The characteristics of patients receiving psychotropic pro re nata medication at discharge for the treatment of schizophrenia and major depressive disorder: A nationwide survey from the EGUIDE project

Ichihashi, Kayo; Kyou, Yoshitaka; Hasegawa, Naomi; Yasui‐Furukori, Norio; Shimizu, Yoshihito; Hori, Hikaru; Hashimoto, Naoki; Ide, Kenta; Imamura, Yayoi; Ochi, Shinichiro; Iga, Jun‐ichi; Takaesu, Yoshikazu; Ohi, Kazutaka; Tsuboi, Takashi; Iida, Hitoshi; Yamagata, Hirotaka; Hishimoto, Akitoyo; Horai, Tadasu; Usami, Masahide; Makinodan, Manabu; Nagasawa, Tatsuya; Komatsu, Hiroshi; Kido, Mikio; Muraoka, Hiroyuki; Atake, Kiyokazu; Takeshima, Masahiro; Kubota, Chika; Inagaki, Taisuke; Tamai, Shinichiro; Kishimoto, Toshifumi; Furihata, Ryuji; Matsumoto, Junya; Miura, Kenichiro; Inada, Keiichi; Watanabe, Koichiro; Kasai, Kazuhiko; Hashimoto, Ryota

doi:10.1016/j.ajp.2022.103007

Cited by 12 publications

(15 citation statements)

References 42 publications

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“…This study was a continuous nationwide cross‐sectional observational study and was conducted as part of the EGUIDE project, which we have reported on in detail elsewhere 21,24–34 . While the EGUIDE project has not address the details of ECT practice, Japanese psychiatrists use the ECT recommendations published by the Japanese Society of Psychiatry and Neurology 46 .…”

Section: Methodsmentioning

confidence: 99%

Effects of electroconvulsive therapy on the use of anxiolytics and sleep medications: a propensity score‐matched analysis

Tsuboi

Takaesu

Hasegawa

et al. 2022

Psychiatry Clin Neurosci

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Aim We investigated the association of electroconvulsive therapy (ECT) with anxiolytic and sleep medication use in patients with major depressive disorder (MDD) and schizophrenia (SZ). Methods This nationwide observational study analyzed data from 3483 MDD inpatients and 6663 SZ inpatients. Patients with MDD and SZ were classified into those who underwent ECT during hospitalization and those who did not. A propensity score‐matching method was performed to adjust for preadmission characteristics and clinical information, which were expected bias between the two groups. Rates of anxiolytic and sleep medication use at discharge were compared in the matched sample. Results 500 MDD patients were assigned to both groups. In the matched MDD sample, the rate of anxiolytic and sleep medication use at discharge was significantly lower in the ECT group than in the non‐ECT group (64.9% vs. 75.8%, P = 1.7 × 10−4). In the ECT group, the rate of anxiolytic and sleep medication use at discharge was significantly lower than that prior to admission (64.9% vs. 73.2%, P = 1.2 × 10−14). 390 SZ patients were allocated. In the matched SZ sample, the ECT group was not significantly different from the non‐ECT group in the rate of anxiolytics and sleep medications use at discharge (61.3% vs. 68.2%, P = 4.3 × 10−2). In the ECT group, the rate of anxiolytics and sleep medications use at discharge was significantly lower than that before admission (61.3% vs. 70.5%, P = 4.4 × 10−4), although this was not the primary outcome. Conclusion Reduction of anxiolytic and sleep medication use may be considered positively when ECT is indicated for treatment of MDD.

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Section: Methodsmentioning

confidence: 99%

Effects of electroconvulsive therapy on the use of anxiolytics and sleep medications: a propensity score‐matched analysis

Tsuboi

Takaesu

Hasegawa

et al. 2022

Psychiatry Clin Neurosci

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“…The field of psychiatry deals primarily with chronic illnesses, and there is a need for new indicators that can be repeatedly assessed over time rather than the use of short‐term events such as death. We set up our own QI and have surveyed and reported how schizophrenia pharmacological treatment is administered in Japan 5–8,10–13 . The survey results showed that those who took the course improved their understanding of the guidelines 5 and their guideline‐oriented practice 10 .…”

Section: Introductionmentioning

confidence: 99%

“…We set up our own QI and have surveyed and reported how schizophrenia pharmacological treatment is administered in Japan. [5][6][7][8][10][11][12][13] The survey results showed that those who took the course improved their understanding of the guidelines 5 and their guideline-oriented practice. 10 Regarding the actual prescribing culture in clinical practice, analysis of pre-course data showed that there was an evidencepractice gap between the standard treatment proposed by the guidelines and clinical practice and there were significant differences between facilities, and standardization was lagging.…”

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confidence: 99%

Development of individual fitness score for conformity of prescriptions to the “Guidelines For Pharmacological Therapy of Schizophrenia”

Inada

Fukumoto

Hasegawa

et al. 2022

Neuropsychopharm Rep

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Clinical practice guidelines are developed to standardize and improve the quality of medical care, and several guidelines for schizophrenia have been published. [1][2][3][4] In Japan, the "Guidelines for Pharmacological Therapy of Schizophrenia" by the Japanese Society of Neuropsychopharmacology has been published. 1 However, it is unclear to what extent the guidelines are followed in clinical settings. Thus, we launched the "Effectiveness of Guidelines for Dissemination and Education in Psychiatric Treatment (EGUIDE)" project to disseminate the guidelines and standardize medical practice. [5][6][7][8] The project aimed to ensure the social implementation of treatment guidelines

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“…It has been reported that PRN psychotropic medications are prescribed to 70–90% of patients hospitalized for psychiatric disorders [ 21 , 22 ]. Moreover, the study from the EGUIDE project reported that the PRN psychotropic prescription ratio was approximately 30% for inpatients with schizophrenia and major depressive disorder, even for discharge prescriptions [ 15 ]. Previous studies on the frequency of PRN psychotropic medication use have been limited to local settings, at a single or a few facilities, and to a wide range of psychiatric diagnoses.…”

Section: Introductionmentioning

confidence: 99%

“…There is no high-quality evidence on the effectiveness of PRN psychotropic medications, and PRN psychotropic drug use is based on clinical experience and habits [ 25 ]. Furthermore, it has been suggested that PRN psychotropic drug prescriptions are at risk of leading to polypharmacy and high-dose prescribing [ 15 , 26 , 27 ]. It has also been suggested that the use of PRN psychotropic medications may in fact prolong hospital stay and increase readmission rate [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

The characteristics of discharge prescriptions including pro re nata psychotropic medications for patients with schizophrenia and major depressive disorder from the survey of the “Effectiveness of guidelines for dissemination and education in psychiatric treatment (EGUIDE)” project

et al. 2022

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Background Several guidelines recommend monotherapy in pharmacotherapy for schizophrenia and major depressive disorder. The content of regular prescriptions has been reported in several studies, but not enough research has been conducted on the content of pharmacotherapy, including pro re nata (PRN) medications. The purpose of this study was to evaluate the content of pharmacotherapy, including PRN medications, and to clarify the relationship with regular prescriptions. Methods We used data from the “Effectiveness of Guidelines for Dissemination And Education in psychiatric treatment” (EGUIDE) project to investigate the presence or absence of PRN psychotropic medications at discharge for each drug category. We compared the PRN psychotropic prescription ratio at discharge by diagnosis for each drug category. The antipsychotic monotherapy ratio and no prescription ratio of other psychotropics for schizophrenia at discharge and the antidepressant monotherapy ratio and no prescription ratio of other psychotropics for major depressive disorder at discharge were calculated for each regular prescription, including PRN psychotropic medications, as quality indicators (QIs). Spearman's rank correlation test was performed for QI values of regular prescriptions and the QI ratio between regular prescriptions and prescriptions including PRN medications for each diagnosis. Results The PRN psychotropic prescription ratio at discharge was 28.7% for schizophrenia and 30.4% for major depressive disorder, with no significant differences by diagnosis. The prescription ratios of PRN antipsychotic medications and PRN antiparkinsonian medications were significantly higher for schizophrenia. The prescription ratios of PRN anxiolytic and hypnotic and PRN antidepressant medications were significantly higher for patients with major depressive disorder. For both schizophrenia and major depressive disorder, the QI was lower for discharge prescriptions, including PRN medications, than for regular prescriptions. QI values for regular prescriptions and the QI ratio were positively correlated. Conclusions Considering PRN psychotropic medications, the monotherapy ratio and no prescription ratio of other psychotropics at discharge decreased in pharmacotherapy for schizophrenia and major depressive disorder. A higher ratio of monotherapy and no prescription of other psychotropics on regular prescriptions may result in less concomitant use of PRN psychotropic medications. Further studies are needed to optimize PRN psychotropic prescriptions.

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The characteristics of patients receiving psychotropic pro re nata medication at discharge for the treatment of schizophrenia and major depressive disorder: A nationwide survey from the EGUIDE project

Cited by 12 publications

References 42 publications

Effects of electroconvulsive therapy on the use of anxiolytics and sleep medications: a propensity score‐matched analysis

Effects of electroconvulsive therapy on the use of anxiolytics and sleep medications: a propensity score‐matched analysis

Development of individual fitness score for conformity of prescriptions to the “Guidelines For Pharmacological Therapy of Schizophrenia”

The characteristics of discharge prescriptions including pro re nata psychotropic medications for patients with schizophrenia and major depressive disorder from the survey of the “Effectiveness of guidelines for dissemination and education in psychiatric treatment (EGUIDE)” project

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