied widely between the low and high range. Furthermore, of the psychotic disorders, 11 (65%) were prescribed a second antipsychotic medication. For diagnoses in which the prescribing indication was clearly off-label, the dosages were predominantly low (100 mg or less).ConclusionQuetiapine was commonly prescribed in our patient population. Its frequent off-label use in low doses suggests that its prescription was for its additional qualities. Our findings highlight the importance of assessing the risk-benefit profile for every patient given the potential side effects, involving patients in the consultation of its off-label use and appropriate monitoring.

scholarly journals Review of antipsychotic prescribing at HMP/YOI Low Newton

2020 ◽  
pp. 1-7
Author(s):  
Lois Carey ◽  
Stephen Barlow
Keyword(s):  
Mental Health ◽  
Antipsychotic Medication ◽  
Best Practice ◽  
Psychotic Disorders ◽  
Psychotropic Medications ◽  
Clinical Implications ◽  
Mental Health Team ◽  
Antipsychotic Medications ◽  
Off Label ◽  
Health Team

Aims and Method The purpose of this review was to establish whether the prescription of antipsychotic medication in HMP Low Newton was safe, rational and consistent with current best practice. A search of the electronic healthcare records was performed on 14 March 2018 to identify all the women in the prison who were prescribed antipsychotic medication, and then data were collected from the records. Results A total of 46 out of 336 prisoners (13.7%) had been prescribed antipsychotic medications; 29 of the 46 patients (84.8%) were also prescribed other psychotropic medications at the same time. Quetiapine was the most frequently prescribed antipsychotic and was also the most likely to be prescribed for off-label indications. Less than one-third of all antipsychotic prescriptions were for psychotic disorders. Clinical implications The rationale for prescribing all antipsychotic medication, especially for off-label indications, should be clearly documented and reviewed regularly within the prison by the mental health team and psychiatrist.

scholarly journals Off-label prescribing by psychiatrists

2006 ◽  
Vol 30 (2) ◽  
pp. 55-57 ◽  
Author(s):  
Richard Hodgson ◽  
Ravindra Belgamwar
Keyword(s):  
One Health ◽  
Atypical Antipsychotics ◽  
Clinical Excellence ◽  
Prescribing Patterns ◽  
Best Interests ◽  
Off Label Use ◽  
Economic Implications ◽  
Off Label ◽  
Icd 10 ◽  
Label Use

Aims and MethodTo report on the use of atypical antipsychotics in one health district by examining secondary care prescribing patterns for these medicines in North Staffordshire between 1994 and 2001. With one exception, these drugs were licensed solely for use in schizophrenia during the study period.ResultsA total of 502 patients were initiated on atypical antipsychotics in the study period. Of these, 297 (59.2%) had a diagnosis of schizophrenia (ICD–10 codes F20–29). Off-label prescribing was common, but psychiatrists were least likely to prescribe clozapine off-label (2.2%). Affective (18.4%) and organic disorders (12.4%) were the main disorders treated off-label. Olanzapine had the highest off-label use (44.5%).Clinical ImplicationsThe high off-label use of atypical antipsychotics has clinical and economic implications. Although off-label prescribing may be in the patient's best interests, they should be informed and give their consent. Commissioning bodies, such as primary care organisations, are basing their budgets on guidance from the National Institute for Clinical Excellence, which can have implications for funding this off-label use.

scholarly journals Patient factors associated with the use of psychotropic polypharmacy in patients under the care of a community mental health team in the West of Ireland

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S106-S106
Author(s):  
Karthika Srikumar ◽  
Richard Walsh ◽  
Donnchadh Walsh ◽  
Sonn Patel ◽  
Sheila O'Sullivan
Keyword(s):  
Mental Health ◽  
Community Mental Health ◽  
Psychotic Disorders ◽  
Drug Regimen ◽  
Psychotropic Medications ◽  
Community Mental Health Team ◽  
Patient Factors ◽  
Mental Health Team ◽  
Health Team ◽  
Factors Associated

AimsPsychiatric polypharmacy refers to the prescription of two or more psychotropic medications to any one patient. This definition is purely quantitative and does not take into account whether such a prescription is detrimental, or unnecessary. In many cases, polypharmacy has been implemented in challenging illnesses, and some studies have shown that it can improve overall outcomes for certain patients. Evidence suggests that the prevalence of psychotropic polypharmacy is increasing, despite advances in psychosocial interventions. The aim of this study was to assess the current prevalence of polypharmacy among patients being treated by a community mental health team (CMHT), and the patient factors associated with its use.MethodWe performed a cross-sectional study of all patients registered with a CMHT in a mixed urban/rural area on a single date. Case records were examined to determine the most recently prescribed drug regimen for each patient. Clinical chart diagnoses were recorded and each one independently verified by the team consultant using ICD-10. A number other sociodemographic variables were recorded. Using Microsoft Excel, we analysed the medications prescribed as well as rates and levels of polypharmacy based on multiple different patient characteristics.ResultOf the 245 patients, the mean age was 56.3 and 51.2% (n = 126) were female. Psychotropic polypharmacy was seen in 62% (n = 152) of patients. 33% (n = 82) of patients were on two psychotropic medications, and of this subset, a combination of one antipsychotic and one antidepressant was the most common drug regimen, seen in 16.7% (n = 41) of all patients. Polypharmacy was more prevalent in females, with 68% (n = 85) being on two or more psychotropics, in comparison to 58% of male patients. In relation to age, patients aged between 51 to 65 years had the highest prevalence of polypharmacy, at a rate of 71% (n = 49). Among all primary diagnoses, polypharmacy was most common in patients with affective disorders, with 80% (n = 40) of this patient cohort on two or more medications. Second to this was psychotic disorders, with polypharmacy seen in 65% (n = 62) of this group.ConclusionWe found that psychotropic polypharmacy is highly prevalent in psychiatric patients being treated in a community setting. Certain demographics and patient factors, such as age, gender and psychiatric diagnosis influenced the rate of polypharmacy and certain drug combinations were more commonly prescribed than others.

scholarly journals Three months in the life of a community mental health team

1994 ◽  
Vol 18 (10) ◽  
pp. 615-617 ◽  
Author(s):  
Jan Scott ◽  
Sara McCluskey ◽  
Lesley Smith
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
Psychotic Disorders ◽  
Community Services ◽  
Community Mental Health Team ◽  
Community Based ◽  
Mental Health Team ◽  
Referral Patterns ◽  
Health Team

An audit was undertaken to assess the efficacy and efficiency of a community-based mental health service which attempts to prioritise the care of those with severe and enduring disorders. Referral patterns over a three month period and change in case-load over the subsequent 12 months were recorded. Seventy-five per cent of new referrals met the priority group criteria, allaying anxieties that community services unceasingly get drawn to the care of those with less severe disorders. Furthermore, at 12 months the service had maintained contact with all patients previously admitted to hospital and all those presenting with psychotic disorders (27% referrals). Some changes in service structure are also suggested as a result of this evaluation.

Off-Label Drug Use in Pediatric Out-Patient Care: A Multi-Center Observational Study

2020 ◽  
pp. 001857872094222
Author(s):  
Aeshah AlAzmi ◽  
Zahra Alasmari ◽  
Consuela Yousef ◽  
Ahmed Alenazi ◽  
Mohammed AlOtaibi ◽  
...  
Keyword(s):  
Drug Use ◽  
Observational Study ◽  
Pediatric Population ◽  
Prescribing Patterns ◽  
Off Label Use ◽  
Kingdom Of Saudi Arabia ◽  
Off Label ◽  
High Incidence ◽  
Study Support ◽  
Label Use

Objective: Prescribing a drug for a child is not an easy task and requires using the best available evidence as a guide, especially when a drug is used off-label. The practice of prescribing a drug for off-label use is fairly widespread worldwide. The FDA does not regulate prescribing patterns or practices of individual practitioners and, therefore, allows off-label use. The main objective of this study is to evaluate off-label prescribing among the pediatric population in the Kingdom of Saudi Arabia (KSA). Method: This is a retrospective, simple random selection observational study of children (≤15 years) who visited pediatric clinics and had at least 1 drug prescribed over a 12-month period (January to December 2018). Results: A total of 865 drugs (mean 1 and SD 0.24) were prescribed to 326 children. Off-label was identified in 39.4% of the drugs with a frequency of 512 (as 1 drug may belong to more than 1 off-label category). The most common reason for off-label prescribing was related to doses that were “higher or lower than the recommended use” (48.6%), and the most frequently identified drug class prescribed for off-label use was anti-infective drugs for systemic use (39.9%). The percentage of off-label drug use was found to be higher in girls and in the age group of 1 month to 2 years ( P = .001) for both variables. In addition, a significant association was found between off label drug use and the total number of drugs prescribed, P < .001. Conclusion: The findings of this study showed a high incidence of off-label prescribing mainly related to dosing and indication. The results of this observational study support the need to establish a unified national pediatric dosing formulary guide to ensure safe drug use in pediatrics.

Multicenter Postmarketing Surveillance of Ondansetron Therapy in Pediatric Patienrs

1994 ◽  
Vol 28 (1) ◽  
pp. 85-92 ◽  
Author(s):  
Kellie D. McQueen ◽  
Jerrod D. Milton
Keyword(s):  
Adverse Reactions ◽  
Prescribing Patterns ◽  
Off Label Use ◽  
Free Standing ◽  
Children's Hospitals ◽  
Off Label ◽  
Children’S Hospitals ◽  
Significant Difference ◽  
Hospital Patients ◽  
Label Use

OBJECTIVE: To identify prescribing patterns of ondansetron, to provide a general overview of the therapeutic responses and possible adverse effects to ondansetron in selected children's hospitals, and to evaluate this methodology of surveillance and assess its effectiveness as a means to collect postmarketing experience with a drug in pediatric patients. DESIGN: This survey examined the use of ondansetron in 210 children. Complete drug and medical histories, indications, doses, possible ondansetron-associated adverse reactions, and daily responses to ondansetron therapy were recorded by a study pharmacist for each patient. Patients were followed until discharged from the clinic or hospital and/or until ondansetron therapy was discontinued. SETTING: The survey was conducted in seven free-standing children's hospitals across the US. Hospitals ranged in size from 100 to 331 beds (average 234). One hospital was located on the West coast, one on the East coast, one in the Rocky Mountain region, one in the Southwest region, and three in the Midwest. PARTICIPANTS: The selection of study participants was limited to member free-standing children's hospitals of the Pediatric Pharmacy Administrative Group. Selection was based on geographic location and availability of a pharmacist to coordinate the study. One pharmacist at each study site served as surveillance coordinator. Each pharmacist monitored without intervention the use of ondansetron in 30 children. Patients were enrolled consecutively from physicians' orders for ondansetron. Enrollment was open to clinic and hospital patients. Patients were excluded if more than 48 hours of retrospective review was required. MAIN OUTCOME MEASURES: The survey queried patient demographics, type of antineoplastic therapy administered, indications and dosing regimen(s) for ondansetron, additional antiemetic agents administered, and clinical response. Adverse drug reactions and prescriptions for ondansetron on discharge were recorded. An evaluation of response rates in hospital patients based on exposure to antineoplastic regimens causing acute (within 24 h) or delayed emesis (after 24 h) was formulated after data collection. Off-label use was summarized. RESULTS: Surveys from 197 of the 210 patients enrolled were complete for evaluation. Ondansetron was used to treat chemotherapy-induced emesis in 88 percent of the patients and 12 percent received it for various other indications. Ondansetron dosing was off-label in 15 percent and 73 percent prior to and after an emetogenic exposure, respectively. Twenty-six percent of the patients were younger than four years. Dosages ranged from 0.15 to 0.45 mg/kg, given in various schedules. The injectable form was given both intravenously and orally. There was a significant difference in the mean number of doses in hospital (9 ± 7.3) versus clinic (2 ± 1.5) patients (p<0.0001). Eighty-seven percent of all patients had a complete or major overall response. Possible ondansetron-associated adverse reactions were similar to those of previous reports for all patients, although some recorded reactions are not currently included in package labeling. CONCLUSIONS: This study documents off-label use of ondansetron in children. Further study of ondansetron use in children less than four years of age, and for indications other than chemotherapy-induced emesis, is needed. Additional evaluation into the most cost-effective dosing of ondansetron would also be valuable.

Sign in / Sign up

Export Citation Format

Share Document