Article Text

Original research
Prescribing of antipsychotics among people with recorded personality disorder in primary care: a retrospective nationwide cohort study using The Health Improvement Network primary care database
  1. Sarah Hardoon1,
  2. Joseph Hayes1,
  3. Essi Viding2,
  4. Eamon McCrory2,
  5. Kate Walters3,
  6. David Osborn1
  1. 1Division of Psychiatry, UCL, London, UK
  2. 2Division of Psychology and Language Sciences, UCL, London, UK
  3. 3Department of Primary Care and Population Health, UCL, London, UK
  1. Correspondence to Prof David Osborn; d.osborn{at}ucl.ac.uk

Abstract

Objectives To investigate the extent of antipsychotic prescribing to people with recorded personality disorder (PD) in UK primary care and factors associated with such prescribing.

Design Retrospective cohort study.

Setting General practices contributing to The Health Improvement Network UK-wide primary care database, 1 January 2000–31 December 2016.

Participants 46 210 people registered with participating general practices who had a record of PD in their general practice notes. 1358 (2.9%) people with missing deprivation information were excluded from regression analyses; no other missing data.

Main outcome measures Prescriptions for antipsychotics in general practice records and length of time in receipt of antipsychotic prescriptions.

Results Of 46 210 people with recorded PD, 15 562 (34%) were ever prescribed antipsychotics. Among the subgroup of 36 875 people with recorded PD, but no recorded severe mental illness (SMI), 9208 (25%) were prescribed antipsychotics; prescribing was lower in less deprived areas (adjusted rate ratio (aRR) comparing least to most deprived quintile: 0.56, 95% CI 0.48 to 0.66, p<0.001), was higher in females (aRR:1.25, 95% CI 1.16 to 1.34, p<0.001) and with a history of adverse childhood experiences (aRR:1.44, 95% CI 1.28 to 1.56, p<0.001). Median time prescribed antipsychotics was 605 days (IQR 197–1639 days). Prescribing frequency has increased over time.

Conclusions Contrary to current UK guidelines, antipsychotics are frequently and increasingly prescribed for extended periods to people with recorded PD, but with no history of SMI. An urgent review of clinical practice is warranted, including the effectiveness of such prescribing and the need to monitor for adverse effects, including metabolic complications.

  • personality disorders
  • primary care
  • therapeutics

Data availability statement

No data are available. No data are available as no new data collected. Read code list for personality disorder in online supplemental material.

https://creativecommons.org/licenses/by/4.0/

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Data availability statement

No data are available. No data are available as no new data collected. Read code list for personality disorder in online supplemental material.

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Supplementary materials

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Footnotes

  • Twitter @osborn_ucl

  • Contributors SH: formulation of research questions, study design, extraction and analysis of data, interpretation of data, writing of first draft of paper, critical revision of paper for important intellectual content, approval of final draft. JH: formulation of research questions, study design, acquisition of data, interpretation of data, writing of first draft of paper, critical revision of paper for important intellectual content, approval of final draft. EV: formulation of research questions, study design, interpretation of data, critical revision of paper for important intellectual content, approval of final draft. EM: formulation of research questions, study design, interpretation of data, critical revision of paper for important intellectual content, approval of final draft. KRW: interpretation of data, critical revision of paper for important intellectual content, approval of final draft. DO: formulation of research questions, study design, interpretation of data, critical revision of paper for important intellectual content, approval of final draft. SH: Guarantor.

  • Funding This work was supported by the Medical Research Council (grant number MC_PC_17216); and the Wellcome Trust (JFH, grant number 211085/Z/18/Z).

  • Disclaimer This funder had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The views expressed in this article are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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