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Ying J, Chew QH, Wang Y, Sim K. Global Neuropsychopharmacological Prescription Trends in Adults with Schizophrenia, Clinical Correlates and Implications for Practice: A Scoping Review. Brain Sci 2023; 14:6. [PMID: 38275511 PMCID: PMC10813099 DOI: 10.3390/brainsci14010006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024] Open
Abstract
It is important to examine the psychotropic prescription practices in schizophrenia, as it can inform regarding changing treatment choices and related patient profiles. No recent reviews have evaluated the global neuropsychopharmacological prescription patterns in adults with schizophrenia. A systematic search of the literature published from 2002 to 2023 found 88 empirical papers pertinent to the utilization of psychotropic agents. Globally, there were wide inter-country and inter-regional variations in the prescription of psychotropic agents. Overall, over time there was an absolute increase in the prescription rate of second-generation antipsychotics (up to 50%), mood stabilizers (up to 15%), and antidepressants (up to 17%), with an observed absolute decrease in the rate of antipsychotic polypharmacy (up to 15%), use of high dose antipsychotic (up to 12% in Asia), clozapine (up to 9%) and antipsychotic long-acting injectables (up to 10%). Prescription patterns were mainly associated with specific socio-demographic (such as age), illness (such as illness duration), and treatment factors (such as adherence). Further work, including more evidence in adjunctive neuropsychopharmacological treatments, pharmaco-economic considerations, and examination of cohorts in prospective studies, can proffer insights into changing prescription trends relevant to different treatment settings and predictors of such trends for enhancement of clinical management in schizophrenia.
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Affiliation(s)
- Jiangbo Ying
- East Region, Institute of Mental Health, Singapore 539747, Singapore
| | - Qian Hui Chew
- Research Division, Institute of Mental Health, Singapore 539747, Singapore
| | - Yuxi Wang
- East Region, Institute of Mental Health, Singapore 539747, Singapore
| | - Kang Sim
- West Region, Institute of Mental Health, Singapore 539747, Singapore
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Shinfuku N. Analysis of the trends of polypharmacy and high-dose prescriptions in Japan. Asia Pac Psychiatry 2022; 14:e12488. [PMID: 34519433 PMCID: PMC9285042 DOI: 10.1111/appy.12488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 02/27/2021] [Accepted: 08/31/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION After extensive research, this study explored whether high-dose prescriptions and polypharmacy remain more frequent in Japan than elsewhere. If confirmed, we aimed to identify the factors that contributed to this unique trend. METHODS The psychotropic drug prescription patterns for patients with schizophrenia in Japan were reviewed. This was based on a large sample collected from surveys of the Research on Asian Psychotropic Prescription Patterns, an international collaborative research project conducted by Asian psychiatrists to monitor prescriptions of psychotropic drugs for people with mental disorders, in 2001, 2004, 2008, and 2016. RESULTS The 2016 Research on Asian Psychotropic Prescription Patterns survey revealed that Japan continued to demonstrate the highest rate of polypharmacy and the highest dosages of psychotropic prescription drugs for patients with schizophrenia among the 15 countries and areas that participated in the survey. DISCUSSION The Research on Asian Psychotropic Prescription Patterns surveys demonstrated that science plays a limited role in the decision-making process for prescriptions of psychotropic medications. Such prescriptions are influenced by a wide range of factors, such as the national mental health policy, prescription-financing systems, the history of psychiatry in each country, and the prevailing culture. Hospital-based national mental health policies and mental health financing systems have been the primary obstacles to reducing polypharmacy in Japan.
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Affiliation(s)
- Naotaka Shinfuku
- Graduate School of Medicine, International Center for Medical Research, Kobe University, Kobe, Japan
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Murata T, Negishi T, Yuki K, Omori S, Abe H. Post-clozapine in a clinical setting: A retrospective case note review in Kumamoto, Japan (2009-2019). Asian J Psychiatr 2021; 65:102845. [PMID: 34543721 DOI: 10.1016/j.ajp.2021.102845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/04/2021] [Accepted: 08/26/2021] [Indexed: 12/28/2022]
Abstract
Clozapine is commonly prescribed in dopamine supersensitivity psychosis (DSP) cases in Japan. However, limited knowledge on treatment post-clozapine discontinuation use exists. We investigated antipsychotic medications, patient status, and DSP episodes before, during, and after clozapine treatment using medical records of 30 schizophrenia patients (mean age, 51 years; mean illness duration before clozapine treatment, 24 years; mean clozapine treatment duration, 1.6 years), who discontinued clozapine between 2009 and 2019. In our region, long-acting injectable antipsychotic monotherapy and polypharmacy (half with aripiprazole) accounted for 17% and 50% post-clozapine use, respectively. Furthermore, patient status rarely improved with subsequent DSP treatment, including clozapine re-initiation.
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Affiliation(s)
| | - Taiki Negishi
- Yatsushiro-Kosei-Hospital, Furushiro, Yatsushiro, Japan
| | - Kuninori Yuki
- Kikuchi National Hospital Organization, Fukuhara, Koshi, Japan
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Valladales-Restrepo LF, Peña-Verjan NM, Vargas-Díaz K, Machado-Alba JE. Potentially inappropriate prescriptions of antipsychotic and anticholinergic drugs in patients with Parkinson's disease. Neurodegener Dis Manag 2021; 11:361-371. [PMID: 34525848 DOI: 10.2217/nmt-2021-0021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Aim: The objective was to determine the prevalence of the potentially inappropriate antipsychotics and anticholinergics used in patients with Parkinson's disease. Materials & methods: A cross-sectional study identified the prescription of antipsychotics, anticholinergics and drugs for the treatment of Parkinson's disease. The anticholinergic burden was evaluated, and quetiapine and clozapine were considered to be adequate antipsychotics. Results: 2965 patients with Parkinson's disease were identified. The presence of psychiatric disorders and other neurological pathologies was associated with a greater probability of receiving potentially inappropriate antipsychotic prescriptions. The presence of greater number of comorbidities was associated with a greater probability of receiving anticholinergics. Conclusion: Older age and associated comorbidities, especially psychiatric and neurological comorbidities, increase the likelihood of patients with Parkinson's disease being prescribed antipsychotics and anticholinergics.
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Affiliation(s)
- Luis Fernando Valladales-Restrepo
- Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia.,Semillero de investigación en Farmacología Geriátrica, Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, 660003, Risaralda, Colombia.,Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Pereira, Risaralda, Colombia
| | - Nathalia Marcela Peña-Verjan
- Semillero de investigación en Farmacología Geriátrica, Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, 660003, Risaralda, Colombia
| | - Katherine Vargas-Díaz
- Semillero de investigación en Farmacología Geriátrica, Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, 660003, Risaralda, Colombia
| | - Jorge Enrique Machado-Alba
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Pereira, Risaralda, Colombia
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Patterns of antipsychotic prescriptions in patients with schizophrenia in China: A national survey. Asian J Psychiatr 2021; 62:102742. [PMID: 34243064 DOI: 10.1016/j.ajp.2021.102742] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 06/16/2021] [Accepted: 06/25/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION To investigate the patterns and correlates of antipsychotic prescriptions among recently discharged inpatients with schizophrenia in China. METHODS The study included discharged patients from 41 tertiary psychiatric hospitals in 29 provinces between March 19-30, 2019. A total of 1032 inpatients with schizophrenia were included. Socio-demographic and clinical data were retrieved from medical records upon discharge. RESULTS Patients received a total of 13 unique antipsychotic medications, which included 9 s-generation antipsychotics (SGAs) and 4 first-generation antipsychotics (FGAs). The utilization rates of SGAs and FGAs were 98.8 % and 6.1 % respectively. The three most commonly antipsychotic medications were risperidone (35.1 %), olanzapine (31.3 %), and clozapine (24.6 %). The mean chlorpromazine equivalent dose was 452.12 ± 230.74 mg/day. The utilization rate of mood stabilizers was 18.9 %, 8.8 % for antidepressants, 20.3 % for sleep improvers, and 9.9 % for anticholinergics. More than two fifths patients (43.1 %) received two or more antipsychotic medications. Predictors of antipsychotic polypharmacy included younger age, residing in Central or West China, a longer duration of illness, a history of prior hospitalizations, and having agitated behavior during the hospitalization. CONCLUSION Antipsychotic polypharmacy in China is common on inpatients settings. The proportion of antipsychotic polypharmacy in China is higher than in many other countries, despite limited data to support the efficacy of many combinations. Clozapine remains one of most commonly prescribed antipsychotics in China, either as a monotherapy or combination therapy.
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Civan Kahve A, Kaya H, Gül Çakıl A, Ünverdi Bıçakçı E, Göksel P, Göka E, Böke Ö. Multiple antipsychotics use in patients with schizophrenia: Why do we use it, what are the results from patient follow-ups? Asian J Psychiatr 2020; 52:102063. [PMID: 32302936 DOI: 10.1016/j.ajp.2020.102063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 10/24/2022]
Abstract
In this study, the rates of antipsychotic polypharmacy, factors affecting combined drug use, the relationship between antipsychotic polypharmacy as it relates to duration of hospitalization and re-hospitalization, and treatment compliance were evaluated in schizophrenia patients. The study data was obtained between January 1, 2017 and December 31, 2017 by examining the files of all patients who were hospitalized in Ondokuz Mayıs University Faculty of Medicine Hospital, Ankara Numune Training and Research Hospital, Ankara Gulhane Training and Research Hospital psychiatric services. The inpatients' drug prescriptions at discharge and after one-year outpatient follow-up, as well as treatment compliance and re-hospitalization, were examined. The mean duration of illness was 109.3 ± 109.7 months, and the mean duration of hospitalization was 24.6 ± 19.1 days. For a total of 599 patients, multiple antipsychotic medication was used in 21.2% of hospitalizations. 11.2% of patients using single antipsychotic and 14.2% of patients using multiple antipsychotics were re-hospitalized within one year (X 2 :0.830, p:0.362). Disease duration (Z:-3.654, p < 0.001) and duration of hospitalization (Z:-3.333, p < 0.001) were found to be longer in multiple antipsychotic users. 37.8% of the patients used a depot antipsychotic. There was no significant difference between depot antipsychotic use and oral antipsychotic use as it related re-hospitalization rates. As a conclusion, multiple antipsychotic use has reduced in Turkey. Contrary to popular belief, the use of multiple antipsychotics does not shorten, but rather may prolongs hospitalization, and it has no effect in reducing re-hospitalization. Drug combinations are generally used together with a depot treatment, clozapine treatment is preferred less frequently in combinations, clinicians have proven effectiveness of the drug combination they prefer, and they should give priority to the treatments recommended in treatment guidelines.
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Affiliation(s)
| | - Hasan Kaya
- University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Atike Gül Çakıl
- University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | | | - Pelin Göksel
- Ondokuz Mayıs University, Faculty of Medicine, Department of Psychiatry, Samsun, Turkey
| | - Erol Göka
- University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Ömer Böke
- Ondokuz Mayıs University, Faculty of Medicine, Department of Psychiatry, Samsun, Turkey
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Frequency, reasons, and factors associated with antipsychotic polypharmacy in Schizophrenia: A retrospective chart review in a tertiary hospital in India. Asian J Psychiatr 2020; 51:102022. [PMID: 32278888 DOI: 10.1016/j.ajp.2020.102022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 03/05/2020] [Accepted: 03/19/2020] [Indexed: 11/21/2022]
Abstract
The practice of antipsychotic polypharmacy in schizophrenia appears to be common although evidence-based guidelines do not routinely recommend it. The reasons for polypharmacy are however unclear. The objective of the study was to assess the frequency of polypharmacy, reasons for initiation and the factors associated with it. A retrospective chart review of case records of all the patients diagnosed with schizophrenia at the department of psychiatry from January 2011 to December 2018 was done. Frequency of antipsychotic polypharmacy, reasons influencing it and factors associated with polypharmacy were extracted using a proforma. Of 529 patients diagnosed with schizophrenia, 232 patients (43.9 %) were receiving antipsychotic polypharmacy. Common reasons for polypharmacy included the usage of depot along with oral antipsychotic for a prolonged period (37.7 %), augmentation of response with the second antipsychotic (17.7 %) and treatment of a different symptom domain like negative symptoms (9.5 %). In comparison to monopharmacy, antipsychotic polypharmacy was more commonly associated with side effects and extrapyramidal symptoms. Patients on polypharmacy had a higher number of hospitalizations too. As the trend of antipsychotic polypharmacy is on the rise, it is important to assess for reasons influencing polypharmacy to avoid undesirable side effects. The side effect burden of polypharmacy is significantly more than those receiving single antipsychotics. Oral antipsychotics should ideally be discontinued after the depot antipsychotic reaches steady-state levels. Irrational usage of second antipsychotic to augment the response of first antipsychotic agent needs to be avoided.
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Lin SK. Antipsychotic Polypharmacy: A Dirty Little Secret or a Fashion? Int J Neuropsychopharmacol 2019; 23:125-131. [PMID: 31867671 PMCID: PMC7093996 DOI: 10.1093/ijnp/pyz068] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 12/18/2019] [Indexed: 11/23/2022] Open
Abstract
The term polypharmacy was originally coined to refer to problems related to multiple drug consumption and excessive drug use during the treatment of a disease or disorder. In the treatment of schizophrenia, polypharmacy usually refers to the simultaneous use of 2 or more antipsychotic medications or combined (adjunct) medications such as mood stabilizers, antidepressants, anxiolytics, or hypnotics in addition to single or multiple antipsychotics. Two decades ago, antipsychotic polypharmacy was criticized as being more expensive, having unproven efficacy, and causing more side effects. However, in recent years, antipsychotic polypharmacy has become more or less acceptable in the views of clinical practitioners and academic researchers. Results from recent reviews have suggested that the common practice of antipsychotic polypharmacy lacks double-blind or high-quality evidence of efficacy, except for negative symptom reduction with aripiprazole augmentation. We reviewed some representative studies that enrolled large numbers of patients and compared antipsychotic polypharmacy and monotherapy during the past decade. The results revealed that a certain proportion of select patients can benefit from antipsychotic polypharmacy without further negative consequences. Because most of the current treatment guidelines from different countries and organizations prefer monotherapy and discourage all antipsychotic polypharmacy, guidelines regarding the use of antipsychotic polypharmacy in clinical practice should be revised. On the basis of the findings of 2 large-scale studies from Asia and Europe, we also suggest ideal rates of various maintenance treatments of schizophrenia, which are as follows: antipsychotic polypharmacy, 30%; combined mood stabilizer, 15%; combined antidepressant, 10%; combined anxiolytics, 30%; and combined hypnotic, 10%.
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Affiliation(s)
- Shih-Ku Lin
- Department of Psychiatry, School of Medicine, Taipei Medical University and Department of Psychiatry, Taipei City Hospital and Psychiatry Center, Taipei, Taiwan,Correspondence: Dr Shih-Ku Lin, Taipei City Hospital and Psychiatric Center, 309 Songde Road, Xinyi District, Taipei 110, Taiwan ()
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Prescription of antipsychotic and concomitant medications for adult Asian schizophrenia patients: Findings of the 2016 Research on Asian Psychotropic Prescription Patterns (REAP) survey. Asian J Psychiatr 2019; 45:74-80. [PMID: 31520884 DOI: 10.1016/j.ajp.2019.08.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 08/11/2019] [Accepted: 08/22/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Regular surveys are important to monitor the use of psychotropic medications in clinical practice. This study examined the psychotropic prescription patterns in adult Asian schizophrenia patients based on the data of the Research on Asian Psychotropic Prescription (REAP) 2016 survey. METHODS This cross-sectional survey across 15 Asian countries/territories collected socio-demographic and clinical data with standardized procedures between March and May 2016. The socio-demographic and clinical characteristics of the patients were recorded with a standardized questionnaire. RESULTS Altogether 3,537 adult patients with schizophrenia were consecutively screened and enrolled in the survey. The mean age was 38.66 ± 11.55 years and 59.7% of the sample were male. The mean dose of antipsychotics in chlorpromazine equivalents (CPZeq) was 424 ± 376 mg/day; 31.3% and 80.8% received first- and second- generation antipsychotics, respectively and 42.6% had antipsychotic polypharmacy, 11.7% had antidepressants, 13.7% had mood stabilizers, 27.8% had benzodiazepines, and 45.6% had anticholinergics. CONCLUSIONS Psychotropic prescription patterns in Asian adult patients with schizophrenia varied across countries. Regular surveys on psychotropic medications for schizophrenia are important to monitor pharmacotherapy practice in Asia.
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Grover S, Sahoo S, Bn S, Malhotra N, Dua D, Avasthi A. Attitude and perceptions of patients towards long acting depot injections (LAIs). Asian J Psychiatr 2019; 44:200-208. [PMID: 31419737 DOI: 10.1016/j.ajp.2019.07.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/23/2019] [Accepted: 07/29/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite the well-established efficacy of the long acting depot injectable (LAIs) antipsychotics, these are significantly underused and underutilized by the mental health professionals, with a belief that patients will not accept the same. AIMS & OBJECTIVES To explore the acceptability and perception of patients towards various psychiatric treatments, with specific focus on LAIs. Additionally the study aimed to compare the acceptability of various types of treatments including LAIs between patients with severe mental disorders (Psychotic disorders and Bipolar disorder) and those with Common mental disorders (Anxiety, neurotic and depressive disorders). METHODOLOGY A self-designed semi-structured questionnaire was used to evaluate the preferred treatment options of all the new patients attending the psychiatry outpatient clinic of a tertiary care hospital. Depending on the response, they were further probed for the reasons for accepting or rejecting the LAIs. RESULTS 2659 patients were interviewed who were divided into two groups (Group I - 321 subjects with psychotic disorders and 120 subjects with bipolar affective disorder (BPAD) and Group II - 2218 subjects with neurotic, stress-related and unipolar depressive disorders). More than three-fourth (78.8%) of the participants in the whole study sample opted for tablets only as their first preferred choice and injectables were opted by about 5% of the participants only, with no significant difference between the 2 groups. After being explained about LAIs, one fourth of the participants (24.9%) reported that they may consider LAIs, without any significant difference between the 2 groups. Among those who refused to take LAIs even after explanation, the commonly reported reasons were difficulty in visiting hospital frequently for the injectables (41.69%), injectables being painful (19.41%), fear of injections (13.96%), no need to take LAIs (12.45%) and preference to take some other types of medicines (8.52%). CONCLUSIONS Considering the fact that LAIs are highly underused in patients with severe mental disorders and there is lack of awareness about LAIs among patients with severe mental disorders, the present study findings suggest that there is reasonable level of acceptance of LAIs among patients with severe mental disorders when explained about the same.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India.
| | - Swapnajeet Sahoo
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Subodh Bn
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Nidhi Malhotra
- Department of Psychiatry, Government Medical College and Hospital, Chandigarh, Sector-32, India
| | - Devakshi Dua
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Ajit Avasthi
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
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Mahmood S, Hussain S, Ur Rehman T, Barbui C, Kurdi AB, Godman B. Trends in the prescribing of antipsychotic medicines in Pakistan: implications for the future. Curr Med Res Opin 2019; 35:51-61. [PMID: 30122062 DOI: 10.1080/03007995.2018.1513834] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Introduction and objectives: There is a paucity of antipsychotic prescribing and utilization data in Pakistan that needs addressing, especially with issues of availability, affordability, gender differences, and domestic violence, to develop pertinent strategies. The objective of this study was to address these issues by describing current antipsychotic utilization patterns in Pakistan among adult patients attending tertiary care hospitals and private practitioners.Methods: A three staged approach was used including (1) assessment of total antipsychotic utilization, expenditure, and costs per unit between 2010 and 2015, (2) an in-depth retrospective study of prescribing patterns, including co-morbidities among representative hospital patients in Pakistan, and (3) assessment of the quality of prescribing against WHO targets.Results: Total use of antipsychotics increased 4.3-fold and the cost/unit increased by 13.2% during the study period. Risperidone and olanzapine were the most prescribed antipsychotics with more limited use of other typical and atypical antipsychotics. The number of medicines per encounter was 4.56. Prescription using generic instead of brand names was 21.4%. Seven per cent were prescribed more than one antipsychotic concurrently.Conclusion: There has been an appreciable increase in antipsychotic utilization in recent years in Pakistan, especially atypical antipsychotics, with little polypharmacy. Ongoing utilization of typical antipsychotics may be due to comorbidities such as diabetes and cardiovascular disease. Issues of international non-proprietary name prescribing need investigating along with the high number of medicines per encounter and gender inequality.
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Affiliation(s)
- Sidra Mahmood
- Department of Pharmacy, Quaid e Azam University, Islamabad, Pakistan
| | | | - Taufeeq Ur Rehman
- Department of Pharmacy, Quaid e Azam University, Islamabad, Pakistan
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Amanj Baker Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
- Health Economics Centre, Liverpool University Management School, Liverpool, UK
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, Guanteng Province, South Africa
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Qiu H, He Y, Zhang Y, He M, Liu J, Chi R, Si T, Wang H, Dong W. Antipsychotic polypharmacy in the treatment of schizophrenia in China and Japan. Aust N Z J Psychiatry 2018; 52:1202-1212. [PMID: 30309245 DOI: 10.1177/0004867418805559] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although antipsychotic monotherapy is recommended as the main treatment for schizophrenia, antipsychotic polypharmacy is not rare in practice. However, longitudinal data on antipsychotic polypharmacy in schizophrenia treatment are limited. METHODS This longitudinal database study described antipsychotic polypharmacy in the treatment of schizophrenia in real-world settings in China and Japan. We retrieved information about antipsychotic treatment for schizophrenia from January 2010 to December 2014 from two hospital Electronic Medical Records databases in China and one claims database, Japan Medical Data Centre in Japan. Eligible patients had a diagnosis of schizophrenia (International Classification of Diseases, Tenth Revision F20.x) and at least one prescription for first or second generation antipsychotics. Antipsychotic polypharmacy was defined as having more than one antipsychotic medication overlapping for ⩾60 days. The Japan Medical Data Centre study cohort was further stratified by employees (insurance beneficiaries) and their dependents. RESULTS The study cohorts comprised 11,961 patients from China and 25,034 (10,661 employee sub-cohort and 14,373 dependent sub-cohort) from 14 days Japan Medical Data Centre in Japan. Most patients were prescribed monotherapy (87.3% in China and 80.1% in Japan), of which oral second-generation antipsychotics were the majority (78.9% in China and 65.8% in Japan). The prevalence rate of antipsychotic polypharmacy was 12.7% in China and 19.9% in Japan (13.7% in employees vs 24.5% in dependents). The most common combinations were two oral antipsychotics. Combinations of more than two drugs were uncommon in China (0.3%) but were prescribed for 5.3% of patients in Japan. Among patients treated with monotherapy, 12.6/100 person-years (11.8%) in China and 9.6/100 person-years (11.0%) in Japan switched to antipsychotic polypharmacy during follow-up. Younger patients were more likely to switch to antipsychotic polypharmacy than older patents in all study cohorts. CONCLUSION The observed rates of antipsychotic polypharmacy ranged from 12.7% in China to 19.9% in Japan. Switching from monotherapy to antipsychotic polypharmacy was most likely to occur in younger patients with schizophrenia.
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Affiliation(s)
- Hong Qiu
- Epidemiology, Janssen Research and Development, Titusville, NJ, USA
| | - Yong He
- Peking University Sixth Hospital (Institute of Mental Health), Beijing, China
| | - Yongjing Zhang
- Epidemiology, Janssen Research & Development, Beijing, China
| | - Minfu He
- Epidemiology, Janssen Research & Development, Beijing, China
| | - Jin Liu
- Peking University Sixth Hospital (Institute of Mental Health), Beijing, China.,National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Rui Chi
- Peking University Sixth Hospital (Institute of Mental Health), Beijing, China.,National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Tianmei Si
- Peking University Sixth Hospital (Institute of Mental Health), Beijing, China.,National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Huaning Wang
- Department of Psychiatry, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Wentian Dong
- Peking University Sixth Hospital (Institute of Mental Health), Beijing, China.,National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
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Yang SY, Chen LY, Najoan E, Kallivayalil RA, Viboonma K, Jamaluddin R, Javed A, Hoa DTQ, Iida H, Sim K, Swe T, He YL, Park Y, Ahmed HU, De Alwis A, Chiu HFK, Sartorius N, Tan CH, Chong MY, Shinfuku N, Lin SK. Polypharmacy and psychotropic drug loading in patients with schizophrenia in Asian countries: Fourth survey of Research on Asian Prescription Patterns on antipsychotics. Psychiatry Clin Neurosci 2018; 72:572-579. [PMID: 29761577 DOI: 10.1111/pcn.12676] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 12/28/2017] [Accepted: 01/30/2018] [Indexed: 11/28/2022]
Abstract
AIM The aim of the present study was to survey the prevalence of antipsychotic polypharmacy and combined medication use across 15 Asian countries and areas in 2016. METHODS By using the results from the fourth survey of Research on Asian Prescription Patterns on antipsychotics, the rates of polypharmacy and combined medication use in each country were analyzed. Daily medications prescribed for the treatment of inpatients or outpatients with schizophrenia, including antipsychotics, mood stabilizers, anxiolytics, hypnotics, and antiparkinson agents, were collected. Fifteen countries from Asia participated in this study. RESULTS A total of 3744 patients' prescription forms were examined. The prescription patterns differed across these Asian countries, with the highest rate of polypharmacy noted in Vietnam (59.1%) and the lowest in Myanmar (22.0%). Furthermore, the combined use of other medications, expressed as highest and lowest rate, respectively, was as follows: mood stabilizers, China (35.0%) and Bangladesh (1.0%); antidepressants, South Korea (36.6%) and Bangladesh (0%); anxiolytics, Pakistan (55.7%) and Myanmar (8.5%); hypnotics, Japan (61.1%) and, equally, Myanmar (0%) and Sri Lanka (0%); and antiparkinson agents, Bangladesh (87.9%) and Vietnam (10.9%). The average psychotropic drug loading of all patients was 2.01 ± 1.64, with the highest and lowest loadings noted in Japan (4.13 ± 3.13) and Indonesia (1.16 ± 0.68), respectively. CONCLUSION Differences in psychiatrist training as well as the civil culture and health insurance system of each country may have contributed to the differences in these rates. The concept of drug loading can be applied to other medical fields.
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Affiliation(s)
- Shu-Yu Yang
- Department of Psychiatry, Taipei City Hospital and Psychiatric Center, Taipei, Taiwan
| | - Lian-Yu Chen
- Department of Psychiatry, Taipei City Hospital and Psychiatric Center, Taipei, Taiwan
| | - Eunice Najoan
- Dr Mintohardjo Indonesian Navy Hospital, Jakarta, Indonesia
| | | | | | - Ruzita Jamaluddin
- Department of Psychiatry & Mental Health, Hospital Tuanku Fauziah, Kangar, Malaysia
| | - Afzal Javed
- Pakistan Psychiatric Research Centre, Fountain House, Lahore, Pakistan
| | | | - Hitoshi Iida
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Kang Sim
- Department of General Psychiatry, Institute of Mental Health, Buangkok Green Medical Park, Singapore
| | - Thiha Swe
- Department of Mental Health, University of Medicine, Magway, Myanmar
| | - Yan-Ling He
- Department of Psychiatric Epidemiology, Shanghai Mental Health Center, Shanghai, China
| | - Yongchon Park
- Department of Psychiatry, Hanyang University, Seoul, Korea
| | - Helal Uddin Ahmed
- Department of Child Adolescent and Family Psychiatry, National Institute of Mental Health, Dhaka, Bangladesh
| | | | - Helen Fung-Kum Chiu
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programs, Geneva, Switzerland
| | - Chay-Hoon Tan
- Department of Pharmacology, National University of Singapore, Singapore
| | - Mian-Yoon Chong
- Department of General Psychiatry, Chiayi Chang Gung Memorial Hospital and School of Medicine, Chang Gung University, Chiayi, Taiwan
| | - Naotaka Shinfuku
- Department of Social Welfare, School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan
| | - Shih-Ku Lin
- Department of Psychiatry, Taipei City Hospital and Psychiatric Center, Taipei, Taiwan.,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Unresolved Issues for Utilization of Atypical Antipsychotics in Schizophrenia: Antipsychotic Polypharmacy and Metabolic Syndrome. Int J Mol Sci 2017; 18:ijms18102174. [PMID: 29057817 PMCID: PMC5666855 DOI: 10.3390/ijms18102174] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 10/11/2017] [Accepted: 10/14/2017] [Indexed: 12/13/2022] Open
Abstract
Atypical antipsychotics (AAP) are the prevailing form of schizophrenia treatment today due to their low side effects and superior efficacy. Nevertheless, some issues still need to be addressed. First, there are still a large number of patients with treatment-resistant schizophrenia (TRS), which has led to a growing trend to resort to AAP polypharmacy with few side effects. Most clinical treatment guidelines recommend clozapine monotherapy in TRS, but around one third of schizophrenic patients fail to respond to clozapine. For these patients, with clozapine-resistant schizophrenia AAP polypharmacy is a common strategy with a continually growing evidence base. Second, AAP generally have great risks for developing metabolic syndrome, such as weight gain, abnormality in glucose, and lipid metabolism. These metabolic side effects have become huge stumbling blocks in today's schizophrenia treatment that aims to improve patients' quality of life as well as symptoms. The exact reasons why this particular syndrome occurs in patients treated with AAP is as yet unclear though factors such as interaction of AAP with neurotransmitter receptors, genetic pholymorphisms, type of AAPs, length of AAP use, and life style of schizophrenic patients that may contribute to its development. The present article aimed to review the evidence underlying these key issues and provide the most reasonable interpretations to expand the overall scope of antipsychotics usage.
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15
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Lin CH, Wang FC, Lin SC, Huang YH, Chen CC. A randomized, double-blind, comparison of the efficacy and safety of low-dose olanzapine plus low-dose trifluoperazine versus full-dose olanzapine in the acute treatment of schizophrenia. Schizophr Res 2017; 185:80-87. [PMID: 28109665 DOI: 10.1016/j.schres.2017.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 11/26/2016] [Accepted: 01/03/2017] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Antipsychotic polypharmacy is common in clinical practice, but not recommended in guidelines for treating schizophrenia patients. This study aimed to compare the efficacy and safety of low-dose olanzapine plus low-dose trifluoperazine (a first-generation antipsychotic [FGA]) to full-dose olanzapine (a second-generation antipsychotic [SGA]) in the treatment of acute schizophrenia. METHOD In this 6-week, double-blind, fixed-dose study, patients were randomized to receive 5mg/day of olanzapine plus 5mg/day of trifluoperazine or 10mg/day of olanzapine for 6weeks. Efficacy measures, including the Positive and Negative Syndrome Scale (PANSS) and other scales, safety measures, side effect measures, and quality of life were assessed regularly. Response was defined as at least a 30% reduction in the PANSS total score. RESULTS Both groups were similar in: 1) baseline characteristics, 2) score changes in all efficacy measures, safety measures, side effect measures, and quality of life, and 3) response rates at each visit. The polypharmacy group with low-dose olanzapine did not have less weight gain and lower lipid levels than the monotherapy group with full-dose olanzapine. CONCLUSION Polypharmacy is as efficacious and safe as, but cheaper than, monotherapy in the acute treatment of schizophrenia. Whether our findings can be generalized to other combinations of an appropriate ratio of one FGA to another SGA dosage, which can achieve favorable clinical responses and side effect profiles, needs further investigation.
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Affiliation(s)
- Ching-Hua Lin
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Fu-Chiang Wang
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Shih-Chi Lin
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Yu-Hui Huang
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Cheng-Chung Chen
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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16
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Abstract
OBJECTIVE Little is known about electroconvulsive therapy (ECT) use in the treatment of schizophrenia in China. This study examined the frequency of ECT use, its trend between 2006 and 2012, and its independent demographic and clinical correlates in a nationwide survey in China. METHODS A total of 5162 inpatients in 45 Chinese psychiatric hospitals/centers were interviewed (2696 in 2006 and 2466 in 2012). Patients' sociodemographic and clinical characteristics were recorded using a standardized protocol and data collection procedure. RESULTS Electroconvulsive therapy was used in 6.1% of the whole sample; 4.7% in 2006 and 7.7% in 2012 (P < 0.001) with wide interprovince variations. Multiple logistic regression analyses of the whole sample revealed that patients receiving ECT were more likely to be women, receive second-generation antipsychotics, treated in tertiary referral centers (level III hospitals), had a shorter illness duration, and more positive and depressive symptoms (R = 0.181; P < 0.001). CONCLUSIONS Electroconvulsive therapy for schizophrenia has increased between 2006 and 2012 in China. Its percentage was higher than the figures reported in most other countries. Reasons for the substantial variations in the frequency of ECT across different provinces in China require further investigations.
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17
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Armstrong KS, Temmingh H. Prevalence of and factors associated with antipsychotic polypharmacy in patients with serious mental illness: Findings from a cross-sectional study in an upper-middle-income country. ACTA ACUST UNITED AC 2017; 39:293-301. [PMID: 28177063 PMCID: PMC7111406 DOI: 10.1590/1516-4446-2016-2015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 11/07/2016] [Indexed: 01/02/2023]
Abstract
Objective: The aim of our study was to examine the prevalence of and factors associated with antipsychotic polypharmacy (APP) among patients with serious mental illness in the current South African health care context. Methods: We collected data on patient, illness, and treatment characteristics of patients discharged on one or more antipsychotic agents from January to June 2014. We analyzed the associations of APP with demographic and clinical variables using hierarchical multivariable logistic regression, and examined prescription patterns. Results: The prevalence of APP in our study population of 577 patients was 28.4%. Demographic and clinical characteristics significantly associated with APP included age > 29, male sex, diagnosis of schizophrenia, comorbid intellectual disability, comorbid substance use, greater number of hospital admissions, and high-dose prescribing. First-generation antipsychotics and long-acting injectable preparations were prominent in APP combinations. Co-prescription of anticholinergic agents and sodium valproate demonstrated a significant association with APP. Conclusion: APP appears common in our population, despite lack of evidence for the practice and possible risk of harm. Our findings suggest a complex interplay among patient, illness, and treatment factors relevant to APP in our setting that could be targeted for intervention.
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Affiliation(s)
- Kerryn S Armstrong
- Department of Psychiatry and Mental Health, University of Cape Town, Valkenberg Hospital, Observatory, Cape Town, South Africa
| | - Henk Temmingh
- Department of Psychiatry and Mental Health, University of Cape Town, Valkenberg Hospital, Observatory, Cape Town, South Africa
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18
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Li Q, Su YA, Xiang YT, Shu L, Yu X, Ungvari GS, Ng CH, Chiu HFK, Ning YP, Wang GH, Zhang KR, Li T, Sun LZ, Shi JG, Chen XS, Mei QY, Li KQ, Si TM. Adjunctive antidepressant use in schizophrenia in China: A national survey (2002-2012). Hum Psychopharmacol 2017; 32. [PMID: 28120487 DOI: 10.1002/hup.2571] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 12/12/2016] [Accepted: 12/13/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study examined the pattern of adjunctive antidepressant use in schizophrenia patients and its demographic and clinical correlates in a nationwide survey in China. METHODS Fourteen thousand and thirteen patients in 45 Chinese psychiatric hospitals or centers were interviewed (4,486 in 2002, 5,288 in 2006, and 4,239 in 2012). Patients' sociodemographic and clinical characteristics were recorded using a standardized protocol and data collection procedure. Chi-square test, independent-samples t test, Mann-Whitney U test, and multiple logistic regression analysis were used in data analyses. RESULTS Antidepressant use was found in 5.2% of the study population with 4.6% in 2002, 4.3% in 2006, and 6.9% in 2012, respectively. A significant increase in use from 2006 to 2012 was found (p < .001). Multiple logistic regression analyses in the whole population revealed that patients receiving adjunctive antidepressants were more likely to be outpatients in tertiary referral centers (level-III hospitals) and who had an earlier age of onset, less severe global illness, but more depressive symptoms. They were less likely to receive first-generation antipsychotics but more likely to receive benzodiazepines (R2 = 0.255, p < .001). CONCLUSIONS Despite an increasing trend, the frequency of antidepressant use in schizophrenia in China was considerably lower than in Western countries. The benefits and risks associated with concomitant use of antidepressants in schizophrenia need to be studied further.
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Affiliation(s)
- Qian Li
- Peking University Sixth Hospital (Institute of Mental Health) and National Clinical Research Center for Mental Disorders and Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Yun-Ai Su
- Peking University Sixth Hospital (Institute of Mental Health) and National Clinical Research Center for Mental Disorders and Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Yu-Tao Xiang
- The National Clinical Research Center for Mental Disorders, China and Center of Depression, Beijing Institute for Brain Disorders and Beijing Anding Hospital, Capital Medical University, Beijing, China.,Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Zhuhai, Macao SAR, China
| | - Liang Shu
- Peking University Sixth Hospital (Institute of Mental Health) and National Clinical Research Center for Mental Disorders and Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Xin Yu
- Peking University Sixth Hospital (Institute of Mental Health) and National Clinical Research Center for Mental Disorders and Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Gabor S Ungvari
- The University of Notre Dame Australia/Marian Centre, Perth, WA, Australia.,School of Psychiatry and Clinical Neuroscience, University of Western Australia, Perth, WA, Australia
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Helen F K Chiu
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yu-Ping Ning
- Guangzhou Psychiatric Hospital, Guangzhou, China
| | - Gao-Hua Wang
- Department of Psychiatry, Renmin Hospital, Wuhan University, Wuhan, China
| | - Ke-Rang Zhang
- The First Hospital of Shanxi Medical University, Taiyuan, Shanxi province, China
| | - Tao Li
- West China Hospital, Sichuan University, Chengdu, China
| | | | | | | | - Qi-Yi Mei
- Suzhou Guangji Hospital, Suzhou, China
| | - Ke-Qing Li
- Hebei Mental Health Center, Hebei, China
| | - Tian-Mei Si
- Peking University Sixth Hospital (Institute of Mental Health) and National Clinical Research Center for Mental Disorders and Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
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19
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Pierce P, Gopal S, Savitz A, Qiu H, Hino T, Busch M, Fujino A, Mathews M, Katsu T, Maeda Y, Takahashi M, Hough D. Paliperidone palmitate: Japanese postmarketing mortality results in patients with schizophrenia. Curr Med Res Opin 2016; 32:1671-1679. [PMID: 27264496 DOI: 10.1080/03007995.2016.1198755] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Paliperidone palmitate once-monthly injectable (PP1M) is approved in Japan and other countries for the treatment of schizophrenia. During the 6 month Japanese early postmarketing phase vigilance (EPPV) period, 32 deaths were reported. This report reviews potential contributing factors to the fatal outcomes in the PP1M-treated population. RESEARCH DESIGN AND METHODS All spontaneously reported adverse events following PP1M use received during EPPV from 19 November 2013 to 18 May 2014 were entered into the global safety database and these events were analyzed. RESULTS During the EPPV period, 10,962 patients were estimated to have been treated with PP1M in Japan. The mortality reporting rate during this EPPV period was higher than that observed in the US or globally after PP1M launch (5.84, 0.43, and 0.38 per 1000 patient-years, respectively), but was consistent with the mortality incidence rates (10.2 per 1000 person-years) observed during interventional clinical studies in Japan and in observational patient cohorts. Of the 32 deaths reported during the Japanese PP1M EPPV period, 19/32 (59.4%) were in patients over 50 years of age, 23/32 (71.9%) reported cardiovascular risk factors and 25/32 (78.1%) received antipsychotic polypharmacy. CONCLUSIONS Based on this review of the 32 fatal cases in the PP1M EPPV period, the observed death rate does not necessarily result from a risk with PP1M treatment in Japanese patients. The higher mortality reporting rates in Japan may be attributed to a variety of factors: the effectiveness of mortality reporting in the unique Japanese EPPV program, the advanced age of the fatal cases, high cardiovascular risk factors, multiple underlying diseases and high antipsychotic polypharmacy among the cases with fatal outcomes.
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Affiliation(s)
| | - Srihari Gopal
- a Janssen Pharmaceutical Research and Development , USA
| | - Adam Savitz
- a Janssen Pharmaceutical Research and Development , USA
| | - Hong Qiu
- a Janssen Pharmaceutical Research and Development , USA
| | - Takahito Hino
- b Janssen Pharmaceutical Research and Development , Japan
| | | | - Akiko Fujino
- b Janssen Pharmaceutical Research and Development , Japan
| | | | | | | | | | - David Hough
- a Janssen Pharmaceutical Research and Development , USA
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20
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Fischler I, Riahi S, Stuckey MI, Klassen PE. Implementation of a clinical practice guideline for schizophrenia in a specialist mental health center: an observational study. BMC Health Serv Res 2016; 16:372. [PMID: 27514778 PMCID: PMC4982005 DOI: 10.1186/s12913-016-1618-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 08/02/2016] [Indexed: 12/14/2022] Open
Abstract
Background In mental health settings, implementation of and adherence to clinical practice guidelines (CPGs) is low. Strategies are needed to overcome barriers and facilitate successful implementation of CPGs into standard care. The goals of this study were to develop a framework for the implementation of a CPG for schizophrenia for hospitalized service users in a mental health care facility, and to monitor adherence to the guideline. Methods An eight-step framework was developed based on project management principles: 1) the Appraisal Guideline for Research and Evaluation (AGREE) tool was used to rate and select a CPG; 2) an algorithm was created from the guideline; 3) a gap analysis identified clinical services and processes not conforming with the CPG recommendations; 4) a governance structure was created; 5) a modified Delphi process determined key outcome and process adherence metrics; 6) a project charter was developed; 7) clinical informatics ensured that systems and tools were in place to support the CPG; and 8) therapeutic services were realigned to match the requirements of the CPG within specified fiscal constraints. Percent adherence to the identified process adherence metrics was calculated before (March 2014) and for 12 months after implementation (April 2014-March 2015). Results The National Institute of Health and Care Excellence guideline scored highest on AGREE and was used to develop the algorithm. Cognitive behavior therapy for psychosis (CBT-P), art therapy and carer assessments were identified as gaps in care. Clinical global impression – Schizophrenia score was identified as the primary service user outcome variable and antipsychotic polypharmacy, metabolic monitoring, CBT-P referral and supported employment/vocational services referral as the primary process adherence measures. Adherence to guidance for metabolic monitoring (March 2014, 76.7 %; March 2015, 81.6 %), CBT-P referral (March 2014, 6.5 %; March 2015, 11.4 %) and vocational rehabilitation referral (March 2014, 36.6 %; March 2015, 49.1 %) were increased after CPG implementation. There was an initial increase in adherence to antipsychotic monotherapy (March 2014, 53.4 %; November 2014, 62.7 %), which decreased back toward baseline (March 2015, 55.1 %). Conclusions The eight-step framework was used to implement a CPG process, though further quality improvements initiatives may be needed to improve adherence.
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Affiliation(s)
- Ilan Fischler
- Ontario Shores Centre for Mental Health Sciences, 700 Gordon Street, Whitby, ON, L1N 5S9, Canada. .,Department of Psychiatry, University of Toronto, Toronto, Canada.
| | - Sanaz Riahi
- Ontario Shores Centre for Mental Health Sciences, 700 Gordon Street, Whitby, ON, L1N 5S9, Canada.,Faculty of Health Sciences, Univeristy of Ontario Institute of Technology, Oshawa, Canada
| | - Melanie I Stuckey
- Ontario Shores Centre for Mental Health Sciences, 700 Gordon Street, Whitby, ON, L1N 5S9, Canada
| | - Philip E Klassen
- Ontario Shores Centre for Mental Health Sciences, 700 Gordon Street, Whitby, ON, L1N 5S9, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
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21
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Wang YX, Xiang YT, Su YA, Li Q, Shu L, Ng CH, Ungvari GS, Chiu HF, Nin YP, Wang GH, Bai PS, Li T, Sun LZ, Shi JG, Chen XS, Mei QY, Li KQ, Yu X, Si TM. Antipsychotic Medications in Major Depression and the Association with Treatment Satisfaction and Quality of Life: Findings of Three National Surveys on Use of Psychotropics in China Between 2002 and 2012. Chin Med J (Engl) 2016; 128:1847-52. [PMID: 26168821 PMCID: PMC4717927 DOI: 10.4103/0366-6999.160485] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Optimizing treatment outcomes for depression requires understanding of how evidence-based treatments are utilized in clinical practice. Antipsychotic medications concurrent with antidepressant treatment are frequently used in major depression, but few studies have investigated trends and patterns of their use over time. This study aimed to examine the prescription patterns of antipsychotic medications for major depression in China from 2002 to 2012 and their association with treatment satisfaction and quality of life (QOL). Methods: A total of 3655 subjects with major depression treated in 45 Chinese psychiatric hospitals/centers nationwide were interviewed between 2002 and 2012. Patients’ socio-demographic and clinical characteristics including psychopathology, medication side effects, satisfaction with treatment and QOL were recorded using a standardized protocol and data collection. Results: The frequency of antipsychotic use was 24.9% in the whole sample; the corresponding figures were 17.1%, 20.3%, and 32.8% in 2002, 2006, and 2012, respectively (χ2 = 90.3, df = 2, P < 0.001). Multiple logistic regression analyses revealed that patients on concurrent antipsychotics had significantly more delusions or hallucinations, longer illness duration, greater side effects, and more likely to be treated as inpatients and in major hospitals (i.e., Level-III hospital). Antipsychotic use was associated with lower treatment satisfaction while there was no significant difference with respect to physical and mental QOL between the antipsychotic and nonantipsychotic groups. Conclusions: Concurrent antipsychotic use was found in about one in four treated depressed patients in China, which has increased over a 10-year period. Considering the association of drug-induced side effects and the lack of patients’ and relatives’ satisfaction with antipsychotic treatment, further examination of the rationale and appropriateness of the use of antipsychotics in depression is needed.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Tian-Mei Si
- National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital/Institute of Mental Health), and The Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China
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22
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Trends in the access to and the use of antipsychotic medications and psychotropic co-treatments in Asian patients with schizophrenia. Epidemiol Psychiatr Sci 2016; 25:9-17. [PMID: 26289066 PMCID: PMC6998674 DOI: 10.1017/s2045796015000694] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
To date, antipsychotics remain the mainstay of treatment for schizophrenia and related disorders although other psychotropic medications and non-pharmaceutical interventions have been used adjunctively in some patients and settings. Regular surveys on access to and prescription patterns of psychotropic medications in clinical practice are an important and efficient way of examining the use and time trends of treatments in a given population and region. Unlike developed Western countries, Asian countries have not fully undergone deinstitutionalisation of the severely and chronically mentally ill, and community-based mental health services are still under-developed. As a result, a large number of psychiatric patients still receive treatments in psychiatric hospitals. Moreover, there have been very limited studies examining access to and prescription patterns of psychotropic medications for schizophrenia patients in Asian countries. In this paper, we focus on the only international project on the use of psychotropic medications in schizophrenia patients in selected East and Southeast Asian countries/territories summarising its major findings. Most of the first- and second-generation antipsychotics (FGAs and SGAs) are available in Asian countries, but the access to psychotropic medications is largely affected by socio-cultural and historical contexts, health insurance schemes, health care policy, medication cost and consumers' preference across different countries/territories. Overall, the proportional use of FGAs, high dose antipsychotic treatment and antipsychotic polypharmacy have decreased, while the use of SGAs and antidepressants have increased and the utilisation of benzodiazepines and mood stabilisers has remained relatively stable over time. However, within these general trends, there is great inter-country variation regarding the psychotropic prescribing patterns and trends in Asian schizophrenia patients that also seems to differ from data in many Western countries.
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23
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WANG C. Psychopharmacological treatment for schizophrenia: less is more. SHANGHAI ARCHIVES OF PSYCHIATRY 2015; 27:368-70. [PMID: 27199528 PMCID: PMC4858508 DOI: 10.11919/j.issn.1002-0829.215086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Antipsychotic polypharmacy in the treatment of schizophrenia is more common in China and other Asian countries than in Western countries. The reasons for this are unclear, but it may be related to an unsubstantiated belief among clinicians that multiple medications are more likely to achieve the desired clinical outcome. Antipsychotic medications are the mainstay of treatment for individuals with schizophrenia, but the use of antipsychotic polypharmacy and of high dosages of antipsychotic medication are associated with substantially increased risks without conferring improved clinical outcomes. It is generally accepted that high dosages of antipsychotic medications and the simultaneous use of multiple antipsychotics are associated with an increased prevalence, duration, and severity of adverse drug effects. More recent evidence also suggests that antipsychotic polypharmacy and the associated high overall dosage of antipsychotic medication lead to excessive striatal D2 receptor occupation (resulting in tolerance and drug withdrawal problems) and exacerbation of the impaired synaptic plasticity seen in schizophrenia (magnifying the cognitive impairment associated with the condition). Clinicians need to apply the 'less is more' principle in the psychopharmacological treatment of schizophrenia.
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24
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Li Q, Xiang YT, Su YA, Shu L, Yu X, Correll CU, Ungvari GS, Chiu HFK, Ma C, Wang GH, Bai PS, Li T, Sun LZ, Shi JG, Chen XS, Mei QY, Li KQ, Si TM, Kane JM. Clozapine in schizophrenia and its association with treatment satisfaction and quality of life: Findings of the three national surveys on use of psychotropic medications in China (2002-2012). Schizophr Res 2015; 168:523-9. [PMID: 26277534 DOI: 10.1016/j.schres.2015.07.048] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 07/26/2015] [Accepted: 07/27/2015] [Indexed: 01/15/2023]
Abstract
OBJECTIVE We examined the time trends and correlates of clozapine use in schizophrenia patients in China. METHOD A total of 14,013 patients with schizophrenia treated in 45 psychiatric hospitals/centers nationwide were interviewed in 2002, 2006 and 2012. Patients' socio-demographic and clinical characteristics including psychopathology, medication side effects, satisfaction with treatment and quality of life (QOL) were recorded in a standardized fashion. RESULTS Clozapine was used in 32.9% of the whole sample; with corresponding figures of 39.7%, 32.5% and 26.4% in 2002, 2006 and 2012 (p<0.001). Families of clozapine users had lower satisfaction with treatment than those of the non-clozapine group, without significant differences with respect to patients' treatment satisfaction and mental or physical QOL. In multiple logistic regression analyses, compared to the non-clozapine group, patients on clozapine had an earlier age of onset, longer illness duration, more global illness severity and drug-induced central nervous system, gastrointestinal and other side effects, lower antipsychotic doses, less delusions and hallucinations, more negative symptoms, were more likely male, inpatients, to have a family history of psychiatric disorders, receive treatments in regional centers and receive antipsychotic polypharmacy, but less likely to have health insurance and receive first-generation antipsychotics and benzodiazepines (R(2)=0.498, p<0.001). CONCLUSIONS Clozapine was used in one-third of schizophrenia patients in China, with decreasing frequency since 2002. Patients prescribed clozapine had multiple markers of greater global illness severity/chronicity and decreased satisfaction with treatment by the families, but similar QOL and less delusions and hallucinations than patients not prescribed clozapine.
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Affiliation(s)
- Qian Li
- The National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital) & Peking University Institute of Mental Health & The Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Yu-Tao Xiang
- The National Clinical Research Center for Mental Disorders (Beijing Anding Hospital) & Department of Psychiatry, Capital Medical University & Center of Depression, Beijing Institute for Brain Disorders, China; Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macau SAR, China.
| | - Yun-Ai Su
- The National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital) & Peking University Institute of Mental Health & The Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Liang Shu
- The National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital) & Peking University Institute of Mental Health & The Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Xin Yu
- The National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital) & Peking University Institute of Mental Health & The Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Christoph U Correll
- Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, NY, USA
| | - Gabor S Ungvari
- School of Psychiatry & Clinical Neuroscience, University of Western Australia, Perth, Australia
| | - Helen F K Chiu
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China
| | - Cui Ma
- Psychiatric Hospital, Guangzhou, China
| | - Gao-Hua Wang
- Department of Psychiatry, Renmin Hospital, Wuhan University, Wuhan, China
| | - Pei-Shen Bai
- The First Hospital of Shanxi Medical University, Shanxi Province, China
| | - Tao Li
- West China Hospital, Sichuan University, China
| | | | | | | | - Qi-Yi Mei
- Suzhou Guangji Hospital, Suzhou, China
| | - Ke-Qing Li
- Hebei Mental Health Center, Hebei, China
| | - Tian-Mei Si
- The National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital) & Peking University Institute of Mental Health & The Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China.
| | - John M Kane
- Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, NY, USA
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Suzuki T, Uchida H, Takeuchi H, Tsunoda K, Ishizuki T, Mimura M. Optimization of psychopharmacotherapy for schizophrenia in a male, locked, non-acute unit serving for persistently ill patients over one year. Psychiatry Res 2015; 228:26-30. [PMID: 25935376 DOI: 10.1016/j.psychres.2015.03.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 12/25/2014] [Accepted: 03/20/2015] [Indexed: 01/29/2023]
Abstract
We describe real-world psychopharmacological treatment in a Japanese, male, closed psychiatric unit where clozapie was still unavailable. Fifty-five persistently-ill patients with schizophrenia (ICD-10), mean ± S.D. age: 57.5 ± 13.0 y.o., duration of illness and admissions: 30.9 ± 15.2 years and 20.7 ± 14.5 years, respectively) treated longitudinally were evaluated. The rule was to treat with a simplest possible psychotropic regimen without polypharmacy. Compared to the baseline, the number and dose of antipsychotics were reduced from 1.9 to 1.1 and 1012 mg/day to 607 mg/day, respectively. The number of total psychotropics was minimized from 4.7 to 2.1, with a simplified once or twice daily dosing. Overall, the CGI-Severity and FACT-Sz (global functioning) improved slightly from 5.8 to 5.5 and 28.7 to 32.6, respectively. Of note, no patients got worse in comparison with the baseline clinical presentation. Forty-four patients were successfully treated with a single antipsychotic; only seven needed two antipsychotics simultaneously while 36 had been treated with antipsychotic polypharmacy at baseline. Benzodiazepines (mostly lorazepam) and antiparkinsonian drugs were prescribed in 28 and only two, respectively. Nineteen needed adjunctive valproate (average blood levels: 99.3 ± 21.8 μg/mL) and nine used lithium (0.61 ± 0.26 mEq/L). Optimization of psychopharmacotherapy is still possible for difficult-to-treat patients and, while augmentation of an antipsychotic with mood stabilizers is frequently needed, antipsychotic polypharmacy should be exceptional.
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Affiliation(s)
- Takefumi Suzuki
- Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan; Department of Psychiatry, Inokashira Hospital, Tokyo, Japan.
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan; Centre for Addiction and Mental Health, Geriatric Mental Health Program, Toronto, Ontario, Canada
| | - Hiroyoshi Takeuchi
- Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan; Centre for Addiction and Mental Health, Schizophrenia Division, Toronto, Ontario, Canada
| | - Kenichi Tsunoda
- Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan; Department of Psychiatry, Minami Hannou Hospital, Saitama, Japan
| | - Tomomi Ishizuki
- Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan; Department of Psychiatry, Kawasaki City Rehabilitation Medical Center, Kanagawa, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan
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Uchida H, Suzuki T. Cardiac Sudden Death in Psychiatric Patients. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2015; 60:203-5. [PMID: 26174522 PMCID: PMC4484688 DOI: 10.1177/070674371506000501] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 02/27/2015] [Indexed: 11/15/2022]
Affiliation(s)
- Hiroyuki Uchida
- Senior Lecturer, Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Research Scientist, Geriatric Mental Health Program, Centre for Addiction and Mental Health, Toronto, Ontario
| | - Takefumi Suzuki
- Senior Lecturer, Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
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Hjorth P, Kilian R, Sørensen HØ, Eriksen SE, Davidsen AS, Jensen SOW, Munk-Jørgensen P. Reducing psychotropic pharmacotherapy in patients with severe mental illness: a cluster-randomized controlled intervention study. Ther Adv Psychopharmacol 2015; 5:67-75. [PMID: 26240746 PMCID: PMC4521442 DOI: 10.1177/2045125314565361] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Many patients with mental illness receive psychotropic medicine in high dosages and from more than one drug. One of the consequences of this practice is obesity, which is a contributing factor to increased physical morbidity and premature death. METHODS Our study was a cluster-randomized intervention study involving 6 facilities and 174 patients diagnosed with severe mental illnesses (73% schizophrenia). The intervention period was 12 months and consisted of teaching sessions with the staff and evaluating the patients' intake of psychotropic medication. At index, 44% met criteria for obesity and 76% met criteria for overweight. Waist circumferences were 108 cm for men and 108 cm for women. Olanzapine, clozapine and quetiapine were the most common prescribed antipsychotics. Mean values of daily doses of antipsychotic were 2.5. RESULTS The intervention showed no significant differences between the intervention and control group regarding psychotropic treatment. At follow up, independent of intervention, patients receiving antipsychotic polypharmacy had a larger waist circumference compared with patients receiving antipsychotic monotherapy of 9.8 cm (1.5-18.1) (p = 0.028). DISCUSSION AND CONCLUSION We found both a high prevalence of obesity and that the patients received treatment with antipsychotic polypharmaceutics in high dosages. Active awareness did not change practice and we must think of other ways to restrict treatment with psychotropics in this group of patients.
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Affiliation(s)
- Peter Hjorth
- Aarhus University Hospital - Randers Lokal Psychiatry, Dronningborg Boulevard 15, Randers, 8900, Denmark
| | - Reinhold Kilian
- Klinik fur Psyckiatrie und Psychotherapie, Ulm University, Gunzburg, Germany
| | | | | | - Annette Sofie Davidsen
- Institut for folkevidenskab, Copenhagen University - Forskningsenheden for Almen Praksis og Afdelingen for Almen Medicin, Copenhagen, Denmark
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28
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Xiang YT, Chiu HFK, Ungvari GS, Correll CU, Lai KYC, Wang CY, Si TM, Lee EHM, He YL, Yang SY, Chong MY, Kua EH, Fujii S, Sim K, Yong MKH, Trivedi JK, Chung EK, Udomratn P, Chee KY, Sartorius N, Tan CH, Shinfuku N. QTc prolongation in schizophrenia patients in Asia: clinical correlates and trends between 2004 and 2008/2009. Hum Psychopharmacol 2015; 30:94-9. [PMID: 25611192 DOI: 10.1002/hup.2458] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 11/09/2014] [Accepted: 12/03/2014] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Little is known about the pattern of QT interval (QTc) prolongation in Asian patients with schizophrenia. This study examined trends of QTc prolongation in schizophrenia inpatients in six Asian countries and territories between 2004 and 2008/2009 and its independent demographic and clinical correlates. METHOD Data on 3482 hospitalized schizophrenia patients (2004 = 1826 and 2008/2009 = 1656) in six Asian countries and territories were collected by either chart review or interviews during a 1-month period. Patients' sociodemographic and clinical characteristics, prescriptions of psychotropic drugs, and QTc interval were recorded using a standardized protocol and data collection procedure. RESULTS The frequency of QTc prolongation (>456 ms) was 2.4% in the whole sample, decreasing from 3.1% in 2004 to 1.6% in 2008/2009 (p = 0.004) with wide intercountry variations. However, this decreased trend was driven by decreased QTc prolongation detected in China and Hong Kong (both p-values < 0.05). Multiple logistic regression analysis of the whole sample revealed that patients having more likely to have an illness lasting longer than 5 years and received antipsychotics classified as list-1 drugs according to the Arizona Centre for Education and Research on Therapeutics. Compared with 2004, patients in 2008/2009 were less likely to have QTc prolongation. Thioridazine caused QTc prolongation most frequently (odds ratio (OR) 4.4; 95% confidence interval (CI) 1.2-15.2), followed by sulpiride (OR 2.4; 95% CI 1.3-4.5), clozapine (OR 2.4; 95% CI 1.4-4.2), and chlorpromazine (OR 1.9; 95% CI 1.07-3.5). CONCLUSIONS Frequency of QTc prolongation was low in Asian patients with schizophrenia. QTc prolongation in schizophrenia decreased in China and Hong Kong between 2004 and 2008/2009 but increased in Taiwan over the same period, remaining low in the other countries.
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Affiliation(s)
- Yu-Tao Xiang
- Faculty of Health Sciences, University of Macau, Macao, Special Administrative Region, China; Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
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29
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Li Q, Xiang YT, Su YA, Shu L, Yu X, Chiu HF, Correll CU, Ungvari GS, Lai KY, Ma C, Wang GH, Bai PS, Li T, Sun LZ, Shi JG, Chen XS, Mei QY, Li KQ, Si TM. Antipsychotic polypharmacy in schizophrenia patients in China and its association with treatment satisfaction and quality of life: findings of the third national survey on use of psychotropic medications in China. Aust N Z J Psychiatry 2015; 49:129-36. [PMID: 24923760 DOI: 10.1177/0004867414536931] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study examined the use, demographic and clinical correlates of antipsychotic polypharmacy (APP) and its associations with treatment satisfaction and quality of life (QOL) in schizophrenia patients in China. METHOD A total of 4239 patients in 45 nationwide Chinese psychiatric hospitals/centers were interviewed in 2012 in the third cross-sectional study, with the first two having been conducted in 2002 and 2006. Patients' socio-demographic and clinical characteristics, including psychopathology, side effects, satisfaction with treatment and QOL, were recorded using a standardized protocol and data collection procedure. RESULTS The proportion of APP prescriptions in 2012 was 34.2%, which was significantly higher than the frequency of APP in 2002 (26.1%) and 2006 (26.4%) (p<0.001). Of patients on APP, 91.1% received two antipsychotics, 8.6% received three and 0.3% received four or more antipsychotics. Multiple logistic regression analyses revealed that compared to those on antipsychotic monotherapy, patients on APP and their families had lower satisfaction with treatment, had higher QOL in the mental domain, younger age of onset, more side effects, higher doses of antipsychotics and were more likely to receive first-generation antipsychotics and less likely to receive benzodiazepines (total R (2)=0.31, p<0.001). CONCLUSIONS APP was found in about one in three schizophrenia patients. The prevalence of APP seems to have been increasing since 2002. Considering the increased frequency of drug-induced side effects and the patients' and their relatives' dissatisfaction with antipsychotic treatment, further examination of the rationale and appropriateness of APP and its alternatives is warranted.
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Affiliation(s)
- Qian Li
- The Key Laboratory of Mental Health, Ministry of Health & Peking University Institute of Mental Health, Beijing, China
| | - Yu-Tao Xiang
- Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Yun-Ai Su
- The Key Laboratory of Mental Health, Ministry of Health & Peking University Institute of Mental Health, Beijing, China
| | - Liang Shu
- The Key Laboratory of Mental Health, Ministry of Health & Peking University Institute of Mental Health, Beijing, China
| | - Xin Yu
- The Key Laboratory of Mental Health, Ministry of Health & Peking University Institute of Mental Health, Beijing, China
| | - Helen Fk Chiu
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Christoph U Correll
- Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, NY, USA
| | - Gabor S Ungvari
- The University of Notre Dame Australia/Marian Centre, Perth, Australia
| | - Kelly Yc Lai
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Cui Ma
- Psychiatric Hospital, Guangzhou, China
| | - Gao-Hua Wang
- Department of Psychiatry, Renmin Hospital, Wuhan University, Wuhan, China
| | - Pei-Shen Bai
- The First Hospital of Shanxi Medical University, Shanxi Province, China
| | - Tao Li
- West China Hospital, Sichuan University, China
| | | | | | | | - Qi-Yi Mei
- Suzhou Guangji Hospital, Suzhou, China
| | - Ke-Qing Li
- Hebei Mental Health Center, Hebei, China
| | - Tian-Mei Si
- The Key Laboratory of Mental Health, Ministry of Health & Peking University Institute of Mental Health, Beijing, China
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Yamanouchi Y, Sukegawa T, Inagaki A, Inada T, Yoshio T, Yoshimura R, Iwata N. Evaluation of the individual safe correction of antipsychotic agent polypharmacy in Japanese patients with chronic schizophrenia: validation of safe corrections for antipsychotic polypharmacy and the high-dose method. Int J Neuropsychopharmacol 2015; 18:pyu016. [PMID: 25522380 PMCID: PMC4376537 DOI: 10.1093/ijnp/pyu016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Polypharmacy for schizophrenia treatment is not justified by the available clinical evidence. We evaluated a treatment reduction approach that reduces the dose and number of antipsychotic medications simultaneously prescribed to patients. METHODS In a randomized open study of the Safe Correction of Antipsychotic Polypharmacy and High-Dose Prescriptions program funded by the Japanese Ministry of Health, Labour, and Welfare, we evaluated a drug reduction method consisting of a dose reduction intervention performed on 163 patients with schizophrenia for twelve or 24 weeks. One antipsychotic medication was removed each week from each patient's treatment regimen by reducing the dose by 0 to 50 chlorpromazine equivalents. Data on health-related indices of quality of life, clinical symptoms, and risk of side effects were analyzed using a two-way repeated-measures mixed linear model. RESULTS Despite a 23% reduction in antipsychotic dose, no differences in outcomes were observed between the dose reduction and observation groups (effect size = 0.001 - 0.085, P = .24-.97), despite high statistical power (1-β = 0.48-0.97). The findings are limited by the nonuniformity of the participants' treatment history, duration, and dose reduction amount. Dose reduction protocol patients exhibited no difference in psychotic symptoms or adverse events compared with the observation group. CONCLUSIONS Importantly, the low dropout rate in our study (6.9% of participants withdrew because of patient factors and 23.8% for all secondary reasons) indicates that our "slowly" method is well tolerated. We hope that this approach will result in therapeutic improvements.
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Affiliation(s)
- Yoshio Yamanouchi
- Department of Social Psychiatry, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan (Dr Yamanouchi); National Hospital Organization, Tottori Medical Center, Tottori, Japan (Dr Sukegawa); School of International Politics, Economics and Communication, Aoyama Gakuin University, Tokyo, Japan (Dr Inagaki); Seiwa Hospital, Institute of Neuropsychiatry, Tokyo, Japan (Dr Inada); Department of Clinical Pharmacy Faculty of Pharmaceutical Sciences, Toho University, Funabashi, Japan (Dr Yoshio); Department of Psychiatry, University of Occupational and Environmental Health, Kitakyushu, Japan (Dr Yoshimura); Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Japan (Dr Iwata).
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Kim HY, Lee HW, Jung SH, Kang MH, Bae JN, Lee JS, Kim CE. Prescription patterns for patients with schizophrenia in Korea: a focus on antipsychotic polypharmacy. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2014; 12:128-36. [PMID: 25191503 PMCID: PMC4153859 DOI: 10.9758/cpn.2014.12.2.128] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 02/19/2014] [Accepted: 03/10/2014] [Indexed: 12/24/2022]
Abstract
Objective This study investigated the prescription patterns for Korean patients with schizophrenia with a particular focus on antipsychotic polypharmacy. All data were gathered from patients presenting at 41 tertiary university hospitals and 8 secondary hospitals. Methods Data from three multicenter studies conducted in Korea were retrospectively reviewed and integrated to identify patients with schizophrenia who had their antipsychotic medication switched to paliperidone extended-release between 2008 and 2009. The rates for antipsychotic polypharmacy, combined use of different antipsychotic classes with a special focus on atypical antipsychotics, and psychotropic polypharmacy using benzodiazepines, mood stabilizers, and other relevant drugs were identified. Results Of the 851 Korean patients analyzed in this study, 20.4% (n=173) had been prescribed antipsychotic polypharmacy. Of the 678 patients receiving antipsychotic monotherapy, 6.9% (n=47) were prescribed a typical antipsychotic and 93.1% (n=631) were prescribed an atypical antipsychotic. Of the 173 patients receiving a combination of antipsychotic drugs, only 6.4% (n=11) had been prescribed polypharmacy with typical antipsychotics, while 46.82% (n=81) were prescribed atypical+atypical antipsychotics or typical+atypical antipsychotics. The highest co-prescription rates for other psychotropic drugs in conjunction with antipsychotics included benzodiazepines (30.3%), anticholinergic drugs (28.8%), antidepressants (13.3%), β-blockers (10.1%), and mood stabilizers (8.7%). Conclusion The present findings demonstrate that the rate of antipsychotic polypharmacy is relatively low in Korea and that Korean clinicians prefer to prescribe atypical, rather than typical, antipsychotic drugs. This suggests that there is a distinct prescription pattern in Korea that is focused on antipsychotic polypharmacy.
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Affiliation(s)
- Hee-Yun Kim
- Department of Psychiatry, Inha University Hospital, Incheon, Korea
| | - Hee-Won Lee
- Department of Psychiatry, Inha University Hospital, Incheon, Korea
| | - Seung-Ho Jung
- Department of Psychiatry, Inha University Hospital, Incheon, Korea
| | - Min-Hee Kang
- Department of Psychiatry, Inha University Hospital, Incheon, Korea
| | - Jae-Nam Bae
- Department of Psychiatry, Inha University Hospital, Incheon, Korea
| | - Jeong-Seop Lee
- Department of Psychiatry, Inha University Hospital, Incheon, Korea
| | - Chul-Eung Kim
- Department of Psychiatry, Inha University Hospital, Incheon, Korea
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Sun F, Stock EM, Copeland LA, Zeber JE, Ahmedani BK, Morissette SB. Polypharmacy with antipsychotic drugs in patients with schizophrenia: trends in multiple health care systems. Am J Health Syst Pharm 2014; 71:728-38. [PMID: 24733136 PMCID: PMC4432466 DOI: 10.2146/ajhp130471] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Patterns of pharmacologic treatment in U.S. outpatients with schizophrenia across multiple health care settings were investigated. METHODS Antipsychotic drug utilization by patients with schizophrenia and related disorders was analyzed using data on 119,662 patients served by the Veterans Affairs (VA) health care system in fiscal years 2005-09, data on 5,440 enrollees in two health maintenance organizations (HMOs) in 2002-09, and National Ambulatory Medical Care Survey (NAMCS) data reflecting the experience of 17.6 million U.S. residents seeking care outside federal systems during the same eight-year period. Polypharmacy was defined as the use of more than one antipsychotic agent during one year (in the VA sample) or one week (in the HMO and NAMCS samples). The association of polypharmacy with hospital admissions was assessed via multivariable logistic regression. RESULTS Rates of antipsychotic use in the VA sample ranged from 74% to 78%, with lower and more variable rates in the NAMCS sample (69-84%) and the HMO sample (22-67%). VA patients were found to have lower polypharmacy rates (20-22%) than patients in the HMO and NAMCS samples (19-31%). In all samples evaluated, polypharmacy was associated with an increased likelihood of hospital admission (odds ratio range, 1.4-2.4). CONCLUSION A multisystem study revealed that antipsychotic use among patients with schizophrenia varied substantially among health care systems and that nearly one fifth of patients with schizophrenia or other psychotic disorders in most of the health care systems experienced antipsychotic polypharmacy.
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Affiliation(s)
- FangFang Sun
- FangFang Sun, M.S., is Health Services Researcher, Center for Applied Health Research, Temple, TX. Eileen M. Stock, Ph.D., is Research Scientist, Center for Applied Health Research, and Assistant Professor, College of Medicine, Texas A&M Health Sciences Center, Bryan. Laurel A. Copeland, Ph.D., is Interim Associate Chief of Staff of Research, Central Texas Veterans Health Care System, Temple, and Associate Director, Center for Applied Health Research, and Associate Professor, College of Medicine, Texas A&M Health Sciences Center. John E. Zeber, Ph.D., is Co-Director, Health Outcomes Core (jointly sponsored by Central Texas Veterans Health Care System and Scott & White Healthcare), Temple, and Associate Professor, College of Medicine, Texas A&M Health Sciences Center. Brian K. Ahmedani, Ph.D., LMSW, is Research Scientist, Center for Health Policy & Health Services Research, Henry Ford Health System, Detroit, MI. Sandra B. Morissette, Ph.D., is Assessment Core Chief, Veterans Affairs VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, and Associate Professor, College of Medicine, Texas A&M Health Sciences Center
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Jaracz J, Tetera-Rudnicka E, Kujath D, Raczyńska A, Stoszek S, Czernaś W, Wierzbiński P, Moniakowski A, Jaracz K, Rybakowski J. The prevalence of antipsychotic polypharmacy in schizophrenic patients discharged from psychiatric units in Poland. Pharmacol Rep 2014; 66:613-7. [PMID: 24948062 DOI: 10.1016/j.pharep.2014.02.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 01/24/2014] [Accepted: 02/14/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The term antipsychotic polypharmacy (APP) refers to the concurrent use of two or more antipsychotic drugs in schizophrenia. The aim of this study was to investigate the range of APP in schizophrenic patients discharged from psychiatric units in Poland, and to determine its demographical and clinical correlates. METHODS Data on the pharmacological treatment of 207 patients with a diagnosis of schizophrenia, discharged from six psychiatric hospitals from September-December 2011 were recorded by experienced psychiatrists. Clinical and demographical information was obtained on each patient. The severity of symptoms at admission, and their improvement during hospitalization were assessed using the Clinical Global Impression Scale. RESULTS At discharge, 52.7% of the patients were prescribed one, 42.5% two and 4.8% three antipsychotic drugs (AP). When two AP were applied, it was usually a combination of two second generation antipsychotics (SGA) (46%), or of both first generation antipsychotics (FGA) and SGA (48%). The SGA's olanzapine and risperidone were those most commonly prescribed. Patients treated with two or more AP had a higher number of previous hospitalizations than patients receiving antipsychotic monotherapy. Mood stabilizers were prescribed for nearly one third of the patients, while antidepressants and benzodiazepines were prescribed for fewer than 10%. CONCLUSIONS The prevalence of polypharmacy in Poland is similar to that reported in other countries. This may suggest that, in a substantial proportion of schizophrenic patients clinical response to the antipsychotic monotherapy is unsatisfactory. Further studies focusing on the efficacy and safety of strategies in the treatment of patients with schizophrenia not responding to antipsychotic monotherapy are necessary.
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Affiliation(s)
- Jan Jaracz
- Department of Adult Psychiatry, Poznań University of Medical Sciences, Poznań, Poland.
| | | | - Dominika Kujath
- The Province Hospital for the Nervously and Mentally Ill, "Dziekanka", Gniezno, Poland
| | - Agnieszka Raczyńska
- The Province Hospital for the Nervously and Mentally Ill, "Dziekanka", Gniezno, Poland
| | - Sebastian Stoszek
- The Province Hospital for the Nervously and Mentally Ill, Cibórz, Poland
| | | | - Piotr Wierzbiński
- Department of Adult Psychiatry, Medical University of Łódź, Łódź, Poland
| | | | - Krystyna Jaracz
- Department of Neurological and Psychiatric Nursing, Poznań University of Medical Sciences, Poznań, Poland
| | - Janusz Rybakowski
- Department of Adult Psychiatry, Poznań University of Medical Sciences, Poznań, Poland
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López-Muñoz F, Sim K, Shen WW, Huelves L, Moreno R, Molina JDD, Rubio G, Noriega C, Pérez-Nieto MÁ, Alamo C. A bibliometric study of scientific research conducted on second-generation antipsychotic drugs in Singapore. Singapore Med J 2014; 55:24-33. [PMID: 24452974 PMCID: PMC4291907 DOI: 10.11622/smedj.2014006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION A bibliometric study was carried out to ascertain the volume and impact of scientific literature published on second-generation antipsychotic drugs (SGAs) in Singapore from 1997 to 2011. METHODS A search of the EMBASE and MEDLINE databases was performed to identify articles originating from Singapore that included the descriptors 'atypic* antipsychotic*', 'second-generation antipsychotic*', 'clozapine', 'risperidone', 'olanzapine', 'ziprasidone', 'quetiapine', 'sertindole', 'aripiprazole', 'paliperidone', 'amisulpride', 'zotepine', 'asenapine', 'iloperidone', 'lurasidone', 'perospirone' and 'blonanserin' in the article titles. Certain bibliometric indicators of production and dispersion (e.g. Price's Law on the increase of scientific literature, and Bradford's Law) were applied, and the participation index of various countries was calculated. The bibliometric data was also correlated with some social and health data from Singapore, such as the total per capita expenditure on health and gross domestic expenditure on research and development. RESULTS From 1997 to 2011, a total of 51 articles on SGAs in Singapore were published. Our results suggested non-fulfilment of Price's Law (r = 0.0648 after exponential adjustment vs. r = 0.2140 after linear adjustment). The most widely studied drugs were clozapine (21 articles), risperidone (16 articles) and olanzapine (8 articles). Division into Bradford zones yielded a nucleus occupied by the Journal of Clinical Psychopharmacology (6 articles) and the Singapore Medical Journal(4 articles). The analysed material was published in a total of 30 journals, with the majority from six journals. Four of these six journals have an impact factor greater than 2. CONCLUSION Publications on SGAs in Singapore are still too few to confirm an exponential growth of scientific literature.
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Affiliation(s)
- Francisco López-Muñoz
- Faculty of Health Sciences, Camilo José Cela University, C/ Castillo de Alarcón, 49, Urb Villafranca del Castillo, Villanueva de la Cañada, 28692 Madrid, Spain.
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Roh D, Chang JG, Kim CH, Cho HS, An SK, Jung YC. Antipsychotic polypharmacy and high-dose prescription in schizophrenia: a 5-year comparison. Aust N Z J Psychiatry 2014; 48:52-60. [PMID: 23671214 DOI: 10.1177/0004867413488221] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The co-prescription of multiple antipsychotic drugs continues to increase despite a lack of evidence supporting this practice. The purpose of this study was to quantify and describe recent trends of antipsychotic polypharmacy in Korean schizophrenic inpatients by comparing prescribed medications between the years of 2005 and 2010. METHODS We reviewed comprehensive medication profiles of schizophrenic patients discharged from a university psychiatric hospital in 2005 (n=194) or 2010 (n=201). Antipsychotic polypharmacy was defined as the concurrent receipt of two or more chemically distinct antipsychotics for at least 14 days. High antipsychotic dose was defined as a prescribed daily dose to defined daily dose ratio of greater than 1.5. RESULTS Antipsychotic polypharmacy increased between 2005 (37.1%) and 2010 (48.3%, p=0.025). The most frequently used drug within combinations of antipsychotics was haloperidol in 2005 (51.4%) and quetiapine in 2010 (48.5%). Overall, no changes were observed between 2005 and 2010 in the rate of prescribing high-dose antipsychotics. High-dose antipsychotic monotherapy decreased across years (from 30.4 to 18.4%), but high-dose antipsychotic polypharmacy increased (from 34.0 to 45.3%). Regression analysis revealed that antipsychotic polypharmacy was strongly associated with high doses of prescribed antipsychotics (odds ratio=18.60, p<0.001). CONCLUSIONS The practice of prescribing multiple antipsychotics to patients with schizophrenia is increasing, and high-dose antipsychotic drugs are more likely to be prescribed in combination than in isolation. The reasons for this pattern of prescription and its impact warrants further study.
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Affiliation(s)
- Daeyoung Roh
- 1Severence Mental Health Hospital, Yonsei University College of Medicine, Gyeonggi-do, Korea
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Xiang YT, Ungvari GS, Wang CY, Si TM, Lee EHM, Chiu HFK, Lai KYC, He YL, Yang SY, Chong MY, Tan CH, Kua EH, Fujii S, Sim K, Yong MKH, Trivedi JK, Chung EK, Udomratn P, Chee KY, Sartorius N, Shinfuku N. Adjunctive antidepressant prescriptions for hospitalized patients with schizophrenia in Asia (2001-2009). Asia Pac Psychiatry 2013; 5:E81-7. [PMID: 23857816 DOI: 10.1111/j.1758-5872.2012.00231.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 07/18/2012] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Little is known about the prescription patterns of adjunctive antidepressants in Asian schizophrenia patients. This study aimed to examine trends in the use of antidepressants and their demographic and clinical correlates in the treatment of schizophrenia in Asia between 2001 and 2009. METHODS A total of 6,761 hospitalized schizophrenia patients in nine Asian countries and territories were examined: 2,399 in 2001, 2,136 in 2004 and 2,226 in 2009. Patients' socio-demographic and clinical characteristics and prescriptions of psychotropic drugs were recorded using a standardized protocol and data collection procedure. RESULTS The proportion of antidepressant prescription was 6.8% in the whole sample; 5.3% in 2001, 6.5% in 2004 and 8.7% in 2009. There were wide inter-country variations at each survey ranging from 0.9% in Hong Kong to 15.3% in Singapore in 2001; from 1.9% in Korea to 15.4% in Singapore in 2004; and from 2.7% in Japan to 22.0% in Singapore in 2009. Multiple logistic regression analysis of the whole sample revealed that patients on antidepressants were younger, more likely to receive benzodiazepines and have significant extrapyramidal side-effects and less likely to have significant positive symptoms. DISCUSSION Unlike findings in Western countries, adjunctive antidepressant prescription for schizophrenia was not common in Asia. The frequency of antidepressant prescription varied among countries and territories, suggesting that a host of clinical and socio-cultural factors played a role in determining antidepressant use in Asia.
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Affiliation(s)
- Yu-Tao Xiang
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China.
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Current world literature. Curr Opin Psychiatry 2013; 26:231-6. [PMID: 23364282 DOI: 10.1097/yco.0b013e32835dd9de] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tani H, Uchida H, Suzuki T, Fujii Y, Mimura M. Interventions to reduce antipsychotic polypharmacy: a systematic review. Schizophr Res 2013; 143:215-20. [PMID: 23158205 DOI: 10.1016/j.schres.2012.10.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 09/23/2012] [Accepted: 10/21/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND It still remains unclear as to how to counteract antipsychotic polypharmacy that remains controversial but common. The objective of this study was to synthesize the clinical evidence to reduce antipsychotic polypharmacy (i.e. use of multiple antipsychotics) in schizophrenia. METHODS A literature search was performed to identify clinical trials that attempted to reduce antipsychotic polypharmacy in patients with schizophrenia by any form of systematic intervention using PubMed as well as MEDLINE, EMBASE, and PsycINFO (last search: June 2012). The search terms included "antipsychotics" and "polypharmacy". Cross-referencing was also performed. RESULTS The literature search identified 17 studies. Only 3 studies (1 randomized controlled trial and 2 open-label trials) were found that systematically switched antipsychotic polypharmacy to monotherapy. In two of them, more than two thirds of the subjects successfully completed the switch (40/58, 69.0%; 34/44, and 77.3%, respectively) while less than half the subjects tolerated it in the other study (6/14 and 42.9%) although the sample size was very small. On the other hand, 14 studies that examined impacts of interventions have physicians refrain from antipsychotic polypharmacy. While a modest intervention with educational approach alone was effective in three of the five articles, a more assertive intervention that directly cautioned physicians on the use of polypharmacy was effective in 10 of 12 articles. CONCLUSION The literature search revealed the paucity of the data. Careful switching from polypharmacy to monotherapy seems feasible in a majority of patients with schizophrenia. Assertive interventions, rather than passive educational approaches alone, appear more effective in reducing antipsychotic polypharmacy.
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Affiliation(s)
- Hideaki Tani
- Department of Psychiatry, Yamanashi Prefectural Kita Hospital, Yamanashi, Japan
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