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Changing prescribing patterns in an Irish community mental health service

Published online by Cambridge University Press:  06 November 2017

R. Rowntree ,
N. McCarthy  and
L. Feeney
R. Rowntree
Affiliation:
Cluain Mhuire Community Mental Health Service, Blackrock, Dublin, Ireland
N. McCarthy
Affiliation:
Cluain Mhuire Community Mental Health Service, Blackrock, Dublin, Ireland
L. Feeney*
Affiliation:
Cluain Mhuire Community Mental Health Service and Royal College of Surgeons in Ireland, Blackrock, Dublin, Ireland
*
*Address for correspondence: L. Feeney, Royal College of Surgeons in Ireland, Cluain Mhuire Community Mental Health Service, Newtownpark Avenue, Blackrock, Dublin, Ireland. (Email: [email protected])
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Abstract

Objectives

Medication is an important component of the treatment of many mental illnesses. Very little information is available about the particular medications that are being prescribed by community mental health services and how this has changed over time. We set out to obtain details of psychiatric medications being prescribed by one Irish community mental health service.

Method

All prescribing by the Cluain Mhuire Community Mental Health Service became electronic during 2004. Using Business Intelligence software, we obtained details of all psychiatric medications prescribed from 2005 to 2016. We compared numbers of prescriptions written in the first 6 years (2005–2010) with the following 6 (2011–2016).

Results

Olanzapine was the most commonly prescribed medication throughout but its use declined by one-quarter over the study period. Clozapine, quetiapine, aripiprazole and haloperidol prescribing increased. Prescriptions for mood stabilisers and antidepressants fell by 25%. Sedative prescriptions declined by almost 50%. Absolute numbers of prescriptions written for methylphenidate and pregabalin were small but increased dramatically over the time period.

Conclusions

This community mental health service prescribed less of most psychiatric medications in 2016, than had been the case in 2005. This is despite an increase in the numbers of patients seen over the same period. It is not clear if this pattern is echoed in other services.

Keywords

Community mental healthmedicationmental illnesspsychiatryside effects
Type
Original Research
Information
Irish Journal of Psychological Medicine , Volume 37 , Issue 1 , March 2020 , pp. 8 - 14
Copyright
© College of Psychiatrists of Ireland 2017

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References

Alexander, GC, Gallagher, SA, Mascola, A, Moloney, RM, Stafford, RS (2011). Increasing off‐label use of antipsychotic medications in the United States, 1995–2008. Pharmacoepidemiology and Drug Safety 20, 177–184.CrossRefGoogle ScholarPubMed
Appignanesi, L (2011). The mental illness industry is medicalising normality. The Guardian, 06 September 2011 (https://www.theguardian.com/commentisfree/2011/sep/06/mental-illness-medicalising-normality). Accessed 13 September 2017.Google Scholar
Appelbaum, PS, Gold, A (2010). Psychiatrists’ relationships with industry: the principal-agent problem. Harvard Review of Psychiatry 18, 255–265.CrossRefGoogle ScholarPubMed
Castle, L, Aubert, RE, Verbrugge, RR, Khalid, M, Epstein, RS (2007). Trends in medication treatment for ADHD. Journal of Attention Disorders 10, 335–342.CrossRefGoogle ScholarPubMed
Centre for Disease Control and Prevention (2016). Attention-deficit hyperactivity disorder (ADHD): data and statistics (https://www.cdc.gov/ncbddd/adhd/data.html) Accessed 13 September 2017.Google Scholar
Central Statistics Office (2017). Census 2016 Summary Results. Central Statistics Office, April 2017 (http://www.cso.ie/en/media/csoie/newsevents/documents/census2016summaryresultspart1/Census2016SummaryPart1.pdf). Accessed 13 September 2017.Google Scholar
Chang, CM, Wu, CS, Huang, YW, Chau, YL, Tsai, HJ (2016). Utilization of psychopharmacological treatment among patients with newly diagnosed bipolar disorder from 2001 to 2010. Journal of Clinical Psychopharmacology 36, 32–44.CrossRefGoogle ScholarPubMed
College of Psychiatrists of Ireland (2012). A consensus statement on the use of benzodiazepines in specialist mental health services: EAP position paper (http://www.drugsandalcohol.ie/23872/1/CPsychI_position_paper_on_benzodiazepimes_June_2012.sflb.pdf). Accessed 13 September 2017.Google Scholar
Cowen, P, Harrison, P, Burns, T (2012). Shorter Oxford Textbook of Psychiatry. Oxford University Press: Oxford.CrossRefGoogle Scholar
Davies, L, Lewis, S, Jones, P, Lloyd, HM (2007). Cost-effectiveness of first- v. second-generation antipsychotic drugs: results from a randomised controlled trial in schizophrenia responding poorly to previous therapy. British Journal of Psychiatry 191, 14–22.CrossRefGoogle Scholar
Department of Community, Rural and Gaeltacht Affairs (2009). National Drugs Strategy 2009–2016 (http://health.gov.ie/wp-content/uploads/2014/03/nds_2009-16.pdf). Accessed 13 September 2017.Google Scholar
Douglas, L, Feeney, L (2016). Thirty years of referrals to a community mental health service. Irish Journal of Psychological Medicine 33, 105–110.CrossRefGoogle ScholarPubMed
Evoy, KE, Morrison, MD, Saklad, SR (2017). Abuse and misuse of pregabalin and gabapentin. Drugs 77, 403–426.CrossRefGoogle ScholarPubMed
Expert Group on Mental Health Policy (2006). A Vision for Change: Report of the Expert Group on Mental Health Policy. The Stationary Office: Dublin.Google Scholar
Field, RI (2010). Antipsychotic medications are spelling legal trouble for drugmakers. Healthcare and Law 35, 621–622.Google ScholarPubMed
Funk, KA, Bostwick, JR (2013). A comparison of the risk of QT prolongation among SSRIs. Annals of Pharmacotherapy 47, 1330–1341.CrossRefGoogle ScholarPubMed
Gibbs, BG, Shafer, K, Dufur, MJ (2015). Why infer? The use and misuse of population data in sport research. International Review for the Sociology of Sport 50, 115–121.CrossRefGoogle Scholar
Hamann, J, Langer, B, Leucht, S, Busch, R, Kissling, W (2004). Medical decision making in antipsychotic drug choice for schizophrenia. Am J Psychiatry 161, 1301–1304.CrossRefGoogle Scholar
Hayes, J, Prah, P, Nazareth, I, King, M, Walters, K, Petersen, I, Osborn, D (2011). Prescribing trends in bipolar disorder: cohort study in the United Kingdom THIN primary care database 1995–2009. PLoS One 6, e28725.CrossRefGoogle ScholarPubMed
Hughes, GC, Hanrahan, SO, Kavanagh, G, McNicholas, F (2017). Review of international clinical guidelines for adolescents on transition to Adult Mental Health Services and adults with attention-deficit hyperactivity disorder and their application to an Irish context. Irish Journal of Psychological Medicine 34, 59–73.CrossRefGoogle Scholar
IBM Corp. (2013). IBM SPSS Statistics for Windows, Version 21.0. IBM Corp: Armonk, NY.Google Scholar
Ilyas, S, Moncrieff, J (2012). Trends in prescriptions and costs of drugs for mental disorders in England, 1998–2010. British Journal of Psychiatry 200, 393–398.CrossRefGoogle Scholar
Jureidini, JN, McHenry, LB (2009). Key opinion leaders and paediatric antidepressant overprescribing. Psychotherapy and Psychosomatics 78, 197–201.CrossRefGoogle ScholarPubMed
Kapil, V, Green, JL, Le Lait, C, Wood, DM, Dargan, PI (2014). Misuse of benzodiazepines and Z-drugs in the UK. British Journal of Psychiatry 205, 407–408.CrossRefGoogle ScholarPubMed
Kaye, J, Bradbury, B, Jick, H (2003). Changes in antipsychotic drug prescribing by general practitioners in the United Kingdom from 1991 to 2000: a population-based observational study. British Journal of Clinical Pharmacology 56, 569–575.CrossRefGoogle ScholarPubMed
Kearney, PM, Cronin, H, O’Regan, C, Kamiya, Y, Savva, GM, Whelan, B, Kenny, R (2011). Cohort profile: the Irish longitudinal study on ageing. International Journal of Epidemiology 40, 877–884.CrossRefGoogle ScholarPubMed
Mars, B, Heron, J, Kessler, D, Davies, NM, Martin, RM, Thomas, KH, Gunnell, D (2017). Influences on antidepressant prescribing trends in the UK: 1995–2011. Social Psychiatry and Psychiatric Epidemiology 52, 193–200.CrossRefGoogle ScholarPubMed
Meyer, JM, Stahl, SM (2009). The metabolic syndrome and schizophrenia. Acta Psychiatrica Scandinavica 119, 4–14.CrossRefGoogle Scholar
Monshat, K, Carty, B, Olver, J, Castle, D, Bosanac, P (2010). Trends in antipsychotic prescribing practices in an urban community mental health clinic. Australasian Psychiatry 18, 238–241.CrossRefGoogle Scholar
My Irish Health (2011). HSE to end free psychiatric medication in greater Dublin area (http://www.myirishhealth.com/news/hse-to-end-free-psychiatric-medication-in-greater-dublin-area). Accessed 14 September 2017.Google Scholar
NACD, PHIRB (2012). Drug use in Ireland and Northern Ireland. 2010/11 Drug Prevalence Survey: Sedatives or Tranquillisers and Anti-depressants Results. Bulletin 6. NACD and PHIRB: Dublin (http://www.drugsandalcohol.ie/18660/1/bulletin6.pdf). Accessed 13 September 2017.Google Scholar
National Institute for Health and Care Excellence (NICE) (2016). Treatment of adults with ADHD. (https://www.nice.org.uk/guidance/CG72). Accessed 13 September 2017.Google Scholar
National Mental Health Conference (2013). The case for change in addiction and mental health services: addiction and mental illness, two problems, one person (http://www.dualdiagnosis.ie/wp-content/uploads/2011/05/national-mental-health-conference-nov-13-published.pdf). Accessed 13 September 2017.Google Scholar
O’Brien, C (2012). Bitter pills to swallow. Irish Times, 14 April 2012 (http://www.irishtimes.com/news/bitter-pills-to-swallow-1.501458). Accessed 13 September 2017.Google Scholar
Oracle (2005). Business Intelligence. OracleBI Discoverer Viewer Version 10.1.2.45.46c (https://www.oracle.com/solutions/business-analytics/business-intelligence/index.html). Accessed 13 September 2017.Google Scholar
Pierce, M, Cahill, S, O’Shea, E (2014). Prevalence and projections of dementia in Ireland, 2011–2046. Genio (www.genio.ie/system/files/publications/Dementia_Prevalence_2011_2046.pdf). Accessed 13 September 2017.Google Scholar
Pincus, HA, Tanielian, TL, Marcus, SC, Olfson, M, Zarin, DA, Thompson, J, Zito, JM (1998). Prescribing trends in psychotropic medication; primary care, psychiatry and other medical specialities. JAMA 279, 526–531.CrossRefGoogle Scholar
Rosholm, JU, Gram, LF, Isacsson, G, Hallas, J, Bergman, U (1997). Changes in the pattern of antidepressant use upon the introduction of the new antidepressants: a prescription database study. European Journal of Clinical Pharmacology 52, 205–209.CrossRefGoogle ScholarPubMed
St John of God Hospitaller Ministries (2014). MHIS (http://www.mhis.ie/profilesummary.htm). Accessed 13 September 2017.Google Scholar
St John of God Hospitaller Ministries (2017). MHIS Dashboard, Version 13. (http://www.mhis.ie/profilesummary.htm). Accessed 02 April 2017.Google Scholar
Thejournal.ie (2017). ‘This is not acceptable’: nearly 2,000 new staff needed in mental health services. Thejournal.ie, 3 August 2017 (http://www.thejournal.ie/mental-health-hse-3527719-Aug2017/). Accessed 13 September 2017.Google Scholar
Verdoux, H, Tournier, M, Begaud, B (2010). Antipsychotic prescribing trends: a review of pharmaco‐epidemiological studies. Acta Psychiatrica Scandinavica 121, 4–10.CrossRefGoogle ScholarPubMed
Walpoth-Niederwanger, M, Kemmler, G, Grunze, H, Weiss, U, Hörtnagl, C, Strauss, R, Blasko, I, Hausmann, A (2012). Treatment patterns in inpatients with bipolar disorder at a psychiatric university hospital over a 9-year period: focus on mood stabilizers. International Clinical Psychopharmacology 27, 256–266.CrossRefGoogle Scholar
Warnez, S, Alessi-Severini, S (2014). Clozapine: a review of clinical practice guidelines and prescribing trends. BMC Psychiatry 14, 102.CrossRefGoogle ScholarPubMed
Whitaker, R (2011). Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. Broadway Books: New York.Google Scholar