A description of antipsychotic prescribing patterns on the inpatient behavioral health setting: a multicenter...

Antipsychotic therapy can bring a great deal of benefit to individuals with schizophrenia and other psychiatric diagnoses, though this class of medications is also associated with intolerabilities due to possible adverse events. Notable adverse events commonly experienced include movement disorders and metabolic concerns that can occur even at low doses and minimal exposure.

Describe the prescribing patterns of antipsychotics in the inpatient behavioral health setting, and report on characteristics that lead to populations having higher or lower dosing exposures to antipsychotic therapy that follows FDA guidelines.

Multicentered, retrospective, cross-sectional chart review.

The study was conducted at two academic hospitals in the inpatient behavioral health setting. Information was collected on 785 cases of patients who were hospitalized during the study period with a psychiatric diagnosis that necessitated a prescription for an antipsychotic medication at the time of discharge. Differences in antipsychotic drug (dose, type, number, and duration of treatment) were characterized, and data were collected on clinician adherence to FDA guidance, as listed in the package insert of each antipsychotic drug. Primary outcomes were the amount of Total Chlorpromazine Equivalent Dosing doses and the clinician's adherence to FDA guidance.

This study found that the male gender (p < 0.0001), no social support (p < 0.0025), more previous antipsychotic trials (p < 0.0001), and longer hospital stays (p < 0.0001) were statistically significant for patients receiving higher antipsychotic doses at discharge. Additionally, patients with comorbid diabetes (p < 0.0001), more antipsychotics at discharge (p = 0.001), and Medicare insurance (p = 0.005) were less likely to receive antipsychotic medication following FDA recommendations and current guidelines.

The results of this study can inform practice regarding antipsychotic prescribing patterns in different populations. Conducting prospective studies across a broader range of institutions, it is recommended to better understand the relationship between patient demographics and prescribing patterns during periods of acute illness.