The status of off-label prescribing drugs in inpatients with schizophrenia, depression, bipolar disorder in Jining Psychiatric Hospital

Objective To investigate the current status on the off-label prescribing of psychoactive drugs of inpatients with schizophrenia, depression, bipolar disorder in Jining Psychiatric Hospital, and provide basic data in order to make expert consensus on off-label prescribing of psychoactive drugs in psychiatry. Methods 834 inpatients with schizophrenia, depression or bipolar disorder were enrolled in this study by stratified cluster sampling. These patients were discharged from Jining Psychiatric Hospital from January 1st 2017 to December 31th 2017. The self-edited survey on the off-label prescribing of psychoactive drugs was used to investigate these patients′ using psychoactive drugs information as inpatients during 2017. To analyze the off-label prescribing situation and rationality according to the specification of psychoactive drugs and guidelines for the prevention and treatment of mental disorders respectively. Results There were 834 inpatients (schizophrenia, n=334, 40.0%; depression, n=275, 33.0%; bipolar disorder, n=225, 27%) in this study. The total rate of off-label prescribing was 85.9% (716/834). The rate of off-label indication was 85.1% (710/834). The rate of overdosing was 9.4%(78/834). The rate of off-label in children and adolescents patients was 18.2%(8/44), and in geriatric patients was 18.4%(23/125). The rates of off-label indication were 71.6%(239/334), 96.4%(265/275), 91.6%(206/225) in schizophrenia, depression and bipolar disorder respectively. The off-label prescribing of anti-anxiety drugs and sedative hypnotics belonged to no grade recommendation. The off-label prescribing of patients with schizophrenia belonged to no grade recommendation. Other off-label prescribing of psychoactive drugs mostly belonged to A-level recommendation and B-level recommendation. Only 2 cases were D-level recommendation. The rate of the off-label indication of mood stabilizers in patients with bipolar disorder was 78.6%(162/206), because sodium valproate in China has no indication to treat bipolar disorder. Conclusions It is very common psychoactive drugs are used with off-label prescribing in the investigated hospital. They are mostly in accord with the guideline of prevention and treatment of mental disorders. It is suggested that the off-label prescribing in the clinical work of psychiatry in China has considerable clinical demand, so it is urgent to strengthen the off-label prescribing and make the proper policy. Key words: Psychotic disorders; Hospitals, special; Prospectuses; Drug therapy