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Factors associated with the prescribing of olanzapine, quetiapine, and risperidone in patients with bipolar and related affective disorders
Journal article

Factors associated with the prescribing of olanzapine, quetiapine, and risperidone in patients with bipolar and related affective disorders

Maithri Prabhakar, William G Haynes, William H Coryell, Elizabeth A Chrischilles, Del D Miller, Stephan Arndt, Vicki L Ellingrod, Lois Warren and Jess G Fiedorowicz
Pharmacotherapy, Vol.31(8), pp.806-812
08/2011
DOI: 10.1592/phco.31.8.806
PMCID: PMC3192400
PMID: 21923607
url
https://www.ncbi.nlm.nih.gov/pmc/articles/3192400View
Open Access

Abstract

To identify the factors associated with newly prescribed, first-line, second-generation antipsychotics (SgAs) associated with weight gain-olanzapine, risperidone, and quetiapine. Retrospective medical record review. Outpatient and inpatient psychiatry services at a tertiary care, academic medical center. Three hundred forty consecutive adults who had major depressive disorder with psychotic features, bipolar I, bipolar II, bipolar not otherwise specified, or schizoaffective disorder over two time periods (August 30-October 30, 2009, and April 1-May 31, 2010). Clinical and sociodemographic variables associated with newly prescribed olanzapine, risperidone, and quetiapine were identified by using univariate and multivariate logistic regression. Several clinical factors were individually associated with initiation of these SgAs: mania (odds ratio [OR] 3.6, 95% confidence interval [CI] 1.2-10.8, p=0.02), psychosis (OR 3.3, 95% CI 1.5-6.9, p=0.002), and inpatient treatment (OR 3.8, 95% CI 1.8-7.9, p=0.0005). Prevalent use of lithium (OR 0.3, 95% CI 0.1-0.9, p=0.03) and being married (OR 0.3, 95% CI 0.1-0.8, p=0.02) were inversely associated with new use of an SgA. Mania, psychosis, married status, and lithium use remained independently associated on multivariate analysis. Factors related to metabolic or vascular risk were not associated with SgA initiation. Psychiatric clinicians were influenced heavily by clinical features related to mental status and acuity when determining whether to prescribe SgAs. However, factors related to vascular risk were not associated. Future observational studies should consider current clinical status as an important factor in determining propensity to receive antipsychotics or other short-term treatments for bipolar and related disorders.
 Multivariate Analysis Antipsychotic Agents - adverse effects Humans Middle Aged Quetiapine Fumarate Logistic Models Male Academic Medical Centers Bipolar Disorder - drug therapy Practice Patterns, Physicians' - statistics & numerical data Dibenzothiazepines - therapeutic use Risperidone - therapeutic use Antipsychotic Agents - therapeutic use Dibenzothiazepines - adverse effects Risperidone - adverse effects Adult Female Weight Gain - drug effects Benzodiazepines - adverse effects Psychotic Disorders - drug therapy Retrospective Studies Benzodiazepines - therapeutic use Depressive Disorder, Major - drug therapy

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