Use of Anticholinergic Drugs in Patients with Schizophrenia in Asia from 2001 to 2009

Xiang, Yu Tao; Wang, Chuanyue; Si, Tianmei; H, Lee; He, Yan; Ungvári, Gábor S.; Chiu, Helen F. K.; Yang, Shuyu; Chong, Mian Yoon; Tan, Chay Hoon; Kua, Ee Heok; Fujii, Senta; Sim, Kang; Yong, K.H.; Jk, Trivedi; Chung, Eun Kee; Udomratn, Pichet; Chee, Kok Yoon; Sartorius, Norman; Shinfuku, Naotaka

doi:10.1055/s-0031-1275658

Cited by 15 publications

(13 citation statements)

References 31 publications

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“…Equivocally, Chalks et al (2006) reported an increase in antipsychotic combination among female patients [31]. Our finding regarding the association between anti cholinergic agents use and antipsychotic combination is consistent with previous studies [22,32,33]. Antipsychotic combination is expected to be associated with higher CPZeq effects which explains the significant association between antipsychotic combination and use of anticholinergic agents [22].…”

Section: Discussionsupporting

confidence: 89%

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

et al. 2013

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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.

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Section: Discussionsupporting

confidence: 89%

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

et al. 2013

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“…These studies have looked into national prescription patterns,[1] prescription patterns in general practice, and specialist care,[2] age, and gender differences in antipsychotic prescription,[3] prescription patterns of antidepressants,[4] mood stabilizers in bipolar disorder patients,[5] and rate of use of anti-cholinergic agents in psychiatric patients. [6] A few surveys of prescription patterns of various psychotropics from Asian centers too are available. [47]…”

Section: Introductionmentioning

confidence: 99%

An audit of first prescription of new patients attending a psychiatry walk-in-clinic in north India

2012

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Background:Although almost all psychotropic medications available worldwide are readily available in India, there is meager data in this country on the prescription patterns of psychiatrists.Aim:To study the first prescription handed over to patients attending the psychiatry outpatient clinic of a tertiary care hospital.Materials and Methods:Data of all patients (for the period of January 1, 2009 to November 30, 2010; diagnosed with an ICD-10 diagnosis of F2-F4) were extracted from the computer-based registry and analyzed.Results:Ten thousand two hundred and fourteen (10 214) patients were diagnosed to have a diagnosis of F2-F4 ICD-10 category. In all diagnostic groups, olanzapine was the most commonly prescribed antipsychotic followed by risperidone. Very few patients (8%) received typical antipsychotic medication. In all diagnostic groups, escitalopram was the most commonly prescribed antidepressant; other frequently prescribed antidepressants were sertraline, paroxetine, and venlafaxine. Among the mood stabilizers, valproate was preferred over lithium. In all the groups, more than half of the patients were prescribed benzodiazepines, clonazepam being the most commonly prescribed agent, followed by lorazepam. The mean number of psychotropic medications was highest in the bipolar disorder group. Very few patients received the combination of same group of drugs.Conclusions:Olanzapine, escitalopram, and clonazepam are the most commonly prescribed antipsychotic, antidepressants, and benzodiazepines, respectively. Valproate was preferred over lithium as a mood stabilizer. In general, the prescription trends were in accordance to the recommendations of various treatment guidelines, except for the use of benzodiazepines, which was higher.

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“…Anticholinergics should be prudently prescribed because these drugs in addition to their well-known peripheral side-effects, may worsen positive symptoms, appear to partially ameliorate negative symptoms and are associated with impaired cognitive functioning of schizophrenic [10] and cognitive impairment in elderly patients [11]. A recent report [12] has confirmed that there is a wide variation in anticholinergic medication prescribing across various countries; a combination of clinical, social, economic and cultural factors are the determinants of the use of these drugs suggesting that there are considerable differences between treatment guidelines and clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Antipsychotic and Anticholinergic Drug Prescribing Pattern in Psychiatry: Extent of Evidence-Based Practice in Bahrain

Khaja¹,

Al-Haddad²,

Sequeira³

et al. 2012

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The aim of this study is to determine the antipsychotic prescribing pattern and the prevalence of concurrent anticholinergic prescribing in a psychiatric referral hospital. A retrospective audit of prescriptions issued for outpatients was carried out at the Psychiatric Hospital, the only facility that provides psychiatric services for both inpatients and outpatients in the Kingdom of Bahrain. Antipsychotic monotherapy was prescribed for 89.2% patients, whereas polytherapy with two-and three-drugs in 10.4% and 0.4%, respectively. Atypical antipsychotics were prescribed more often (67.7%) than typical antipsychotics. Risperidone and haloperidol were the most frequently prescribed antipsychotics. Long-acting risperidone injection was the only depot preparation prescribed. The mean antipsychotic dose expressed as chlorpromazine equivalent (CPZeq; mg/day) was 242 (220 for monotherapy and 414 for polytherapy). The prevalence of high dose antipsychotic (mean CPZeq > 1000 mg/day) was 1.8%, prescribed at a mean CPZeq dose of 1531 (1925 for monotherapy and 1137 for polytherapy), mainly attributed to haloperidol. Anticholinergics were co-prescribed for almost two third of patients receiving antipsychotics, particularly for those on polytherapy (monotherapy 57.3%; polytherapy 87.5%). Antipsychotic polytherapy, high dose and co-prescription of an oral with a depot antipsychotic preparation were strongly associated with concurrent prescription of anticholinergics. Procyclidine and orphenadrine were the most often prescribed anticholinergics. In Bahrain, antipsychotic monotherapy is a common practice for outpatients with psychotic disorders. Some of the antipsychotic polytherapies, dosage strategies, and high prevalence of anticholinergic use are therapeutic issues that need to be addressed to foster evidence-based prescribing practice.

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Use of Anticholinergic Drugs in Patients with Schizophrenia in Asia from 2001 to 2009

Cited by 15 publications

References 31 publications

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

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

An audit of first prescription of new patients attending a psychiatry walk-in-clinic in north India

Antipsychotic and Anticholinergic Drug Prescribing Pattern in Psychiatry: Extent of Evidence-Based Practice in Bahrain

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