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Off-label prescription of psychiatric drugs by non-psychiatrist physicians in three general hospitals in Germany
BACKGROUND: Off-label prescribing of psychoactive drugs is a common practice in psychiatry. Here, we sought to investigate the frequency of off-label prescribing in a population of hospitalized patients with a somatic illness who were also suffering from a psychiatric pathology. METHODS: Using a pro...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5806239/ https://www.ncbi.nlm.nih.gov/pubmed/29449869 http://dx.doi.org/10.1186/s12991-018-0176-4 |
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author | Lücke, Caroline Gschossmann, Jürgen M. Grömer, Teja W. Moeller, Sebastian Schneider, Charlotte E. Zikidi, Aikaterini Philipsen, Alexandra Müller, Helge H. O. |
author_facet | Lücke, Caroline Gschossmann, Jürgen M. Grömer, Teja W. Moeller, Sebastian Schneider, Charlotte E. Zikidi, Aikaterini Philipsen, Alexandra Müller, Helge H. O. |
author_sort | Lücke, Caroline |
collection | PubMed |
description | BACKGROUND: Off-label prescribing of psychoactive drugs is a common practice in psychiatry. Here, we sought to investigate the frequency of off-label prescribing in a population of hospitalized patients with a somatic illness who were also suffering from a psychiatric pathology. METHODS: Using a prospective, observational design, we collected data from 982 hospitalized patients with a somatic illness for whom a psychiatric consultation was requested because of the presence of additional psychiatric symptoms. Data were collected at three hospitals in Germany. Demographic and clinical data, including the previous psychoactive medications and an assessment of the suitability of the previous medications, were recorded and analyzed. RESULTS: Data on the previous psychiatric medications were available for 972 patients. In 16.6% of patients, at least one psychoactive drug had been prescribed off-label, 20.2% had received on-label medication, and 63.2% had not received any psychiatric medication. Among all patients receiving psychiatric medication, 45.1% had received off-label medication. The logistic regression analysis showed a significant influence of age on the likelihood of receiving off-label medication (p = 0.018). Benzodiazepines were the most frequent off-label prescription (25.8% of off-label prescriptions), followed by atypical antipsychotics (18.2%) and low-potency antipsychotics (17.2%). Notably, 57.1% of off-label prescriptions were judged to be ‘not indicated’ by experienced psychiatrists. CONCLUSIONS: Our data show a high frequency of the off-label prescription of psychoactive drugs by physicians treating patients with somatic illnesses in general hospitals. Because more than half of these cases were judged to be “not indicated”, these prescriptions indicate a potential risk to patients. Furthermore, the classes of drugs that were most frequently prescribed off-label, benzodiazepines and antipsychotics, both show a substantial risk profile, particularly for elderly patients. |
format | Online Article Text |
id | pubmed-5806239 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-58062392018-02-15 Off-label prescription of psychiatric drugs by non-psychiatrist physicians in three general hospitals in Germany Lücke, Caroline Gschossmann, Jürgen M. Grömer, Teja W. Moeller, Sebastian Schneider, Charlotte E. Zikidi, Aikaterini Philipsen, Alexandra Müller, Helge H. O. Ann Gen Psychiatry Primary Research BACKGROUND: Off-label prescribing of psychoactive drugs is a common practice in psychiatry. Here, we sought to investigate the frequency of off-label prescribing in a population of hospitalized patients with a somatic illness who were also suffering from a psychiatric pathology. METHODS: Using a prospective, observational design, we collected data from 982 hospitalized patients with a somatic illness for whom a psychiatric consultation was requested because of the presence of additional psychiatric symptoms. Data were collected at three hospitals in Germany. Demographic and clinical data, including the previous psychoactive medications and an assessment of the suitability of the previous medications, were recorded and analyzed. RESULTS: Data on the previous psychiatric medications were available for 972 patients. In 16.6% of patients, at least one psychoactive drug had been prescribed off-label, 20.2% had received on-label medication, and 63.2% had not received any psychiatric medication. Among all patients receiving psychiatric medication, 45.1% had received off-label medication. The logistic regression analysis showed a significant influence of age on the likelihood of receiving off-label medication (p = 0.018). Benzodiazepines were the most frequent off-label prescription (25.8% of off-label prescriptions), followed by atypical antipsychotics (18.2%) and low-potency antipsychotics (17.2%). Notably, 57.1% of off-label prescriptions were judged to be ‘not indicated’ by experienced psychiatrists. CONCLUSIONS: Our data show a high frequency of the off-label prescription of psychoactive drugs by physicians treating patients with somatic illnesses in general hospitals. Because more than half of these cases were judged to be “not indicated”, these prescriptions indicate a potential risk to patients. Furthermore, the classes of drugs that were most frequently prescribed off-label, benzodiazepines and antipsychotics, both show a substantial risk profile, particularly for elderly patients. BioMed Central 2018-02-08 /pmc/articles/PMC5806239/ /pubmed/29449869 http://dx.doi.org/10.1186/s12991-018-0176-4 Text en © The Author(s) 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Primary Research Lücke, Caroline Gschossmann, Jürgen M. Grömer, Teja W. Moeller, Sebastian Schneider, Charlotte E. Zikidi, Aikaterini Philipsen, Alexandra Müller, Helge H. O. Off-label prescription of psychiatric drugs by non-psychiatrist physicians in three general hospitals in Germany |
title | Off-label prescription of psychiatric drugs by non-psychiatrist physicians in three general hospitals in Germany |
title_full | Off-label prescription of psychiatric drugs by non-psychiatrist physicians in three general hospitals in Germany |
title_fullStr | Off-label prescription of psychiatric drugs by non-psychiatrist physicians in three general hospitals in Germany |
title_full_unstemmed | Off-label prescription of psychiatric drugs by non-psychiatrist physicians in three general hospitals in Germany |
title_short | Off-label prescription of psychiatric drugs by non-psychiatrist physicians in three general hospitals in Germany |
title_sort | off-label prescription of psychiatric drugs by non-psychiatrist physicians in three general hospitals in germany |
topic | Primary Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5806239/ https://www.ncbi.nlm.nih.gov/pubmed/29449869 http://dx.doi.org/10.1186/s12991-018-0176-4 |
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