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Articles   |    
Prescribing of Psychotropic Medications to Patients Without a Psychiatric Diagnosis
Ilse R. Wiechers, M.D., M.P.P.; Douglas L. Leslie, Ph.D.; Robert A. Rosenheck, M.D.
Psychiatric Services 2013; doi: 10.1176/appi.ps.201200557
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Dr. Wiechers is with the Robert Wood Johnson Foundation Clinical Scholars Program and Dr. Rosenheck is with the Department of Psychiatry, both at the Yale School of Medicine, 333 Cedar St., P.O. Box 208088, New Haven, CT 06520 (e-mail: ilse.wiechers@yale.edu). Dr. Leslie is with the Department of Public Health Sciences and Psychiatry, Penn State University College of Medicine, Hershey, Pennsylvania.

Abstract

Objective  This study used a private insurance claims database to examine the use of diverse classes of psychotropic medications among patients without a psychiatric diagnosis.

Methods  MarketScan claims data for 2009 were used to identify privately insured individuals who filled a prescription for at least one psychotropic medication (5.1 million patients). Bivariate and multivariate analyses were used to compare the proportion of patients with and without a psychiatric diagnosis who received a prescription for six different classes of psychotropic medications. The analyses were adjusted for potential medical indications and severity of comorbid general medical illness.

Results  Altogether, 58% of individuals who were prescribed a psychotropic medication in 2009 had no psychiatric diagnosis during the year. The proportion of patients who were prescribed a psychotropic medication without a psychiatric diagnosis was highest among individuals aged 50 to 64 (69%) and among individuals who did not receive any mental health specialty care (67%). The odds of being prescribed psychotropic medication without a psychiatric diagnosis were 2.9 times higher among patients aged 50 to 64 than among younger patients. Diagnoses signifying potential medical indications for use and severity of comorbid medical conditions were only weakly related to absence of a psychiatric diagnosis and did not alter these age trends.

Conclusions  In a large private claims database, a majority of recipients of psychotropic medication, especially older patients and those not utilizing mental health specialty care, lacked a clear indication for such use. This phenomenon deserves further study and may reflect less than desirable care.

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Figure 1 Percentage of patients without a psychiatric diagnosis who filled a prescription for a psychotropic medication in 2009, by age and drug classa

aAD, antidepressants; AP, antipsychotics; ANX, anxiolytics; STIM, stimulants; MS/AC, anticonvulsant mood stabilizers; and LITH, lithium

Figure 2 Percentage of mental health care utilizers and non–mental health care utilizers without a psychiatric diagnosis who filled a prescription for a psychotropic medication in 2009, by age and drug classa

aAD, antidepressants; AP, antipsychotics; ANX, anxiolytics; STIM, stimulants; MS/AC, anticonvulsant mood stabilizers; and LITH, lithium. Mental health care utilizers are defined as patients who submitted a claim for the following: psychotherapeutic services; a visit with a mental health or substance abuse specialist, such as a psychiatric nurse, a psychiatrist, or a psychologist; or services at a mental health or substance use specialty clinic, such as mental health facilities and chemical dependency treatment centers.

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Table 1Characteristics of individuals with and without a psychiatric diagnosis who filled a prescription for psychotropic medication in 2009
Table Footer Note

a Submitted a claim for psychotherapeutic services; a visit with a mental health or substance abuse specialist, such as a psychiatric nurse, a psychiatrist, or a psychologist; or services at a mental health or substance use specialty clinic, such as mental health facilities and chemical dependency treatment centers

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Table 2Individuals with and without a psychiatric diagnosis who received a prescription for psychotropic medication, by prescription class and utilization of mental health specialty care
Table Footer Note

a Submitted a claim for psychotherapeutic services; a visit with a mental health or substance abuse specialist, such as a psychiatric nurse, a psychiatrist, or a psychologist; or services at a mental health or substance use specialty clinic, such as mental health facilities and chemical dependency treatment centers

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Table 3Odds of not having a psychiatric diagnosis among patients prescribed a psychotropic medication in 2009, by characteristic
Table Footer Note

a Submitted a claim for psychotherapeutic services; a visit with a mental health or substance abuse specialist, such as a psychiatric nurse, a psychiatrist, or a psychologist; or services at a mental health or substance use specialty clinic, such as mental health facilities and chemical dependency treatment centers

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