Antipsychotic prescription trends according to ethnicity

The UK is ethnically very diverse. ¹ It has been shown that individuals from Black and minority ethnic groups have poorer self-reported experiences of pathways in mental health and worse outcomes. ² The National Institute for Health and Clinical Excellence (NICE) guidelines for antipsychotics state that individuals on conventional antipsychotics who do not tolerate the side-effects or whose symptoms are not controlled should be switched to atypical agents. ³ The Department of Health recommendations state that prescribing for Black and minority ethnic patients should be audited on a yearly basis to ensure that prescribing discrepancies between ethnicities continue to fall. ⁴

Bolton, in Greater Manchester, has a total population of 261 037, of which Asians represent the largest ethnic minority (8.5%). ¹ We examined whether there was significant difference in the proportion of Asian patients switched from typical to atypical antipsychotics compared with White patients. We also looked at the reasons for these switches and at adherence to NICE guidelines.

A total of 178 patients were studied through retrospective case-note analysis. All Asian patients with a diagnosis of psychotic disorder were selected from the open referral list in a Bolton mental health unit. To ensure they were initially on a conventional antipsychotic, we selected patients that had onset of illness prior to the advent of clozapine (the first atypical antipsychotic) in 1990. Overall, 36 Asian patients were eligible for inclusion in the study and a total of 72 similar White patients were then randomly selected for comparison.

There was no significant difference in the proportion of Asian patients switched to atypical antipsychotics (where indicated) compared with the proportion of White patients (P = 0.489, 95% CI –0.042 to 0.42). Most switches in medication were made due to poor tolerability than ineffectiveness, but this was not significantly different between the two groups (P = 0.577, 95% CI –0.056 to 0.491). Documentation of tolerability was 100% for the Asian group and 97% for the White group; documentation of effectiveness of antipsychotic treatment was 100% for both groups.

There is indication of equity in prescribing and adherence to NICE guidelines for both Asian and White patients in Bolton, Greater Manchester. This is encouraging given the difficulty that Black and minority ethnic groups experience with outcomes in healthcare. However, this particular study would need replication on a larger scale to establish national trends. Furthermore, such information would help contribute to relevant research in mental health service provision to Black and minority ethnic groups in the UK.