Pharmacology drugs, Pharmacologie, galénique, Sciences biologiques et medicales, Biological and medical sciences, Sciences medicales, Medical sciences, Pharmacologie. Traitements medicamenteux, Pharmacology. Drug treatments, Psychopathologie. Psychiatrie, Psychopathology. Psychiatry, Etude clinique de l'adulte et de l'adolescent, Adult and adolescent clinical studies, Troubles de l'humeur, Mood disorders, Etat dépressif, Depression, Troubles bipolaires, Bipolar disorders, Psychologie. Psychanalyse. Psychiatrie, Psychology. Psychoanalysis. Psychiatry, PSYCHOPATHOLOGIE. PSYCHIATRIE, Antagoniste dopamine, Dopamine antagonist, Antagonista dopamina, Antagoniste sérotonine, Serotonin antagonist, Antagonista serotonina, Benzisoxazole dérivé, Benzisoxazole derivatives, Benzisoxazol derivado, Dérivé de la dibenzodiazépine, Dibenzodiazepine derivatives, Dibenzodiazepina derivado, Dérivé de la dibenzothiazépine, Dibenzothiazepine derivatives, Dibenzotiazepina derivado, Dérivé de la thiénobenzodiazépine, Thienobenzodiazepine derivatives, Tienobenzodiazepina derivado, Récepteur dopaminergique D2, D2 Dopamine receptor, Receptor dopaminérgico D2, Récepteur sérotoninergique, Serotonine receptor, Receptor serotoninérgico, Ambulatoire, Ambulatory, Ambulatorio, Antipsychotique atypique, Atypical antipsychotic, Antipsicótico atípico, Etat dépressif, Depression, Estado depresivo, Homme, Human, Hombre, Hypnotique, Hypnotic, Hipnótico, Hôpital, Hospital, Modèle, Models, Modelo, Neuroleptique, Neuroleptic, Neuroléptico, Olanzapine, Olanzapina, Prescription médicale, Medical prescription, Prescripción médica, Psychose, Psychosis, Psicosis, Psychotrope, Psychotropic, Psicotropo, Quétiapine, Quetiapine, Quetiapina, Rispéridone, Risperidone, Risperidona, Tranquillisant, Tranquillizer, Tranquilizante, Trouble affectif, Affective disorder, Trastorno afectividad, Trouble bipolaire, Bipolar disorder, Trastorno bipolar, Trouble de l'humeur, Mood disorder, Trastorno humor, Score, antipsychotic agents, bipolar disorder, inpatients, logistic models, major depressive disorder, outpatients, propensity score, and psychotic disorders
Study Objective. To identify the factors associated with newly prescribed, first-line, second-generation antipsychotics (SGAs) associated with weight gain—olanzapine, risperidone, and quetiapine. Design. Retrospective medical record review. Setting. Outpatient and inpatient psychiatry services at a tertiary care, academic medical center. Patients. Three hundred forty consecutive adults who had major depressive disorder with psychotic features, bipolar I, bipolar II, bipolar not otherwise specified, or schizoaffective disorder over two time periods (August 30-October 30, 2009, and April 1-May 31, 2010). Measurements and Main Results. Clinical and sociodemographic variables associated with newly prescribed olanzapine, risperidone, and quetiapine were identified by using univariate and multivariate logistic regression. Several clinical factors were individually associated with initiation of these SGAs: mania (odds ratio [OR] 3.6, 95% confidence interval [CI] 1.2-10.8, p=0.02), psychosis (OR 3.3, 95% CI 1.5-6.9, p=0.002), and inpatient treatment (OR 3.8, 95% CI 1.8-7.9, p=0.0005). Prevalent use of lithium (OR 0.3, 95% CI 0.1-0.9, p=0.03) and being married (OR 0.3, 95% CI 0.1-0.8, p=0.02) were inversely associated with new use of an SGA. Mania, psychosis, married status, and lithium use remained independently associated on multivariate analysis. Factors related to metabolic or vascular risk were not associated with SGA initiation. Conclusion. Psychiatric clinicians were influenced heavily by clinical features related to mental status and acuity when determining whether to prescribe SGAs. However, factors related to vascular risk were not associated. Future observational studies should consider current clinical status as an important factor in determining propensity to receive antipsychotics or other short-term treatments for bipolar and related disorders.