We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Editor's Correspondence |

Variations in Antipsychotic Prescribing in Nursing Homes: Can This Be Reflective of Referral Patterns?

Glen L. Xiong, MD; Y. Pritham Raj, MD
Arch Intern Med. 2010;170(10):917-918. doi:10.1001/archinternmed.2010.143.
Text Size: A A A
Published online


We read with interest the study by Chen and colleagues1 detailing the discrepancies in prescribing rates of antipsychotics in US nursing homes (NHs). This issue has been rendered far from trivial, given the parade of well-publicized articles and Food and Drug Administration warnings about the increased risk of death from antipsychotics in elderly individuals with dementia.2,3 The investigators raise the concern that NH prescribing differences may be rooted primarily in prescribing bias. In our experience as practicing internists and psychiatrists, we are accustomed to the referral bias that occurs among NHs—statistics that are not captured well by Minimum Data Set codes. We routinely find nursing facilities that are more “willing” to accept challenging patients, either those receiving antipsychotics (with no clear indication) or the minority who become highly symptomatic after antipsychotic discontinuation. These facilities often care for complex patients who have received multiple psychotropic medication trials, including antidepressants, sedative hypnotics, and not infrequently, several antipsychotics.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections