{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,13]],"date-time":"2026-11-13T05:27:31Z","timestamp":1794547651605,"version":"4.9.1"},"reference-count":27,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2022,3,7]],"date-time":"2022-03-07T00:00:00Z","timestamp":1646611200000},"content-version":"unspecified","delay-in-days":6,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MC_PC_17216"],"award-info":[{"award-number":["MC_PC_17216"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["211085\/Z\/18\/Z"],"award-info":[{"award-number":["211085\/Z\/18\/Z"]}],"id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,2,3]]},"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To investigate the extent of antipsychotic prescribing to people with recorded personality disorder (PD) in UK primary care and factors associated with such prescribing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>General practices contributing to The Health Improvement Network UK-wide primary care database, 1 January 2000\u201331 December 2016.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>46 210 people registered with participating general practices who had a record of PD in their general practice notes. 1358 (2.9%) people with missing deprivation information were excluded from regression analyses; no other missing data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>Prescriptions for antipsychotics in general practice records and length of time in receipt of antipsychotic prescriptions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 46 210 people with recorded PD, 15 562 (34%) were ever prescribed antipsychotics. Among the subgroup of 36 875 people with recorded PD, but no recorded severe mental illness (SMI), 9208 (25%) were prescribed antipsychotics; prescribing was lower in less deprived areas (adjusted rate ratio (aRR) comparing least to most deprived quintile: 0.56, 95% CI 0.48 to 0.66, p&lt;0.001), was higher in females (aRR:1.25, 95% CI 1.16 to 1.34, p&lt;0.001) and with a history of adverse childhood experiences (aRR:1.44, 95% CI 1.28 to 1.56, p&lt;0.001). Median time prescribed antipsychotics was 605 days (IQR 197\u20131639 days). Prescribing frequency has increased over time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Contrary to current UK guidelines, antipsychotics are frequently and increasingly prescribed for extended periods to people with recorded PD, but with no history of SMI. An urgent review of clinical practice is warranted, including the effectiveness of such prescribing and the need to monitor for adverse effects, including metabolic complications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-053943","type":"journal-article","created":{"date-parts":[[2022,3,9]],"date-time":"2022-03-09T20:30:26Z","timestamp":1646857826000},"page":"e053943","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":27,"title":["Prescribing of antipsychotics among people with recorded personality disorder in primary care: a retrospective nationwide cohort study using The Health Improvement Network primary care database"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3044-3713","authenticated-orcid":false,"given":"Sarah","family":"Hardoon","sequence":"first","affiliation":[{"name":"Division of Psychiatry, UCL, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Hayes","sequence":"additional","affiliation":[{"name":"Division of Psychiatry, UCL, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Essi","family":"Viding","sequence":"additional","affiliation":[{"name":"Division of Psychology and Language Sciences, UCL, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eamon","family":"McCrory","sequence":"additional","affiliation":[{"name":"Division of Psychology and Language Sciences, UCL, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2173-2430","authenticated-orcid":false,"given":"Kate","family":"Walters","sequence":"additional","affiliation":[{"name":"Department of Primary Care and Population Health, UCL, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Osborn","sequence":"additional","affiliation":[{"name":"Division of Psychiatry, UCL, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,3,9]]},"reference":[{"key":"2025121510221870000_12.3.e053943.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)61995-4"},{"key":"2025121510221870000_12.3.e053943.2","doi-asserted-by":"publisher","DOI":"10.3109\/09540261.2011.588200"},{"key":"2025121510221870000_12.3.e053943.3","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0447.2000.102001052.x"},{"key":"2025121510221870000_12.3.e053943.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)61394-5"},{"key":"2025121510221870000_12.3.e053943.5","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b93"},{"key":"2025121510221870000_12.3.e053943.6","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp1007358"},{"key":"2025121510221870000_12.3.e053943.7","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.158.1.1"},{"key":"2025121510221870000_12.3.e053943.8","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.108.062984"},{"key":"2025121510221870000_12.3.e053943.9","doi-asserted-by":"crossref","first-page":"e512","DOI":"10.4088\/JCP.14m09228","article-title":"The use of psychotropic medication in patients with emotionally unstable personality disorder under the care of UK mental health services","volume":"76","author":"Paton","year":"2015","journal-title":"J Clin Psychiatry"},{"key":"2025121510221870000_12.3.e053943.10","first-page":"8","article-title":"Antipsychotic medications: metabolic and cardiovascular risk","volume":"68 Suppl 4","author":"Newcomer","year":"2007","journal-title":"J Clin Psychiatry"},{"key":"2025121510221870000_12.3.e053943.11","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1111\/acps.13118","article-title":"Childhood adversity and borderline personality disorder: a meta-analysis","volume":"141","author":"Porter","year":"2020","journal-title":"Acta Psychiatr Scand"},{"key":"2025121510221870000_12.3.e053943.12","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph15061145"},{"key":"2025121510221870000_12.3.e053943.13","doi-asserted-by":"publisher","DOI":"10.14236\/jhi.v19i4.820"},{"key":"2025121510221870000_12.3.e053943.14","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.300.6732.1092"},{"key":"2025121510221870000_12.3.e053943.15","doi-asserted-by":"publisher","DOI":"10.1002\/pds.1770"},{"key":"2025121510221870000_12.3.e053943.16","doi-asserted-by":"publisher","DOI":"10.1002\/pds.1688"},{"key":"2025121510221870000_12.3.e053943.17","doi-asserted-by":"publisher","DOI":"10.1002\/pds.3368"},{"key":"2025121510221870000_12.3.e053943.18","doi-asserted-by":"publisher","DOI":"10.1017\/S0047279400020341"},{"key":"2025121510221870000_12.3.e053943.19","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0082365"},{"key":"2025121510221870000_12.3.e053943.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2010.03.015"},{"key":"2025121510221870000_12.3.e053943.21","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0049808"},{"key":"2025121510221870000_12.3.e053943.22","doi-asserted-by":"publisher","DOI":"10.1097\/01.yic.0000224784.90911.66"},{"key":"2025121510221870000_12.3.e053943.23","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1097\/JCP.0b013e31822c1636","article-title":"Antipsychotics, antidepressants, anticonvulsants, and placebo on the symptom dimensions of borderline personality disorder: a meta-analysis of randomized controlled and open-label trials","volume":"31","author":"Vita","year":"2011","journal-title":"J Clin Psychopharmacol"},{"key":"2025121510221870000_12.3.e053943.24","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2007.01.005"},{"key":"2025121510221870000_12.3.e053943.25","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2014-006135"},{"key":"2025121510221870000_12.3.e053943.26","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2012-002080","article-title":"Trends in the prevalence of antipsychotic drug use among patients with Alzheimer\u2019s disease and other dementias including those treated with antidementia drugs in the community in the UK: a cohort study","volume":"3","author":"Martinez","year":"2013","journal-title":"BMJ Open"},{"key":"2025121510221870000_12.3.e053943.27","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.2336126100"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2021-053943","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T18:22:23Z","timestamp":1765822943000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2021-053943"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3]]},"references-count":27,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,3,9]]},"published-print":{"date-parts":[[2022,3]]}},"alternative-id":["10.1136\/bmjopen-2021-053943"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2021-053943","relation":{"has-part":[{"id-type":"doi","id":"https:\/\/doi.org\/10.1136\/bmjopen-2021-053943.supp1","asserted-by":"subject"}]},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3]]}}}