Winter Jonathan D, Kerns J William, Qato Danya M, Wastila Linda, Winter Katherine M, Brandt Nicole, Winter Christopher, Fu Yu-Hua, Elonge Eposi, Reves Sarah R, Bergman C J Christian, Krist Alex H, Etz Rebecca S
Virginia Commonwealth University School of Medicine (JDW, JWK, CW, SRR, AHK), Department of Family Medicine and Population Health, Richmond, VA; Shenandoah Valley Family Practice Residency (JDW, JWK), Front Royal, VA.
Virginia Commonwealth University School of Medicine (JDW, JWK, CW, SRR, AHK), Department of Family Medicine and Population Health, Richmond, VA; Shenandoah Valley Family Practice Residency (JDW, JWK), Front Royal, VA.
Am J Geriatr Psychiatry. 2025 Nov;33(11):1197-1206. doi: 10.1016/j.jagp.2025.07.008. Epub 2025 Jul 26.
Valproate, an anti-seizure medication (ASM) approved for seizures, bipolar mania, and migraine prophylaxis, is increasingly used in nursing homes (NHs) for reasons unclear. Mandated NH reporting of ASMs began in October 2024, a requirement for other psychotropics since 2012. This study surveyed NH clinicians to explain why valproate is prescribed and why such prescribing is increasing.
National cross-sectional survey. Developed by a multidisciplinary team using pilot data and existing literature, conducted anonymously via SurveyMonkey (November 2024-April 2025), and leveraging convenience sampling through crowdsourcing.
United States' NHs.
A total of 159 NH clinician prescribers: 58% female, 73% white; 57% physicians, 43% advanced practice providers; 60% holding geriatric or psychiatric certifications.
Ninety-seven percent of clinicians reported that off-label valproate use for psychiatric symptoms drove observed prevalence increases, while 74% affirmed such use individually. Few clinicians attributed gains to FDA-approved prescribing indications. Eighty-five percent identified efforts to reduce antipsychotics and benzodiazepines as key contributors to increases. Infrequent valproate dose reduction, staffing shortages, and limited access to nonpharmacologic interventions were also highlighted as causative factors. Generally, clinicians consider valproate low-to-moderate risk (93%) and effective for psychiatric symptoms in NHs (77%), though not superior to alternatives.
Clinicians report that perceived increases in NH valproate use are primarily off-label, and may reflect strategies to manage psychiatric symptoms while circumventing regulatory scrutiny emphasizing other psychotropic medications. They believe policies targeting high-risk psychotropic reduction while overlooking ASMs have driven unmonitored ASM increases with unclear safety and efficacy implications. Whether incorporating ASMs into reporting mandates existing for other psychotropics closes these regulatory gaps remains uncertain.
丙戊酸盐是一种被批准用于治疗癫痫、双相躁狂和预防偏头痛的抗癫痫药物（ASM），目前在养老院（NHs）中的使用越来越多，原因尚不清楚。自2012年起，养老院就被要求上报其他精神药物的使用情况，而对ASM的上报要求则始于2024年10月。本研究对养老院的临床医生进行了调查，以解释为何开具丙戊酸盐处方以及此类处方增加的原因。
全国横断面调查。由一个多学科团队利用试点数据和现有文献开发，通过SurveyMonkey（2024年11月至2025年4月）进行匿名调查，并通过众包利用便利抽样。
美国的养老院。
共有159名养老院临床医生开处方者：58%为女性，73%为白人；57%为医生，43%为高级执业提供者；60%持有老年病学或精神病学认证。
97%的临床医生报告称，丙戊酸盐用于精神症状的非标签使用导致了观察到的患病率增加，而74%的临床医生个人确认有此类使用。很少有临床医生将增加的使用归因于FDA批准的处方适应症。85%的人认为减少抗精神病药物和苯二氮䓬类药物的努力是增加的主要原因。丙戊酸盐剂量减少不频繁、人员短缺以及非药物干预措施获取有限也被强调为致病因素。总体而言，临床医生认为丙戊酸盐在养老院中的风险为低至中度（93%）且对精神症状有效（77%），尽管并不优于其他替代药物。
临床医生报告称，养老院中丙戊酸盐使用的增加主要是在非标签情况下，这可能反映了在规避强调其他精神药物的监管审查的同时管理精神症状的策略。他们认为，针对高风险精神药物减少的政策在忽视ASM的情况下，导致了未受监测的ASM增加，其安全性和有效性影响尚不清楚。将ASM纳入现有的其他精神药物报告要求是否能填补这些监管空白仍不确定。
