Naoki Hashimoto1, Norio Yasui-Furukori2, Naomi Hasegawa3, Shuhei Ishikawa1, Shusuke Numata4, Hikaru Hori5, Hitoshi Iida6, Kayo Ichihashi7, Ryuji Furihata8, Atsunobu Murata3, Takashi Tsuboi9, Masahiro Takeshima10, Yoshitaka Kyou11, Hiroshi Komatsu12, Chika Kubota13, Shinichiro Ochi14, Yoshikazu Takaesu15, Masahide Usami16, Tatsuya Nagasawa17, Akitoyo Hishimoto18, Kenichiro Miura3, Junya Matsumoto3, Kazutaka Ohi19, Hisashi Yamada20, Ken Inada21, Koichiro Watanabe9, Kazutaka Shimoda22, Ryota Hashimoto3. 1. Department of Psychiatry, Hokkaido University Graduate School of Medicine, Hokkaido, Japan. 2. Department of Psychiatry, Dokkyo Medical University School of Medicine, Tochigi, Japan. Electronic address: furukori@dokkyomed.ac.jp. 3. Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan. 4. Department of Psychiatry, Graduate School of Biomedical Science, Tokushima University, Tokushima, Japan. 5. Department of Psychiatry, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan. 6. Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka, Japan. 7. Department of Neuropsychiatry, University of Tokyo Hospital, Tokyo, Japan. 8. Kyoto University Health Services, Kyoto, Japan. 9. Department of Neuropsychiatry, Kyorin University School of Medicine, Mitaka, Japan. 10. Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan. 11. Department of Psychiatry, Kitasato University, School of Medicine, Kanagawa, Japan. 12. Department of Psychiatry, Tohoku University Hospital, Sendai, Japan. 13. National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan. 14. Department of Neuropsychiatry, Molecules and Function, Graduate School of Medicine, Ehime University, Ehime, Japan. 15. Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan. 16. Department of Child and Adolescent Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa, Chiba, Japan. 17. Department of NeuroPsychiatry Kanazawa Medical University, Ishikawa, Japan. 18. Department of Psychiatry, Yokohama City University Graduate School of Medicine, Yokohama, Japan. 19. Department of Psychiatry and Psychotherapy, Gifu University Graduate School of Medicine, Gifu, Japan. 20. Department of Neuropsychiatry, Hyogo College of Medicine, Hyogo, Japan. 21. Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan. 22. Department of Psychiatry, Dokkyo Medical University School of Medicine, Tochigi, Japan.
Abstract
BACKGROUND: Monopharmacy with antipsychotics and antidepressants is the first-line treatment for schizophrenia and major depressive disorder (MDD) in most clinical guidelines, while polypharmacy with psychotropic agents in the treatment of schizophrenia is common in clinical practice. There are no detailed data on the prescription patterns for inpatients with mental illness with reliable diagnoses made by treating psychiatrists. METHODS: We gathered prescription data at discharge from 2177 patients with schizophrenia and 1238 patients with MDD from October 2016 to March 2018. RESULTS: The patients with schizophrenia aged between 60 and 79 were prescribed lower doses of antipsychotics and hypnotics/anxiolytics than those aged between 40 and 59. There were significant differences between the prescription rate of antipsychotics in the patients with schizophrenia and that of antidepressants in the patients with MDD. The frequency of concomitant drugs such as anti-Parkinson drugs, anxiolytics/hypnotics and mood stabilizers in the subjects with schizophrenia prescribed antipsychotic polypharmacy was significantly higher than that with monotherapy. For the patients with schizophrenia, olanzapine, risperidone, aripiprazole, quetiapine, and blonanserin were the five most prescribed antipsychotics. For the patients with MDD, mirtazapine, duloxetine, escitalopram, trazodone and sertraline were the five most prescribed antidepressants. CONCLUSIONS: Our results showed the use of high doses of antipsychotics, high percentages of antipsychotic polypharmacy and concurrent use of hypnotics/anxiolytics in patients with schizophrenia. Notably, these data were collected before intensive instruction regarding the guidelines; therefore, we need to assess the change in the prescription pattern post guideline instruction.
BACKGROUND: Monopharmacy with antipsychotics and antidepressants is the first-line treatment for schizophrenia and major depressive disorder (MDD) in most clinical guidelines, while polypharmacy with psychotropic agents in the treatment of schizophrenia is common in clinical practice. There are no detailed data on the prescription patterns for inpatients with mental illness with reliable diagnoses made by treating psychiatrists. METHODS: We gathered prescription data at discharge from 2177 patients with schizophrenia and 1238 patients with MDD from October 2016 to March 2018. RESULTS: The patients with schizophrenia aged between 60 and 79 were prescribed lower doses of antipsychotics and hypnotics/anxiolytics than those aged between 40 and 59. There were significant differences between the prescription rate of antipsychotics in the patients with schizophrenia and that of antidepressants in the patients with MDD. The frequency of concomitant drugs such as anti-Parkinson drugs, anxiolytics/hypnotics and mood stabilizers in the subjects with schizophrenia prescribed antipsychotic polypharmacy was significantly higher than that with monotherapy. For the patients with schizophrenia, olanzapine, risperidone, aripiprazole, quetiapine, and blonanserin were the five most prescribed antipsychotics. For the patients with MDD, mirtazapine, duloxetine, escitalopram, trazodone and sertraline were the five most prescribed antidepressants. CONCLUSIONS: Our results showed the use of high doses of antipsychotics, high percentages of antipsychotic polypharmacy and concurrent use of hypnotics/anxiolytics in patients with schizophrenia. Notably, these data were collected before intensive instruction regarding the guidelines; therefore, we need to assess the change in the prescription pattern post guideline instruction.
Authors: R Taurines; S Fekete; A Preuss-Wiedenhoff; A Warnke; C Wewetzer; P Plener; R Burger; M Gerlach; M Romanos; K M Egberts Journal: J Neural Transm (Vienna) Date: 2022-03-18 Impact factor: 3.850
Authors: Mary K Lam; Lawrence T Lam; Kerryn Butler-Henderson; Jonathan King; Tahnee Clark; Peta Slocombe; Katherine Dimarco; Wendell Cockshaw Journal: Front Psychiatry Date: 2022-09-09 Impact factor: 5.435