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 it has a low prevalence compared to other mental conditions, it has a negative impact on social and occupational functions. This study aimed to assess the appropriateness of antipsychotic medications administered to schizophrenic patients and describe current treatment patterns for schizophrenia. A retrospective cohort study was conducted in 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. A total of 19,718 patients were eligible for inclusion. The main outcome assessed was inappropriateness of the pharmacotherapeutic management, including polypharmacy use. Altogether, 30.4% of patients received antipsychotic polypharmacy, and 6.8% were prescribed three or more antipsychotics. Overdosage affected 318 individuals (1.6%), and 21.5% used concomitant psychotropics without an associated psychiatric diagnosis. Women and people with a comorbid condition like anxiety or depression were less likely to receive antipsychotic polypharmacy. In contrast, increased polypharmacy was associated with concomitant treatment with other psychoactive drugs, and only in user on maintenance therapy, with more visits to the mental health hospital. Overall, we observed a high level of inappropriateness in antipsychotic prescriptions. Greater adherence to guidelines could maximize the benefits of antipsychotic medications while minimizing risk of adverse effects.

revisão do tratamento da esquizofrenia: monoterapia vs associação de antipsicóticos

“…Na série de casos de Suzuki et al foram incluídos 25 pacientes com esquizofrenia, em tratamento com combinação de antipsicóticos com dose equivalente de clorpromazina acima de 1000 mg/dia, por mais de seis semanas e sem controle sintomático adequado. A idade média dos participantes foi de 40,8 anos, 14 deles eram do sexo masculino, o número médio de antipsicóticos em uso foi de 3,5 (2-5) e de psicotrópicos de 6,8 (3)(4)(5)(6)(7)(8)(9)(10)(11). Além disso, 18 estavam em regime de internação.…”

“…Apesar da falta de recomendação pelas diretrizes de tratamento e de poucas evidências científicas relevantes sobre as vantagens e riscos do uso de antipsicóticos em associação, tal prática é amplamente observada na clínica, muitas vezes sem a tentativa prévia de todos os ensaios clínicos recomendados. [8,[12][13][14][15][16] A prevalência deste tipo de tratamento possui ampla variação (de 4 a 95%), dependendo do local e perfil dos pacientes [9][10][11][12].…”

Prescriptions of Antipsychotics in Younger and Older Geriatric Patients with Polypharmacy, Their Safety, and the Impact of a Pharmaceutical-Medical Dialogue on Antipsychotic Use

“…Antipsychotics are commonly used in older people [ 28 ]. In the available literature, the frequency of antipsychotic use is reported up to 45.1% [ 3 , 5 , 29 ]. In the present study, the proportion of patients with at least one antipsychotic in their medication was 30.7%.…”

Tardive dyskinesia in Asia— current clinical practice and the role of neurologists in the care pathway

“…To reduce the risk of developing TD when prescribing APDs, ideally clinicians should employ the principle of “minimum dose utilization,” and select a suitable dose that achieves sufficient clinical benefit while at the same time minimizing adverse effects. However, this approach is often confounded by the fact that clinicians may prescribe multiple APDs at a time (polypharmacy) and use higher doses than necessary ( 116 ), a problem that has also been identified in Asian countries ( 74 – 76 ).…”