The purpose of this international collaborative study was to investigate the prescription patterns of antipsychotic drugs for schizophrenia in East Asia and to analyze factors that affect these patterns. Prescription patterns for patients admitted for treatment of schizophrenia were surveyed using a standardized protocol from six East-Asian region/countries: China, Hong Kong, Japan, Korea, Singapore and Taiwan. Patients' social and clinical characteristics, psychiatric symptoms, course of illness, and adverse effects of medications were systematically assessed and recorded. Prescriptions of the first-and second-generation antipsychotic drugs were compared. A total of 2399 patients were recruited. The second-generation drugs comprised 28.1% of all prescribed antipsychotics, and 46% of the antipsychotic prescriptions were in the context of polypharmacy. The mean dosage of antipsychotics for the whole sample was 675.3 + 645.1 mg chlorpromazine equivalents. Japan had a high frequency of prescribing high doses and polypharmacy; Singapore had a high utilization of depot injections while China had a higher prescription of clozapine. Using multiple logistic regression analysis, distinctions in the prescription patterns of antipsychotic drugs were found: first-generation drugs were mainly for controlling aggressive behavior, while second-generation drugs were targeted at the alleviation of positive, negative psychotic symptoms as well as disruptive behavior in schizophrenia. The present collaborative study highlighted differences in the prescription patterns, especially the under-utilization of second-generation antipsychotic drugs in East Asia. The pattern of antipsychotic medication use varied from country to country and is likely to be influenced by the prevailing health-care system, the availability and cost of the drugs.

AimsPrevious studies of the prescription patterns of psychotropic medications in patients with schizophrenia have highlighted a high rate of antipsychotic polypharmacy, but data in Asia are sparse. This study seeks to examine the prevalence of antipsychotic polypharmacy in patients with schizophrenia and compare the differences between patients receiving one vs. those receiving more than one antipsychotic. MethodsAntipsychotic prescription for a sample of 2399 patients with schizophrenia from six countries and territories was evaluated. Daily doses of antipsychotic medications were converted to standard chlorpromazine equivalents (CPZ). ResultsAntipsychotic polypharmacy was found in 45.7% ( n = 1097) of the patients with wide intercountry variations. Polypharmacy was associated with male gender [odds ratio (OR) 1.24, 95% confidence interval (CI) 1.06, 1.46, P < 0.01], advanced age ( t = -7.81, d.f. = 2396, P < 0.001), psychiatric hospital setting (OR 1.34, 95% CI 1.11, 1.62) as well as higher daily CPZeq doses (411.47 vs. 983.10 CPZeq day -1 , z = -25.94, P < 0.001), anticholinergic use (OR 3.17, 95% CI 2.65, 3.79, P < 0.001) and less use of an atypical antipsychotic drug (OR 0.83, 95% CI 0.71, 0.98, P < 0.05). On multivariate analysis, country, age and duration of illness were significantly associated with antipsychotic polypharmacy. ConclusionThis study highlighted the wide intercountry variations of antipsychotic polypharmacy which are likely to be influenced by a complex combination of clinical, setting, cultural and personal practice factors, requiring more research.

Genetic variations in GADL1 are associated with the response to lithium maintenance treatment for bipolar I disorder in patients of Han Chinese descent. (Funded by Academia Sinica and others.).

Contrary to most previous reports, we found that the prevalence of depressive disorders among the elderly in the community in Taiwan is high and comparable to rates reported in some studies of UK samples.

Numerous studies have shown that doctors, nurses or other hospital staff may suffer from tremendous stress at work. A high level of work‐related stress might increase vulnerability to mental illness and result in a poor quality of clinical care. This study was conducted in a Taiwanese regional general hospital. Minor psychiatric disorder, depressive disorder and quality of life were assessed for all staff, using self‐rating questionnaires including the Chinese Health Questionnaire 12‐item version, the Center for Epidemiologic Studies Depression Scale and World Health Organization Quality of Life Scale brief version. Nearly half of the staff had either a minor psychiatric disorder or depressive disorder. Nurses and pharmacists had the highest prevalence. The risk factors included single/divorced and being a nurse or pharmacist. Quality of life for hospital staff was poor, as compared with the Taiwanese norms, and was even worse for the nurses and pharmacists. In conclusion, the management teams of hospitals should pay more attention to the mental condition of all hospital staff, especially nurses and pharmacists. Adequate staffing, support, counselling or psychological intervention are required for further management, and may logically result in better mental health on the part of the staff and a better quality of care. Copyright © 2009 John Wiley & Sons, Ltd.

R ecent evidence suggests that psychiatric patients may be at increased risk for cardiovascular events. Large community studies report that people with mental illnesses have a 2-to 5-fold greater risk of coronary heart disease and a 2-to 3-fold greater risk of cardiac mortality than the general population. [1][2][3] This increased risk might be explained by risk factors commonly noted in these patients, including smoking, obesity, and unhealthy lifestyles. 4-6 Clinical Perspective on p 243The association of risk for acute myocardial infarction (AMI) with antipsychotic treatment remains unclear because earlier analyses have methodological issues (eg, residual confounding and limited statistical power and external validity). 3,[7][8][9][10][11] If the link exists, more attention might be paid to monitoring drug safety, especially because of current increased use of antipsychotics and the widening range of disorders for which they are being indicated. 12This study tapped a large nationwide population-based data set to investigate the association between antipsychotic treatment and risk of AMI in patients with mental disorders. A casecrossover design was used to eliminate known or unknown within-subject time-invariant confounders while examining the acute effects of various antipsychotics on subsequent AMI Background-Antipsychotic medications have been increasingly and more widely prescribed despite continued uncertainty about their association with the incidence of acute myocardial infarction (AMI

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This survey revealed that high antipsychotic dosing is not an uncommon practice in East Asia. It behooves the prescribing clinicians to constantly reevaluate the rationale for such a practice.