Nationwide trends in psychiatric prescription practices for drugs with putative cognitive adverse effects in schizophrenia spectrum and bipolar disorders from 2013 to 2022.

Abstract

Background: The management of schizophrenia spectrum (SZ) and bipolar disorders (BD) can involve psychotropic polypharmacy, high psychotropic doses, a high anticholinergic burden, and the use of anticholinergic agents and benzodiazepines, which are associated with poorer cognitive performance. We evaluated trends in those prescription practices in adult outpatients with SZ or BD between 2013 and 2022, to guide future treatment guidelines and interventions for improving cognition.

Methods: We performed a retrospective longitudinal analysis of the nationwide French health claims database. We identified the deliveries of psychotropic drugs (antipsychotics, antidepressants, anxiolytics, hypnotics, and antiepileptics) occurring between 2013 and 2022. We estimated mixed-effects linear regression models of the number of psychotropics prescribed, the total daily dose/DDD of psychotropics, cumulative anticholinergic burden, and the frequencies of benzodiazepine and anticholinergic agent use across diagnoses and age groups.

Results: Between 2013 and 2022, we measured small but significant declines in the number (β between -0.006 and -0.031) and dose of psychotropic drugs (β between -0.003 and -0.029) and the frequency of benzodiazepine use (β between -0.26% and -0.88%) within most groups. The use of anticholinergic agents decreased in adults with SZ but not BD, and the anticholinergic burden remained globally constant. In 2022, 42.1% adults with BD and 49.4% with SZD had at least once a high anticholinergic burden due to psychotropic drugs. Most trends towards deprescription halted after 2020.

Conclusion: The slight decrease in the number and total dose of psychotropic drugs and the deliveries of benzodiazepines from 2013 to 2022 suggest a better consideration of adverse effects in adults with SZ or BD. However, the use of anticholinergic agents and the anticholinergic burden did not consistently decrease, suggesting that prescribers fail to reduce anticholinergic burden. Efforts to support deprescribing are further required after the pandemic.