Patterns of neuroleptic drug prescription: a national cross-sectional survey of a random sample of French psychiatrists (original) (raw)

2001, British Journal of Clinical Pharmacology

To describe the psychiatric indications of neuroleptics (especially the relative share of schizophrenic and other psychotic disorders) and the usage patterns of these drugs (dose, duration, coprescriptions). Methods A one-day national cross-sectional survey in a random sample of 723 French psychiatrists was carried out in 1996. Each psychiatrist was asked to complete a standardized questionnaire for the first three patients seen the day of the survey to whom at least one neuroleptic was prescribed (initiated or renewed). Results One thousand seven hundred and fifty-four questionnaires were returned. Three quarters of the patients (74%) were psychotic (664 with schizophrenia, and 636 other psychosis), 19.3% were depressive and 6.7% had other psychiatric disorders. Phenothiazines were the most often prescribed (40.8%), followed by butyrophenones (22.5%), benzamides (15.8%), other neuroleptics (14.8%) and thioxanthenes (6.1%). Among schizophrenic subjects, an average number of 1.54 (95% CI: 1.50-1.60) neuroleptics were prescribed per patient, compared with 1.4 (95% CI: 1.32-1.41) and 1.2 (95% CI: 1.14-1.23) in other psychotic and depressive subjects, respectively. Regardless of the indication, non-neuroleptic psychotropic drugs were coprescribed in 75.4%, mainly benzodiazepines (75.7%). Adjuvant drugs used in prevention or treatment of side-effects were coprescribed in 46.7%, mostly anticholinergic antiparkinsonians (86.1%). Conclusions Neuroleptics are mainly prescribed for psychotic disorders and especially schizophrenia. However, current recommendations are not always followed.

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The Use of Atypical Neuroleptics in Drugs Management in Fann’s Psychiatry Department

Open Journal of Psychiatry, 2021

Background and Objectives: Neuroleptics have revolutionized pharmacological management in psychiatry. The advent of atypical neuroleptics constitutes a major turning point in this therapeutic challenge. The objective of our study was to determine the prescription of these atypical neuroleptics in Fann's psychiatry department. Methodology: It was a descriptive retrospective cross-sectional study that involved 223 patients hospitalized in the psychiatry department of Fann Hospital during the period from January 2015 to December 2017. Results: Our study shows a majority prescription of classic neuroleptics in combination Haloperidol-Chlorpromazine 53% and 14% in monotherapy and a prescription of atypical neuroleptics at 4%. They are prescribed in combination with the classics at 4%. Conclusion: These results show a still low prescription of atypical neuroleptics which raises questions about the availability and affordability of such drugs, but also about prescription habits in the context of developing country.

Atypical and typical neuroleptics in acute schizophrenia and related delusional disorders

European Archives of Psychiatry and Clinical Neuroscience, 2003

Atypical neuroleptics have improved drug treatment in schizophrenia. However, their use varies greatly between countries and continents. Recent metaanalyses have deemphasized the range and magnitude of their superiority compared to typical neuroleptics. Aims of the present study were to contribute effectiveness data to this discussion. In 725 inpatients with ICD-10 diagnoses F20, 22-25 from four German psychiatric inpatient units acute neuroleptic treatment and outcome were analyzed under naturalistic conditions. Treatment strategies were stratified post hoc to answer the question, which proportion-and which kind-of patients are primarily given atypicals or typicals, for how long, at which rate and when the atypical/typical drugs are switched to typical/atypical drugs, and what the respective outcomes are. As the results demonstrate, atypicals were administered one time during inpatient treatment in nearly 48 % of the patients, however as first choice drugs in only 15 % of this population. Treatment change occurred in 28 % after 5-6 weeks irrespective of the first drug choice. Outcome differences were, if at all, only modest and not systematically biased towards a single strategy. In conclusion, frequency of inpatient treatment with atypical neuroleptics corresponds to pharmaco-epidemiological data in Europe, but is still lower than in the US. Contrary to contemporary guideline recommendations atypical neuroleptics under routine inpatient treatment conditions were scarcely administered as first choice treatment, and acute clinical outcome is comparable to that under treatment with typical neuroleptics. Reasons and implications of these findings considering the methodological limitations are discussed. s Key words schizophrenia • acute drug treatment • treatment guidelines • typical and atypical neuroleptics • drug switching

Psychotic Disorders, Definition, Sign and Symptoms, Antipsychotic Drugs, Mechanism of Action, Pharmacokinetics Pharmacodynamics with Side Effects Adverse Drug Reactions: Updated Systematic Review Article

Journal of Drug Delivery and Therapeutics

Psychosis is a mental disorder characterized by a disconnection from reality. Psychosis is a group of disorder characterized by thought disorder, abnormal behaviour, defective cognition, delusion and hallucination. Adverse drug reaction is defined as any undesired or unintended effects of drugs treatment. According to the World Health Organization (WHO)- “adverse drug reaction (ADRs) has been defined one which is noxious and unintended, and which occurs at doses normally used in man for prophylaxis, diagnosis, or therapy of disease, or modification of physiological function”. Adverse drug reactions are the most important causes of the mortality and morbidity. Antipsychotics are the most effective drugs which are used in the psychiatry in the maintenance therapy of mania, psychoses and schizophrenia. The antipsychotics drugs are chemically disparate but have the common property of alleviating the symptoms of organic as well as functional psychosis. But they also have a capacity to ca...

Pattern of Neuroleptic Drug Use in Italian Mental Health Services

DICP, 1991

The relationship between the prescribed daily dose of neuroleptic (NL) drugs and patient-, and drug-related characteristics was explored in a cross-sectional sample of 1141 patients treated in Italian mental health services. The results of a multiple linear regression showed that the prescribed daily dose was significantly lower in women, the elderly, and those with a shorter (one to six year) psychiatric history. In contrast, being an inpatient in psychiatric wards in general and public mental hospitals was significantly associated with a higher dose; marital status, education, and diagnosis were not. The number and potency (low to moderate vs. high) of the prescribed NLs were also significantly associated with the prescribed dose, and an interaction was found between the two. Implications of these findings for improvement in NL prescription patterns are discussed.

Antipsychotic agents: efficacy and safety in schizophrenia

Drug, healthcare and patient safety, 2012

Antipsychotics have provided a great improvement in the management of people with schizophrenia. The first generation antipsychotics could establish the possibility of managing many psychotic subjects in an outpatient setting. With the advent of the second (SGA) and third generation antipsychotics (TGA), other psychiatric disorders such as bipolar depression, bipolar mania, autism, and major depressive disorder have now been approved for the use of these drugs for their treatment. Also, the administration of more specific assessment tools has allowed for better delineation of the repercussions of these drugs on symptoms and the quality of life of patients who use antipsychotic agents. In general, the SGA share similar mechanisms of action to achieve these results: dopamine-2 receptor antagonism plus serotonin-2A receptor antagonism. The TGA (eg, aripiprazole) have partial agonist activity at the dopamine-2 receptor site, and are also called dopaminergic stabilizers. The pharmacological profile of SGA and TGA may provide better efficacy against negative symptoms, and are less likely to produce extrapyramidal symptoms; however, the SGA and TGA are associated with many other adverse events. The clinician has to balance the risks and benefits of these medications when choosing an antipsychotic for an individual patient.

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