Initiation of new psychotropic prescriptions without a psychiatric diagnosis among US adults: Rates, correlates, and national trends from 2006 to 2015

Abstract

Objectives To estimate rates and national trends of initiation of new psychotropic medications without a psychiatric diagnosis and to identify demographic and clinical correlates independently associated with such use among US adults in outpatient settings. Data Source Data were gathered from the 2006‐2015 National Ambulatory Medical Care Survey (NAMCS), a nationally representative sample of office‐based U.S. outpatient care. The sample was limited to adults aged 18 or older who received a new psychotropic drug prescription (n = 8618 unweighted). Study Design Using a repeated cross‐sectional design with survey sampling techniques, we estimated prescription initiation rates and national trends. Multivariable‐adjusted logistic regression analysis was used to identify correlates independently associated with initiation of new psychotropic prescriptions without a psychiatric diagnosis. Data Collection/Extraction Methods Data were publicly available, and we extracted them from the Centers for Disease Control and Prevention website. Principal Findings Altogether, at 60.4% of visits at which a new psychotropic prescription was initiated, no psychiatric diagnosis was recorded for the visit. Overall, the rate increased from 59.1% in 2006‐2007 to 67.7% in 2008‐2009 and then decreased to 52.0% in 2014‐2015. Visits to psychiatrists were associated with very low odds of having no psychiatric diagnosis when compared to primary care visits (OR = 0.02; 95% CI, 0.01‐0.04). Visits to non‐psychiatric specialists showed 6.90 times greater odds of not having a psychiatric diagnosis when compared to primary care visits (95% CI, 5.38‐8.86). Conclusion New psychotropic medications are commonly initiated without any psychiatric diagnosis, especially by non‐psychiatrist physicians. Non‐psychiatrists should document relevant diagnoses more vigilantly to prevent potentially inappropriate use or misuse.

Prevalence and Outcomes of Major Psychiatric Disorders Preceding Index Surgery for Degenerative Thoracic/Lumbar Spine Disease

“…This study has several strengths. First, the nationwide population-based database provides prevalence of specific major psychiatric disorders diagnosed strictly by psychiatrists and reduces the bias regarding internal validity of psychiatric diagnosis between non-psychiatrists and psychiatrists [ 52 ]. Second, we expanded the spectrum of psychiatric disorders, including bipolar disorder and schizophrenia, and gave more comprehensive information of the differential outcome risks of each psychiatric disorder among patients with degenerative spine disease to fill the gap of previous studies in accordance with ageing population.…”

20-Year Trends in the Pharmacologic Treatment of Bipolar Disorder by Psychiatrists in Outpatient Care Settings

“…Antidepressants included monoamine oxidase (MAO) inhibitors, tricyclic antidepressants, selective serotonin reuptake inhibitors, serotonin-norepinephrine inhibitors, and "other" antidepressants (bupropion, mirtazapine, vilazodone, nefazodone, vortioxetine, and trazodone). We also analyzed trends in the use of benzodiazepines and stimulants (18)(19)(20) in visits for which bipolar disorder was listed among the primary diagnoses.…”

Social determinants of mental health care systems: intensive community based Care in the Veterans Health Administration

“…These studies, however, did not examine community-based services, specifically, and most studies have focused on people with mild to moderate mental illness. For example, studies of the National Ambulatory Medical Care Survey found that treatment for depression tripled between 1987 and 1997 [ 61 ], and that most antidepressants are prescribed by primary care providers [ 62 , 63 ].…”