Lücke Caroline, Gschossmann Jürgen M, Grömer Teja W, Moeller Sebastian, Schneider Charlotte E, Zikidi Aikaterini, Philipsen Alexandra, Müller Helge H O
Medical Campus University of Oldenburg, School of Medicine and Health Sciences, Psychiatry and Psychotherapy-University Hospital, Karl-Jaspers-Klinik, Hermann-Ehlers-Straße 7, 26160 Bad Zwischenahn, Germany.
Department of Internal Medicine, Klinikum Forchheim, Forchheim, Germany.
Ann Gen Psychiatry. 2018 Feb 8;17:7. doi: 10.1186/s12991-018-0176-4. eCollection 2018.
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.
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.
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 ( = 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.
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.
精神活性药物的超说明书用药在精神病学中是一种常见做法。在此，我们试图调查患有躯体疾病且同时患有精神疾病的住院患者中超说明书用药的频率。
采用前瞻性观察设计，我们收集了982例因存在额外精神症状而被要求进行精神科会诊的患有躯体疾病的住院患者的数据。数据收集于德国的三家医院。记录并分析了人口统计学和临床数据，包括先前的精神活性药物以及对先前药物适用性的评估。
972例患者有先前精神科用药的数据。16.6%的患者至少有一种精神活性药物是超说明书用药，20.2%的患者接受了说明书用药，63.2%的患者未接受任何精神科药物治疗。在所有接受精神科药物治疗的患者中，45.1%接受了超说明书用药。逻辑回归分析显示年龄对接受超说明书用药的可能性有显著影响（P = 0.018）。苯二氮䓬类药物是最常见的超说明书处方药物（占超说明书处方的25.8%），其次是非典型抗精神病药物（18.2%）和低效价抗精神病药物（17.2%）。值得注意的是，57.1%的超说明书处方被经验丰富的精神科医生判定为“不适用”。
我们的数据显示，综合医院中治疗躯体疾病患者的医生超说明书开具精神活性药物的频率很高。由于这些病例中有一半以上被判定为“不适用”，这些处方对患者存在潜在风险。此外，最常被超说明书处方的药物类别，即苯二氮䓬类药物和抗精神病药物，都显示出相当大的风险，尤其是对老年患者。
