Di Leone Flavio, Steingrimsson Steinn, Carlsen Hanne Krage, Liljedahl Sophie I, Sand Peter
Department of Psychiatry for Affective Disorders, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
Section of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
BMC Psychiatry. 2025 Apr 1;25(1):314. doi: 10.1186/s12888-025-06716-4.
The purpose of this study was to examine trends in prescribing practices for individuals diagnosed with personality disorders (PD) over a 10-year period in a major metropolitan area in Sweden. Our aim was to assess the alignment of prescribing patterns with national clinical guidelines.
A register analysis was conducted on 26,520 pharmacological prescriptions from patients' Electronic Health Records (EHRs), documented between January 2011 and December 2020. The study compared the annual proportion of prescriptions across various psychotropic medication classes over time between individuals diagnosed with PD alone and those diagnosed with PD and co-occurring clinical conditions. Additionally, polypharmacy (≥ 3 psychiatric medications) was investigated in both groups.
The proportion of individuals diagnosed with PD alone who received medication increased significantly over the study period. No significant changes were observed in polypharmacy, which remained prevalent in both groups. In the PD alone group, significant negative trends were observed in prescriptions for antidepressants, mood stabilizers, and benzodiazepine derivatives, while stimulant prescriptions rose significantly. In contrast, non-benzodiazepine sedatives and antipsychotics increased significantly in the group with co-occurring conditions.
Our study indicates mixed adherence to Swedish national prescribing guidelines for PD. While there was alignment with recommendations, such as reduced benzodiazepine use, challenges remain in addressing polypharmacy and the prescribing of medications without clear indications, particularly in individuals without comorbidities. These findings emphasize the need for improved diagnostic accuracy, ongoing clinician education, and the integration of prescribing data with diagnostic and treatment records. Future research should explore prescribing practices across various clinical settings and assess the influence of psychopharmacological trends on prescribing, while also defining polypharmacy in the context of personality disorders to guide clinical practice.
本研究的目的是调查瑞典一个主要大都市地区在10年期间被诊断为患有精神障碍（PD）的个体的处方用药趋势。我们的目的是评估处方模式与国家临床指南的一致性。
对2011年1月至2020年12月期间记录在患者电子健康记录（EHR）中的26520份药理处方进行了登记分析。该研究比较了仅被诊断为PD的个体与被诊断为PD且伴有其他临床疾病的个体在不同精神药物类别上随时间的年度处方比例。此外，还对两组中的多药联用情况（≥3种精神科药物）进行了调查。
在研究期间，仅被诊断为PD且接受药物治疗的个体比例显著增加。多药联用情况未观察到显著变化，两组中多药联用情况仍然普遍。在仅患有PD的组中，抗抑郁药、心境稳定剂和苯二氮䓬衍生物的处方呈显著负趋势，而兴奋剂处方显著增加。相比之下，在伴有其他疾病的组中，非苯二氮䓬类镇静剂和抗精神病药物显著增加。
我们的研究表明，在瑞典关于PD的国家处方指南的遵循情况参差不齐。虽然与一些建议相符，如减少苯二氮䓬类药物的使用，但在解决多药联用以及无明确适应症的药物处方方面仍存在挑战，特别是在无合并症的个体中。这些发现强调了提高诊断准确性、持续开展临床医生教育以及将处方数据与诊断和治疗记录相结合的必要性。未来的研究应探索不同临床环境中的处方实践，并评估精神药理学趋势对处方的影响，同时在人格障碍的背景下定义多药联用，以指导临床实践。
