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Annals of General Psychiatry
Published in: Annals of General Psychiatry 1/2018

Open Access 01-12-2018 | Primary research

Off-label prescription of psychiatric drugs by non-psychiatrist physicians in three general hospitals in Germany

Authors: Caroline Lücke, Jürgen M. Gschossmann, Teja W. Grömer, Sebastian Moeller, Charlotte E. Schneider, Aikaterini Zikidi, Alexandra Philipsen, Helge H. O. Müller

Published in: Annals of General Psychiatry | Issue 1/2018

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Abstract

Background

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.

Methods

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.

Results

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 (p = 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.

Conclusions

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.
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Metadata
Title
Off-label prescription of psychiatric drugs by non-psychiatrist physicians in three general hospitals in Germany
Authors
Caroline Lücke
Jürgen M. Gschossmann
Teja W. Grömer
Sebastian Moeller
Charlotte E. Schneider
Aikaterini Zikidi
Alexandra Philipsen
Helge H. O. Müller
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Annals of General Psychiatry / Issue 1/2018
Electronic ISSN: 1744-859X
DOI
https://doi.org/10.1186/s12991-018-0176-4

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