Woodall Alan, Gampel Alex, Walker Lauren E, Mair Frances S, Sheard Sally, Symon Pyers, Buchan Iain
Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool; clinical lead for integrated care, Powys Teaching Health Board, Bronllys, Powys.
Powys Teaching Health Board, Bronllys, Powys.
Br J Gen Pract. 2024 Dec 26;75(750):e68-e79. doi: 10.3399/BJGP.2024.0367. Print 2025 Jan.
Long-term use of antipsychotics confers increased risk of cardiometabolic disease. Ongoing need should be reviewed regularly by psychiatrists.
To explore trends in antipsychotic management in general practice, and the proportions of patients prescribed antipsychotics receiving psychiatrist review.
Serial cross-sectional study using linked general practice and hospital data in Wales (2011-2020).
Participants were adults (aged ≥18 years) registered with general practices in Wales. Outcome measures were prevalence of patients receiving ≥6 antipsychotic prescriptions annually, the proportion of patients prescribed antipsychotics receiving annual psychiatrist review, and the proportion of patients prescribed antipsychotics who were registered on the UK serious mental illness, depression, and/or dementia registers, or not on any of these registers.
Prevalence of adults prescribed long-term antipsychotics increased from 1.055% (95% confidence interval [CI] = 1.041 to 1.069) in 2011 to 1.448% (95% CI = 1.432 to 1.464) in 2020. The proportion receiving annual psychiatrist review decreased from 59.6% (95% CI = 58.9 to 60.4) in 2011 to 52.0% (95% CI = 51.4 to 52.7) in 2020. The proportion of overall antipsychotic use prescribed to patients on the serious mental illness register decreased from 50.0% (95% CI = 49.4 to 50.7) in 2011 to 43.6% (95% CI = 43.0 to 44.1) by 2020.
Prevalence of long-term antipsychotic use is increasing. More patients are managed by GPs without psychiatrist review and are not on monitored disease registers; they thus may be less likely to undergo cardiometabolic monitoring and miss opportunities to optimise or deprescribe antipsychotics. These trends pose risks for patients and need to be addressed urgently.
长期使用抗精神病药物会增加患心脏代谢疾病的风险。精神科医生应定期评估持续用药的必要性。
探讨全科医疗中抗精神病药物管理的趋势,以及接受精神科医生评估的抗精神病药物处方患者的比例。
采用威尔士2011 - 2020年全科医疗与医院的关联数据进行系列横断面研究。
参与者为在威尔士全科医疗注册的成年人(年龄≥18岁)。观察指标包括每年接受≥6次抗精神病药物处方的患者患病率、接受精神科医生年度评估的抗精神病药物处方患者比例,以及在英国严重精神疾病、抑郁症和/或痴呆症登记册上登记或未在任何这些登记册上登记的抗精神病药物处方患者比例。
2011年长期使用抗精神病药物的成年人患病率为1.055%(95%置信区间[CI]=1.041至1.069),到2020年增至1.448%(95% CI = 1.432至1.464)。接受精神科医生年度评估的比例从2011年的59.6%(95% CI = 58.9至60.4)降至2020年的52.0%(95% CI = 51.4至52.7)。在严重精神疾病登记册上的患者中,抗精神病药物总体使用比例从2011年的50.0%(95% CI = 49.4至50.7)降至2020年的43.6%(95% CI = 43.0至44.1)。
长期使用抗精神病药物的患病率正在上升。更多患者由全科医生管理,未接受精神科医生评估,且未在监测疾病登记册上登记;因此,他们接受心脏代谢监测的可能性较小,错过优化或减少抗精神病药物处方的机会。这些趋势给患者带来风险,需要紧急解决。