Prescribing Second-Generation Antipsychotics and the Evolving Standard of Care in Italy

C. Barbui; A. Danese; G. Guaiana; L. Mapelli; L. Miele; E. Monzani; M. Percudani on behalf of the Study Group

doi:10.1055/s-2002-36394

Pharmacopsychiatry 2002; 35(6): 239-243
DOI: 10.1055/s-2002-36394

Original Paper

Prescribing Second-Generation Antipsychotics and the Evolving Standard of Care in Italy

C. Barbui¹ , A. Danese¹ , G. Guaiana¹ , L. Mapelli¹ , L. Miele¹ , E. Monzani¹ , M. Percudani on behalf of the Study Group¹

¹Laboratory of Epidemiology and Social Psychiatry, ”Mario Negri” Institute for Pharmacological Research, Milan, Italy

E. Caverzasi, A. Danese, P. Brambilla, L. Fagioli, C. Civardi, S. Astori (Laboratorio di Valutazione dell’Assistenza, Dipartimento di Scienze Sanitarie Applicate e Psicocomportamentali, Università di Pavia); C.M. Cornaggia, L. Mapelli (Clinica Psichiatrica, Università degli Studi di Milano-Bicocca, Ospedale S.Gerardo, Monza); L. Miele, S. Gianetti, A. Ruggeri (Clinica Psichiatrica, Università degli Studi di Milano, Ospedale Maggiore I.R.C.C.S.); M. Percudani, P. Castiglioni, D. Merckling, R. Colombo (Unità Operativa di Psichiatria, Legnano); E. Amato, I. Rota Graziosi, M. Pellegril, G. Tarchini (Centra Psico-Sociale Bergamo Orientale, Ospedali Riuniti di Bergamo); R. Corsa, A. Pagliara, E. Cavallaro, V. Restelli (Centro Psico-Sociale Bergamo Occidentale, Ospedali Riuniti di Bergamo); E. Monzani, M. Frova, M. Alessandri, T. Melorio (Dipartimento di Salute Mentale, Azienda Ospedaliera Niguarda Ca’ Granda, Milano)

Abstract

The present study was carried out to investigate the routine use of second-generation antipsychotic drugs in the Italian psychiatric care system. Seven outpatient psychiatric services enrolled a consecutive case series of patients who were being treated, or had started treatment, with clozapine, olanzapine, risperidone, or quetiapine. Information on sociodemographic and clinical variables, current psychotropic drug use, side-effects and past use of typical drugs was collected. In addition, patient symptoms and functional status were evaluated by the Health of the Nation Outcome Scale. Patients receiving off-label prescribing of second-generation antipsychotics were identified. A total of 209 patients were collected. In comparison with patients receiving other second-generation antipsychotics, living in residential facilities, unemployment, long psychiatric histories, and problems with activities of daily living and living conditions were more common in clozapine-treated patients. Nearly 80 % of patients receiving clozapine had schizophrenia compared to less than 50 % of those receiving other second-generation antipsychotics. Overall, 109 patients (52 %) received off-label prescriptions of second-generation antipsychotic drugs. This survey indicates that clozapine was mostly reserved for severe cases and poor responders; the high rate of off-label prescriptions highlights the gap existing between recommendations derived from randomised clinical trials and the current use of drugs.

Full Text

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Dr. Corrado Barbui

Dept of Medicine and Public Health

Psychiatry Section

University of Verona

Ospedale Policlinico

37134 Verona

Italy

Phone: +39 (045) 807 44 41

Fax: +39 (045) 585 871

Email: corrado.barbui@univr.it