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Approximately half of antipsychotic prescriptions are for people who do not have a severe mental illness (SMI), such as schizophrenia or bipolar affective disorder, BMJ Open reports.

Researchers used a UK general practice database to identify people who received first- generation (n=13,941) or second-generation (n=27,966) antipsychotics. The proportion of people prescribed one of the three commonest first-generation antipsychotics who had a diagnosis of SMI was 27 per cent for haloperidol, 30 per cent for trifluoperazine and 35 per cent for chlorpromazine.

For the three commonest second-generation antipsychotics, 36 per cent of those prescribed quetiapine, 46 per cent of those receiving risperidone and 62 per cent of those receiving olanzapine had a SMI diagnosis. The commonest non-SMI conditions treated with antipsychotics were anxiety, depression and sleep disorders. Antipsychotics were also prescribed for ADHD, dementia, obsessive- compulsive disorder, personality disorder and post-traumatic stress disorder. Between 6 and 17 per cent of people on antipsychotics had neither a SMI nor one of these non-SMI diagnoses. In general, median daily doses were higher and treatment duration was longer in people with schizophrenia than for non-SMI disorders. In those receiving risperidone, for example, median daily doses were 4mg for schizophrenia, 2mg for bipolar and 1mg for non-SMI disorders. Median duration of treatment was 1.15, 0.76 and 0.77 years respectively. The mean duration of antipsychotic treatment for dementia ranged from 0.44 to 1.30 years.

Antipsychotics can cause potentially serious adverse events including, in dementia, increased risks of strokes and all-cause mortality. The authors note that antipsychotics are more likely to be prescribed for older people who may be more sensitive to adverse effects such as movement disorders and cardiometabolic risk. They suggest that, “further effort is required to decrease primary care antipsychotic prescribing in dementia”. (BMJ Open 4: e006135)