Contemporary data relating to antipsychotic prescribing in UK primary care for patients diagnosed with severe mental illness (SMI) are lacking.

To describe contemporary patterns of antipsychotic prescribing in UK primary care for patients diagnosed with SMI.

Cohort study of patients with an SMI diagnosis (i.e. schizophrenia, bipolar disorder, other non-organic psychoses) first recorded in primary care between 2000 and 2017 derived from Clinical Practice Research Datalink. Patients were considered exposed to antipsychotics if prescribed at least one antipsychotic in primary care between 2000 and 2019. We compared characteristics of patients prescribed and not prescribed antipsychotics; calculated annual prevalence rates for antipsychotic prescribing; and computed average daily antipsychotic doses stratified by patient characteristics.

Of 309 378 patients first diagnosed with an SMI in primary care between 2000 and 2017, 212,618 (68.7%) were prescribed an antipsychotic between 2000 and 2019. Antipsychotic prescribing prevalence was 426 (95% CI, 420–433) per 1000 patients in the year 2000, reaching a peak of 550 (547–553) in 2016, decreasing to 470 (468–473) in 2019. The proportion prescribed antipsychotics was higher among patients diagnosed with schizophrenia (81.0%) than with bipolar disorder (64.6%) and other non-organic psychoses (65.7%). Olanzapine, quetiapine, risperidone and aripiprazole accounted for 78.8% of all antipsychotic prescriptions. Higher mean olanzapine equivalent total daily doses were prescribed to patients with the following characteristics: schizophrenia diagnosis, ethnic minority status, male gender, younger age and greater relative deprivation.

Antipsychotic prescribing is dominated by olanzapine, quetiapine, risperidone and aripiprazole. We identified potential disparities in both the receipt and prescribed doses of antipsychotics across subgroups. To inform efforts to optimise prescribing and ensure equity of care, further research is needed to understand why certain groups are prescribed higher doses and are more likely to be treated with long-acting injectable antipsychotics compared with others.

缺乏与英国初级保健机构中诊断为严重精神疾病 （SMI） 患者开具抗精神病药物处方相关的当代数据。

描述英国初级保健中诊断为 SMI 的患者的当代抗精神病药物处方模式。

对 SMI 诊断患者的队列研究（即 精神分裂症、双相情感障碍、其他非器质性精神病）于 2000 年至 2017 年间在初级保健中首次记录，来自临床实践研究数据链。如果在 2000 年至 2019 年期间在初级保健中开具至少一种抗精神病药，则患者被认为暴露于抗精神病药。我们比较了开具和未开具抗精神病药的患者的特征;计算抗精神病药物处方的年患病率;并计算了按患者特征分层的平均每日抗精神病药物剂量。

在 2000 年至 2017 年期间在初级保健中首次诊断为 SMI 的 309 378 名患者中，有 212,618 名 （68.7%） 在 2000 年至 2019 年期间被开具了抗精神病药。2000 年抗精神病药物处方流行率为每 1000 名患者 426 例（95% CI，420-433），在 2016 年达到 550 （547-553） 的峰值，在 2019 年下降到 470 （468-473）。在被诊断为精神分裂症 （81.0%） 的患者中，开具抗精神病药物的比例高于双相情感障碍 （64.6%） 和其他非器质性精神病 （65.7%）。奥氮平、喹硫平、利培酮和阿立哌唑占所有抗精神病药物处方的 78.8%。对具有以下特征的患者开具更高的平均奥氮平等效总日剂量： 精神分裂症诊断、少数民族地位、男性、年轻和更大的相对剥夺。

抗精神病药处方以奥氮平、喹硫平、利培酮和阿立哌唑为主。我们确定了各亚组之间接受和处方剂量抗精神病药物的潜在差异。为了为优化处方和确保护理公平性的工作提供信息，需要进一步的研究来了解为什么某些群体被开出更高的剂量，并且与其他群体相比，他们更有可能接受长效注射抗精神病药的治疗。