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Factors Associated with the Prescribing of Olanzapine, Quetiapine, and Risperidone in Patients with Bipolar and Related Affective Disorders
Author(s) -
Prabhakar Maithri,
Haynes William G.,
Coryell William H.,
Chrischilles Elizabeth A.,
Miller Del D.,
Arndt Stephan,
Ellingrod Vicki L.,
Warren Lois,
Fiedorowicz Jess G.
Publication year - 2011
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1592/phco.31.8.806
Subject(s) - quetiapine , olanzapine , risperidone , bipolar disorder , mania , psychiatry , schizoaffective disorder , medicine , odds ratio , bipolar i disorder , schizophrenia (object oriented programming) , lithium (medication) , psychosis , psychology , pediatrics
Study Objective. To identify the factors associated with newly prescribed, first‐line, second‐generation antipsychotics (SgAs) associated with weight gain—olanzapine, risperidone, and quetiapine. Design. Retrospective medical record review. Setting. Outpatient and inpatient psychiatry services at a tertiary care, academic medical center. Patients. 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). Measurements and Main Results. 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. Conclusion. 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.