Treatment Patterns and Appropriateness of Antipsychotic Prescriptions in Patients with Schizophrenia

Abstract

Schizophrenia is a chronic mental condition presenting a wide range of symptoms. Although this mental disorder has a low prevalence in comparison to other mental conditions, it has a negative impact on social and occupational functioning. This study is aimed to assess the inappropriateness of antipsychotic medication among schizophrenic patients and describe current patterns in the treatment of schizophrenia. A retrospective cohort study was conducted including all patients over the age of 15 with an active diagnosis of schizophrenia and treated with antipsychotics between 2008 and 2013 in the Valencia region. 19,718 patients with a diagnosis of schizophrenia and treated with antipsychotic medication were identified. The main outcome was inappropriateness of the pharmacotherapeutic management, including polypharmacy use: 30.4% of patients received antipsychotic polypharmacy (6.8% were prescribed 3 or more antipsychotics); overdosage: a total of 318 individuals (1.6%) exceeded the maximum daily doses; and use of concomitant psychotropics without an associated diagnosis: 21.5% of patients received psychotropic drugs concomitantly without associated psychiatric diagnoses. Overall, females and those who had a comorbid condition, such as anxiety or depression, were less likely to receive antipsychotic polypharmacy. In contrast, concomitant treatment with other psychoactive drugs, such as antiparkinson drugs, anxiolytics and hypnotics and more visits to mental health hospital increased the risk of polypharmacy use. In conclusion, a high level of inappropriateness has been detected among antipsychotic prescriptions. Practitioners should follow guidelines recommendations whenever possible in order to obtain the maximum benefit of antipsychotic medications without an increased risk of adverse effects in patients.