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Open Access 01-12-2021 | Schizophrenia | Research

Off-label use of antipsychotic medications in psychiatric inpatients in China: a national real-world survey

Authors: Juan Wang, Feng Jiang, Yating Yang, Yulong Zhang, Zhiwei Liu, Xiaorong Qin, Xueqin Tao, Tingfang Liu, Yuanli Liu, Yi-lang Tang, Huanzhong Liu, Robert O. Cotes

Published in: BMC Psychiatry | Issue 1/2021

Abstract

Background

The off-label use of antipsychotic medications is common in many countries, and the extent of such use in psychiatric inpatients in China has not been sufficiently studied. The purpose of this study was to survey the incidence and examine the correlates of off-label antipsychotic use in a large, nationally–representative sample in China.

Methods

This study included discharged psychiatric patients between March 19 and 31, 2019 from 41 tertiary psychiatric hospitals across 29 provinces in China. Their socio-demographic and clinical data were collected and analyzed.

Results

After excluding patients with schizophrenia spectrum disorder or bipolar disorder, 981 patients were included in the analysis. Overall, antipsychotics were prescribed to 63.2% (95%CI 60.2–66.2%) of the sample. Antipsychotics were used in a wide spectrum of psychiatric disorders, with the rate being the highest among patients with dissociative (conversion) disorders (89.9, 95%CI 83.0–94.8%), organic mental disorders (81.7, 95%CI 73.1–88.7%), dementia (79.0,95%CI 67.8–87.9%), obsessive-compulsive disorder (77.8, 95%CI 55.7–92.5%), mental disorders due to psychoactive substances (75.3,95%CI 64.7–84.2%), behavioural and emotional disorders with onset usually occurring in childhood and adolescence (71.4, 95%CI 45.5–90.1%), somatoform disorders (63.2, 95%CI 40.8%–82..2%), major depression disorder (53.7,95%CI 48.8–58.6%), anxiety disorder (38.8,95%CI 30.5–47.7%), and insomnia (25.0, 95%CI 8.5–28.9%). The top three most commonly used antipsychotics were olanzapine (29.1%), quetiapine (20.3%) and risperidone (6.8%), and their corresponding average doses were 9.04 ± 5.80 mg/day, 185.13 ± 174.72 mg/day, and 2.98 ± 1.71 mg/day, respectively. A binary logistic regression showed that younger age, having the Employee Health Insurance or Residents Health Insurance, having psychotic symptoms and requiring restraint during hospitalization were significantly associated with off-label use of antipsychotics.

Conclusion

Off-label use of antipsychotics is very common in psychiatric inpatients in China, mainly with moderate-dose use of single agents. However, the efficacy and safety of this practice is uncertain for many diagnoses and for the elderly. Clinicians should be cautious about this practice while waiting for more research data.

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Title: Off-label use of antipsychotic medications in psychiatric inpatients in China: a national real-world survey
Authors: Juan Wang
Feng Jiang
Yating Yang
Yulong Zhang
Zhiwei Liu
Xiaorong Qin
Xueqin Tao
Tingfang Liu
Yuanli Liu
Yi-lang Tang
Huanzhong Liu
Robert O. Cotes
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Schizophrenia
Insomnia
Somatoform Disorder
Neurocognitive Disorders
Electroconvulsive Therapy
Anxiety Disorder
Obsessive-Compulsive Disorder
Somatoform Disorder
Antipsychotics
Antipsychotics
Olanzapine
Quetiapine
Risperidone
Published in: BMC Psychiatry / Issue 1/2021
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/s12888-021-03374-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Off-label use of antipsychotic medications in psychiatric inpatients in China: a national real-world survey

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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