Antipsychotic Prescribing Patterns in First-episode Schizophrenia: A Five-year Comparison

Abstract

ObjectiveEarly treatment choice is critical in first-episode schizophrenia-spectrum disorders. The purpose of this study was to describe prescribing trends of antipsychotics use in patients with first-episode schizophrenia in 2005 and 2010, respectively.MethodsWe reviewed the medical records of newly treated patients with schizophrenia from a university psychiatric hospital in 2005 (n=47) and 2010 (n=52). We defined patients as receiving a high antipsychotic dose if their ratio of prescribed daily dose (PDD) to defined daily dose (DDD) was greater than 1.5.ResultsThe rates of high-dose antipsychotic prescription were 61.7% and 53.8% in 2005 and 2010, respectively. The rates of antipsychotic polypharmacy were 34.6% in 2005 and 34.0% in 2010. The most common first-prescribed antipsychotics were (in descending order of prescription frequency) olanzapine, risperidone, aripiprazole, and haloperidol in 2005 and risperidone, quetiapine, paliperidone, and olanzapine in 2010. High-dose antipsychotics were significantly associated with antipsychotic poly-pharmacy (odds ratio=23.97; p<0.01). More individuals were treated with mood stabilizers in 2010 than in 2005 (p=0.003).ConclusionThe practice of prescribing high-dose antipsychotics and associated antipsychotic polypharmacy were common even for initial treatment of first-episode schizophrenia in 2005 and 2010. In 2010, the list of the most common first-prescribed antipsychotics changed, and the use of mood stabilizers increased in non-affective schizophrenia.

Factors associated with adherence to guidelines of good clinical practice during hospital treatment of patients with the first episode of schizophrenia spectrum disorders

“…The average age of the patients in this study was 28.5, most of them were males, with secondary education, unemployed, not married, and more than two-thirds lived with parents. Apart from the age, employment and living within the primary family, other findings were consistent with other studies 7,14,23 . A somewhat higher average age when diagnosing the first episode of schizophrenic disorder than most other studies, where patients were diagnosed for the first time in the mid 20s, can be explained by longer duration of DUP in the patients in this study 24,25 .…”

“…Also, this can be partly attributed to the fact that in the mentioned studies, the upper age limit of 30-40 years was set as the inclusion criterion. In other studies, with no upper age limit, and in the large national cohort studies with a similar operational definition of FPE, the average age is similar, or even significantly higher 5,7,23 . It is known that in the patients with schizophrenic disorders, the neurodevelopmental and neurocognitive changes are registered at the beginning of the disease and that a clear psychotic symptomatology usually preceded by a prolonged period with reduced functionality, which has a negative impact on the educational, social and professional achievements of the afflicted 26 .…”

“…With each subsequent relapse, further deterioration occurs in the psychopathological, neurocognitive and functional domain and the time required for achieving remission is prolonged, and the possibility for good treatment response decreases [7][8][9] . It is considered that a critical period of 2 to 5 years after the onset of psychosis determines the functional outcome of the disease and during this period therapeutic interventions have a maximum effect 10 .…”

Dying Too Soon: Excess Mortality in Severe Mental Illness

“…DDDs greater than 1 indicate a dosage that is higher than average. DDDs greater than 1.5 were classified as excessive (56)(57)(58).…”

Evaluation of Paraoxonase, Arylesterase and Malondialdehyde Levels in Schizophrenia Patients Taking Typical, Atypical and Combined Antipsychotic Treatment

“…One percent of the general population is affected by schizophrenia, and the expected life span is shorter among these patients than for those who do not suffer from this disease 1,2). Both typical and atypical antipsychotic drugs are used to treat schizophrenia 3).…”