Psychiatry - July 2008 - (Page 29)

[trend watch] May, 2007, to April, 2008, data from Verispan’s Prescription Drug and Diagnosis Audit (PDDA) regarding reasons for use of atypical antipsychotics. PDDA captures data on disease state and associated therapy from 3,100 office-based physicians representing 29 specialties across the United States. RESULTS Over the past year, 5.5 million Americans filled at least one prescription for an atypical antipsychotic; 19 percent of whom (approximately 1 million) were age 65 and older. Figure 1 displays reasons for use of atypical antipsychotics in patients under age 65 and age 65 and older. As seen in Figure 1, while bipolar disorder and schizophrenia combine to represent over 70 percent of atypical antipsychotic uses in younger patients, these same indications represent only 38 percent of product use in older patients. The difference between the two age groups is driven primarily by the additional 28 percent of use among patients with cognitive impairment (dementia and Alzheimer’s combined). We examined the data further to determine whether there were differences in use of atypical antipsychotics by dementia patients with and without and behavioral disturbances. Although ICD-9 coding tends to group patients into less specific diagnoses, we did isolate a small group of approximately 10 percent of patients who were classified based on the presence or absence of behavioral disturbances. Figure 2 displays the prevalence of atypical antipsychotic use among these patient groups. As seen in Figure 2, 18 percent of dementia patients without behavioral disturbances FIGURE 1. Reasons for use of atypical antipsychotics by patient age Source: Verispan PDDA, Atypical Antipsychotics May 2007 to April 2008. FIGURE 2. Proportion of Alzheimer's disease patients receiving antipsychotics Source: Verispan PDDA, ICD-9 Diagnosis 294.10 (without behavioral disturbance) and 294.11 (with behavioral disturbance), May 2007 to April 2008 received atypical antipsychotics as compared to 66 percent of patients with behavioral disturbances. COMMENTARY by Jeffrey L. Cummings This article focuses on an area of continuing unmet need in the elderly population: agents that effectively treat behavioral disturbances in elderly patients without compromising safety. All current atypical antipsychotics carry a “black box” type of warning required by the Food and Drug Administration (FDA), indicating [JULY] Psychiatry 2008 29

Table of Contents Feed for the Digital Edition of Psychiatry - July 2008

Psychiatry - July 2008 Editor's Message Editorial Advisory Board Contents PsychRx Letters to the Editor Reliability of Diagnoses: Do Psychiatrists Use Structured Interviews In Real Clinical Settings? Trend Watch: Use of Atypical Antipsychotics in the Elderly Review: The Struggle for Mental Healthcare in New Orleans-One Case at a Time Psychotherapy Rounds: Psychotherapeutic and Adjuntive Pharmacologic Approaches to Treating Posttraumatic Stress Disorder Original Research: Baseline Dissociation and Prospective Success in Special Forces Assessment and Selection Commentary: Performance-Enhancing Drugs: Where Should the Line Be Drawn and By Whom? Commentary: Psychiatric Diagnosis and the Pathlogist's View of Schizophrenia Journal Watch Classified Advertising Information for Authors

Psychiatry - July 2008

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