Prescribing trends for the same patients with schizophrenia over 20 years

Abstract

BACKGROUND: Recent pharmacoepidemiology data show an increase in the proportion of patients receiving second-generation antipsychotic (SGA) monotherapy, but no studies have analyzed the same patients over a long period of time. Therefore, in this study, we decided to evaluate retrospectively schizophrenia patients with available data for 20 years to see whether the drug treatments in the same patients have changed in the past 20 years. METHODS: The study began in April 2021 and was conducted in 15 psychiatric hospitals in Japan. Schizophrenia patients treated in the same hospital for 20 years were retrospectively examined for all prescriptions in 2016, 2011, 2006, and 2001 (i.e., every 5 years). RESULTS: The mean age of the 716 patients surveyed in 2021 was 61.7 years, with 49.0% being female. The rate of antipsychotic monotherapy use showed a slight increasing trend over the past 20 years; the rate of SGA use showed a marked increasing trend from 28.9% to 70.3% over the past 20 years, while the rate of SGA monotherapy use showed a gradual increasing trend over the past 20 years. The rates of concomitant use of anticholinergics, antidepressants, anxiolytics/sleep medications, and mood stabilizers showed decreasing, flat, decreasing, and flat trends over the past 20 years, respectively. CONCLUSION: The results of this study showed a slow but steady substitution of SGAs for first-generation antipsychotics (FGAs) over time, even in the same patients.

Factors associated with the initiation of laxative use in the same patients with schizophrenia over a 20‐year period: Retrospective cohort study

“…This is consistent with a previous study that reported that lithium and carbamazepine were the medications associated with constipation 3 . The biperiden equivalent of total anticholinergic drug in 2021 was smaller than that in 2001, as we previously reported 11 . There was no significance between the initiation of laxative use and the daily dose of anticholinergic drugs in 2021 or 2001.…”

“…3 The biperiden equivalent of total anticholinergic drug in 2021 was smaller than that in 2001, as we previously reported. 11 There was no significance between the initiation of laxative use and the daily dose of anticholinergic drugs in 2021 or 2001. This is not consistent with a previous study by Lin and their colleagues who reported that a higher dose of anticholinergic drugs was associated with increasing laxative use.…”

“…Previously in this survey, we reported a slow but steady substitution of SGAs for FGAs over time. 11 Since many guidelines recommend that monotherapy with SGAs is the first-line treatment for schizophrenia, [22][23][24] polytherapy with benzodiazepine and mood stabilizers, including lithium and carbamazepine, should be minimized. In Japan, the Effectiveness of Guidelines for Dissemination and Education (EGUIDE) psychiatric treatment project, which aims to disseminate the guidelines that present the treatments for schizophrenia and major depressive disorder via education programs for psychiatrists, was reported to be effective.…”

“…This study was initiated in April 2021 and was conducted in 14 psychiatric hospitals 11 . Participants were selected based on the consecutive sampling method.…”

“…This study was initiated in April 2021 and was conducted in 14 psychiatric hospitals. 11 Participants were selected based on the consecutive sampling method. To obtain an equivalent number of participants from each site, we set the number (n = 70) due to the feasibility.…”