Benzodiazepines and Mood Stabilizers in Schizophrenia Patients Treated with Oral versus Long-Acting Injectable Antipsychotics—An Observational Study

Abstract

Schizophrenia is a chronic, invalidating, and polymorphic disease, characterized by relapses and remission periods. The main treatment option in schizophrenia are antipsychotics, administered as an oral or as a long-acting injectable (LAI) formulation. Although international guidelines rarely recommend it, mood stabilizers (MS) and/or benzodiazepines (BZD) are frequently prescribed as adjunctive therapy in schizophrenia patients for various reasons. This is an observational, cross-sectional study including stabilized schizophrenia patients. A total of 315 patients were enrolled. Of these, 77 patients (24.44%) were stabilized on LAIs and 238 (75.56%) patients on oral antipsychotics (OAP). Eighty-four patients (26.66%) had concomitant treatment with MS and 119 patients (37.77%) had concomitant benzodiazepine treatment. No statistical significance was observed in MS or BZD use between LAIs and OAPs. In total, 136 patients (43.17%) were stabilized on antipsychotic monotherapy. Our study shows that the long-term use of benzodiazepines and mood stabilizers remains elevated among stabilized schizophrenia patients, regardless of the antipsychotic formulation (oral or LAI). Patients receiving second-generation LAI antipsychotics (SGA-LAI) seem to be more likely to be stabilized on monotherapy compared to those receiving oral antipsychotics. Further randomized controlled trials are necessary in order to clarify the benefits of the current drug polypharmacy trends.

Global Neuropsychopharmacological Prescription Trends in Adults with Schizophrenia, Clinical Correlates and Implications for Practice: A Scoping Review

“…The frequency of AP use was 67-98.8% in schizophrenia patients in these studies [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39]. Most patients (52.3% to 90.9%) were on AP monotherapy [28][29][30][31]34,38,[40][41][42][43][44][45][46][47][48][49][50][51][52], except for five studies [27,[53][54][55][56]. Monotherapy AP prescription generally showed an upward trend over the years [38], particularly for second-generation AP (SGA) monotherapy [43].…”

“…Monotherapy AP prescription generally showed an upward trend over the years [38], particularly for second-generation AP (SGA) monotherapy [43]. Monotherapy is generally more frequent in patients receiving SGA [29,40,47,[56][57][58], particularly those initiated on olanzapine [53]. Nonetheless, there were several earlier studies reporting higher rates of first-generation AP (FGA) as compared to SGA monotherapy [31,45,50,54,59,60].…”

Medication Dosage Impact on Mortality in Old-Age Individuals with Schizophrenia: A National Cohort Study

“…The current study demonstrated that the use of sedative-hypnotics at a low dosage is linked to a substantial decrease in both all-cause and CVD mortality among individuals diagnosed with OAS, displaying HRs of 0.855 and 0.685, respectively. In the treatment of schizophrenia, benzodiazepines are commonly prescribed alongside antipsychotic medications to alleviate symptoms of anxiety, sleep disorders, agitation, and antipsychotic-related side effects [ 31 , 32 , 33 ]. Approximately 20% of OAS were prescribed benzodiazepines in Asia [ 34 ].…”

Outcome of COVID-19 mRNA Vaccination in Patients Treated With Clozapine WHO Previously Went Through SARS-COV-2 Infection

“…Data suggest that dose-dependent toxicity was greatest in the case of chlorpromazine, followed by olanzapine, clozapine, and quetiapine. 79 In addition, medication frequently used as concomitant treatment in schizophrenia, such as benzodiazepines or mood stabilizers, 78 may supplementarily increase the risk of neutropenia or agranulocytosis (carbamazepine, for instance, has a neutropenia risk of 1 in 200 patients). 75 Given the fact that a multitude of other nonpsychotropic drugs (such as antihypertensives, analgesics, diuretics, antimicrobials, etc.)…”