Conformance to schizophrenia treatment guidelines in North West-Bank, Palestine: focus on antipsychotic dosing and polytherapy

Abstract

BackgroundAnalysis of the prescribing patterns of antipsychotic drugs can improve therapeutic outcomes. The purpose of this study was to evaluate the prescribing pattern of antipsychotics and its conformance to international treatment guidelines.MethodsA cross sectional study at primary psychiatric centers was carried out. Patients’ medical files were used to obtain demographic, medication and clinical information. International guidelines for schizophrenia were used to create conformance indicators. All statistical analyses were conducted using Statistical Package for Social Sciences.Results250 patients were included in this study. A total of 406 antipsychotic agents were used; 348 (85.7%) were first generation antipsychotics (FGA). The prevalence of antipsychotic combination was 50.4% (n=126). There was no significant difference in positive (p=0.3), negative (p=0.06) and psychopathology (p=0.5) scores of schizophrenia symptoms among patients on monotherapy versus those on antipsychotic combination. Furthermore, no significant difference was observed in the annual cost of antipsychotic monotherapy versus combination therapy. One hundred and five patients (42%) were using optimum dose of (300 – 600 mg CPZeq) while the remaining were using sub or supra therapeutic doses. Analysis showed that use of depot, use of anticholinergic agents and increasing amount of total CPZeq were significant factors associated with antipsychotic combination.ConclusionsThis study indicated that antipsychotic prescribing was not in conformance with international guidelines with respect to maintenance dose and combination therapy. Type of antipsychotic treatment regimen, combination versus monotherapy, was not associated with better clinical or economic outcome.

Schizophrenia in the context of mental health services in Palestine: a literature review

“…Both newly diagnosed patients and patients who were not on antipsychotic therapy were excluded. The characteristics of the 250 participants in the study were 182; (73.8%) male patients, 145 (58%) live in village/camp, 213 (85.2%) have completed school education or less, 112 (44.8%) were single/divorced, 153 (61.2%) were smokers, 219 (87.6%) without a job and 161 (64.4%) reported having a duration of illness for more than 10 years [35].…”

Schizophrenia in The Context of Mental Health Services in Palestine: a literature review

“…Both newly diagnosed patients and patients who were not on antipsychotic therapy were excluded. The characteristics of the 250 participants in the study were 182; (73.8%) male patients, 145 (58%) live in village/camp, 213 (85.2%) have completed school education or less, 112 (44.8%) were single/divorced, 153 (61.2%) were smokers, 219 (87.6%) without a job and 161(64.4%) reported having a duration of illness for more than ten years [35].…”

“…Antipsychotic drug therapy is considered to be one of the treatment regimens for schizophrenia and has been reported to successfully minimize the frequency of acute episodes for schizophrenia and hospitalization [36]. According to Sweileh et al, several major well-known algorithms were used for the treatment of schizophrenia [35]. Schizophrenia treatment guidelines in Palestine were investigated, and results revealed there were 406 prescriptions of antipsychotic drugs used by the 250 patients.…”

“…The antipsychotics were primarily from First-generation type (FGT) (85.7%), and the most common antipsychotic medications that were consumed by the patients: Chlorpromazine tablet 10 (31.5%), followed by Fluphenazine IM depot injection (30.8%), Haloperidol tablet (18.2%), Clozapine (8.6%), Olanzapine (3.7%), Haloperidol Decanoate (2.7%), Risperidone (2%), Trifluoperazine (1.7%), Thioridazine (0.2%) and Zuclopenthixol (0.5%). This study also indicated that antipsychotic prescribing was not in the conformance with the international guidelines with respect to maintenance dose and combination therapy; categorization of Chlorpromazine dose equivalencies (CPZeq) showed that 88 (35.2%) clients were using sub-therapeutic treatments (< 300 mg CPZeq), 105 (42%) were using the optimum dose (300-600 mg CPZeq), 57 (22.8%) were using supratherapeutic treatments ( > 600 mg CPZeq) and 7 (2.8%) were using the supra-maximal dose (CPZeq > 1000 mg) [35].…”

Schizophrenia in the Context of Mental Health Services in Palestine

“…According to Sweileh et al, several major well-known algorithms were used for the treatment of schizophrenia [35]. Antipsychotic drug therapy is considered to be one of the treatment regimens for schizophrenia and has been reported to successfully minimize the frequency of acute schizophrenic episodes and hospitalization [36].…”