Table 3.
Psychotropic medication prescribing practices over time
| Treatment Characteristics | No. of TP* |
1970–1979 (1) | 1980–1989 (2) | 1990–1999 (3) | 2000–2009 (4) | P value+ |
Post- Hoc++ |
<1996 | ≥1996 | P value^ |
|---|---|---|---|---|---|---|---|---|---|---|
| Antipsychotics | ||||||||||
| 0 Antipsychotic (median, IQR) | 158 | 13.8(0.0–42.5) | 6.0(0.0–39.0) | 0.0(0.0–4.3) | 0.0(0.0–0.0) | 0.003 | 2>4 | 6.0(0.0–23.9) | 0.0(0.0–1.2) | <0.001 |
| 1 Antipsychotic | 158 | 44.0(41.0–51.3) | 56.2(40.0–67.4) | 70.8(54.5–82.4) | 77.7(60.7–84.1) | <0.001 | 4,3>1; 4>2 | 56.2(41.8–70) | 75.0(59.0–84.0) | <0.001 |
| 2 Antipsychotics | 90 | 26.0(6.2–41.0) | 14.7(4.5–31.0) | 19.3(12.8–32.2) | 17.1(12.4–34) | 0.62 | - | 16.5(5.5–34.3) | 18.7(12.8–31.7) | 0.33 |
| 3 or more Antipsychotics | 90 | 2.0(0.0–13.0) | 0.0(0.0–4.7) | 2.7(0.0–8.3) | 0.0(0.0–1.2) | 0.15 | - | 0.0(0.0–5.0) | 0.2(0.0–4.2) | 0.90 |
| APP (≥2 Antipsychotics) a | 196 | 28.8(7.5–44.4) | 17.6(10.8–38.2) | 22.0(11.0–40.0) | 19.2(14.4–29.9) | 0.78 | - | 19.0(10.8–40.0) | 19.8(14.1–34.0) | 0.90 |
| First-generation antipsychotics | 139 | 88.4(56.0–100) | 86.8(55.9–100) | 53.0(38.5–88.0) | 40.5(21.7–51.0) | <0.001 | 1,2,3>4 | 88.2(56.0–100) | 44.0(28.0–53.0) | <0.001 |
| Second-generation antipsychotics | 131 | 0.0(0.0–0.0) | 0.0(0.0–1.0) | 56.0(24–100) | 67.9(46–86.6) | <0.001 | 4,3>1,2 | 0.0(0.0–23.4) | 67.6(45.0–89.6) | <0.001 |
| Clozapine | 97 | 0.0(0.0–0.0) | 0.0(0.0–6.5) | 11.9(6.2–23.3) | 13.6(3.3–19.6) | <0.001 | 4,3>1,2 | 0.0(0.0–11.7) | 13.5(5.8–21.0) | <0.001 |
| Long-acting Injectable preparation | 65 | 62.1(13.4–100) | 25.4(11.0–58.0) | 23.3(18.0–35.0) | 19.4(8.7–22.9) | 0.24 | - | 25.2(11.0–54.0) | 22.7(17–26.9) | 0.47 |
| Comedications | ||||||||||
| Mood stabilizers b | 40 | None | 5.0(3.0–17.7) | 20.3(10.9–27.7) | 16.7(7.0–31.1) | 0.24 | - | 6.5(5.0–17.7) | 20.0(10.5–30.0) | 0.07 |
| Lithium b | 49 | 3.7(0.8–8.0) | 9.0(3.7–12.3) | 5.2(3.2–11.8) | 4.2(3.0–6.1) | 0.32 | - | 8.0(3.7–12.3) | 4.7(2.9–7.7) | 0.13 |
| Anticonvulsants b | 40 | 7.0(0.0–10.7) | 3.5(0.0–8.0) | 10.1(6.3–20.7) | 10.0(5.7–13.1) | 0.04 | 3>2 | 5.6(2.0–9.0) | 10.0(6.9–23.0) | 0.02 |
| Anxiolytics/hypnotics | 94 | 15.0(8.2–71.0) | 31.2(16.0–38.8) | 39.5(21.8–51.8) | 35.1(24.8–62.1) | 0.38 | - | 33.1(15.0–51.1) | 36.2(23.6–57.3) | 0.30 |
| Antidepressants | 98 | 9.0(5.3–21.5) | 14.1(9.8–30.7) | 21.4(10.6–27.3) | 28.8(12.5–38.1) | 0.08 | - | 15.5(9.0–28.0) | 22.2(11.3–33.3) | 0.14 |
| Anticholinergics | 94 | 38.7(23.0–72.1) | 37.0(26.9–48.3) | 30.0(21.3–41.9) | 23.9(15.5–44.6) | 0.36 | - | 37.0(21.6–51.0) | 27.5(17.9–41.9) | 0.06 |
| APP (>/=2 Antipsychotics) | ||||||||||
| FGA + FGA | 98 | 100(100–100) | 100(100–100) | 0.0(0.0–55.4) | 0.0(0.0–12.0) | <0.001 | 1,2>3,4 | 100(100–100) | 0.0(0.0–17.2) | <0.001 |
| SGA + SGA | 94 | 0.0(0.0–0.0) | 0.0(0.0–0.0) | 4.1(0.0–23.5) | 28.5(8.3–55.5) | <0.001 | 3,4>1,2 | 0.0(0.0–0.0) | 16.6(2.0–42.5) | <0.001 |
| FGA + SGA | 106 | 0.0(0.0–0.0) | 0.0(0.0–0.5) | 50.0(10.0–85.7) | 57.5(39.5–69.9) | <0.001 | 3,4>1,2 | 0.0(0.0–0.0) | 57.5(39.0–79.0) | <0.001 |
| Long-acting injectable preparation | 29 | 100(100–100) | 80.0(13.6–100) | 25.0(8.4–81.0) | 25.0(16.4–31.8) | 0.047 | 1,2>3,4 | 81.0(13.6–100) | 25.0(12.0–40.7) | 0.04 |
Number of time points: some studies reported in a single article two or more APP rates, examined at different points in time (e.g. 1999 and 2000), constituting two or more different individual samples in our database. Total Number of studies: 147. Total number of time points: 196.
Kruskal Wallis test.
Using a rank test corrected for multiple comparisons at p<0.05.
Mann-Whitney test. APP: Antipsychotic Polypharmacy. FGA: First-Generation Antipsychotic. SGA: Second-Generation Antipsychotic. IQR: Interquantile range (percentile 25–75).
The APP rate is not identical to the sum of patients taking 2 or ≥3 antipsychotics, as not all studies reporting on APP specified the exact number of antipsychotics prescribed;
Although overlapping conceptually, the terms “mood stabilizers”, “anticonvulsants” and “lithium” are taken directly from the publication