Prescribing Trends in Bipolar Disorder Cohort Study in the United Kingdom THIN Primary Care Database 1995–2009 英文参考文献.docVIP

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Prescribing Trends in Bipolar Disorder Cohort Study in the United Kingdom THIN Primary Care Database 1995–2009 英文参考文献.doc

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Prescribing Trends in Bipolar Disorder Cohort Study in the United Kingdom THIN Primary Care Database 1995–2009 英文参考文献

PrescribingTrendsinBipolarDisorder:CohortStudyin theUnitedKingdomTHINPrimaryCareDatabase 1995–2009 JosephHayes1*,PhilipPrah2,IrwinNazareth2,3,MichaelKing1,KateWalters3,IrenePetersen3 ,David Osborn1 1Mental Health Sciences Unit, University College London, London, United Kingdom, 2MRC General Practice Research Framework, London, United Kingdom, 3DepartmentofPrimaryCareandPopulationHealth,UniversityCollegeLondon,London,UnitedKingdom Abstract Objectives:Todeterminechangesinprescribingpatternsinprimarycareofantipsychoticandmoodstabilisermedication inarepresentativesampleofpatientswithbipolardisorderintheUnitedKingdomoverafifteenyearperiodandassociation withsocio-demographicfactors. Methods:Weidentified4700patientsintheHealthImprovementNetwork(THIN)primarycaredatabase,whohadreceived treatmentforbipolardisorderbetween1995and2009.Theproportionoftimeforwhicheachindividualwasprescribeda particularmedicationwasstudied,alongwithvariationbysex,ageandsocialdepravationstatus(quintilesofTownsend scores).Thenumberofdrugsanindividualwastakingwithinaparticularyearwasalsoexamined. Results:In1995,40.6%ofpatientswithbipolardisorderwereprescribedapsychotropicmedicationatleasttwice.By2009 this had increased to 78.5% of patients. Valproate registered with the greatest increase in use (22.7%) followed by olanzapine (15.7%) and quetiapine (9.9%). There were differences by age and sex; with young (18–30 year old) women havingthebiggestincreaseinproportionoftimeonmedication.Therewerenodifferencesbysocialdeprivationstatus.By 2009,34.2%ofwomenofchildbearingageweretreatedwithvalproate. Conclusions: Lithium useoverallremainedrelativelyconstant,whilstsecondgeneration antipsychoticandvalproateuse increaseddramatically.Changesinprescribingpracticeprecededpublishedtrialevidence,especiallywiththeuseofsecond generationantipsychotics,perhapswithinferencesbeingmadefromtreatmentofschizophreniaanduseoffirstgeneration antipsychotics.Womenofchildbearingagewereprescribedvalproatefrequently,againstbestadvic