Recent Patterns and Predictors of Antipsychotic Medication Regimens Used To Treat Schizophrenia and Other Psychotic Disorders

Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Schizophrenia Bulletin (Impact Factor: 8.45). 02/2000; 26(2). DOI: 10.1093/oxfordjournals.schbul.a033465
Source: PubMed


Up-to-date data are needed on the types of treatments used by psychiatrists and the reasons for use of particular treatments. Using 1997 American Psychiatric Association (APA) Practice Research Network (PRN) Study data on patients with schizophrenia and other psychotic disorders, we identified the characteristics of antipsychotic medications (APMs) currently being prescribed and factors associated with the use of particular regimens. In this study population, use of the newer APMs, including risperidone, olanzapine, and clozapine, has increased rapidly and now accounts for over one-half of all APM use. Other intriguing findings include the fact that one-sixth of patients with schizophrenia and other psychotic disorders are concurrently treated with two or more APMs. Factors associated with being prescribed one of the newer APMs risperidone or otanzapine include being elderly, having more education, being white, having psychiatric comorbidity, and making fewer recent visits to a psychiatrist. The APA PRN Study data are an important new resource for mental health services researchers.

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Available from: Harold Alan Pincus, Oct 04, 2015
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    • "Furthermore, the tendency to use atypical antipsychotic polypharmacy may be due to the increased availability of newer antipsychotics or the changing pattern of prescriptions in recent years. Additionally, difficulties in computing titrations between typical and atypical antipsychotics may also be a factor.31) It has been shown that antipsychotic polypharmacy may be superior to monotherapy in certain clinical situations32) and a pharmacological justification for the combination and long-term use of atypical drugs with conventional drugs based on differing receptor profiles has been proposed.33) "
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    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.
    Clinical Psychopharmacology and Neuroscience 08/2014; 12(2):128-36. DOI:10.9758/cpn.2014.12.2.128
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    • "Blacks more likely to be prescribed depot Wang et al. (2000) Newer AP Non-white less likely than whites Tendency found, significance of racial difference not to receive newer AP specifically tested AA, African-American; AP, Antipsychotic; CI, confidence interval; OR, odds ratio. response (Frackiewicz et al., 1997; Ruiz et al., 1999). "
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    ABSTRACT: Ethnicity is reported to be an important, but often ignored factor in psychopharmacology. However, recent advances in molecular biology and the vision of 'personalised medicine' have spurred a debate on the role of ethnicity in this field. This paper reviews literature on the role of race and ethnicity in psychopharmacology. Despite considerable controversy on what the concepts of ethnicity and race actually measure, they are considered as important proxies for a person's culture, diet, beliefs, health behaviours and societal attitudes. Research has shown ethnic differences in the clinical presentation, treatment, clinical response and outcome of mental illnesses. A number of ethnically specific variations have been found in the genetic and non-genetic mechanisms affecting pharmacokinetics and dynamics of psychotropic drugs, which might underlie the previously mentioned differences in drug use and response across ethnicities. Although some of these ethnic differences could be partially explained by genetic factors, a number of ethnically based variables like culture, diet and societal attitudes could potentially have a significant, but as yet unquantified influence as well. Future research needs to address the problems with defining and accurately measuring 'ethnicity', as well as focus upon conducting studies that could guide treatments for people from diverse backgrounds.
    Journal of Psychopharmacology 03/2008; 22(6):673-80. DOI:10.1177/0269881107082105 · 3.59 Impact Factor
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    • "This level falls within the range reported by McCombs et al. (1999), who found a 76 percent prescription rate in Medicaid patients with a diagnosis of schizophrenia, and the PORT study on schizophrenia (Lehman 19986), which found a 92 percent utilization rate in a random sample of outpatient subjects. Based on current reports of a 50 percent use rate of atypicals (Lehman 1999; Glazer 2000; Wang et al. 2000), our 39 percent atypical use rate in 1996 appears consistent with the general trend. Surprisingly, data from a survey done by the Bazelon Center for Mental Health Law found access to atypical antipsychotics even better in the Medicaid program than under private insurance (Anonymous 2000), but access was based not on pharmacy records but on formulary policies. "
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    ABSTRACT: This article examines trends in antipsychotic medication use in a treated population of publicly funded patients with schizophrenia between 1991 and 1996. Findings from administrative claims data show that antipsychotic prescription rates increased from 79 percent to 83 percent between 1991 and 1996. Atypical antipsychotics were used by 39 percent of the population and comprised 41 percent of all antipsychotic agents prescribed compared to 59 percent for typical agents. Duration on a typical agent was 8 months versus 7.4 months for newer atypicals, with duration 11 months for those on clozapine. The highest switching behavior is found in users of atypicals (58% versus 25% for those on typicals) as is the percent of those who received an antidepressant concurrently with an antipsychotic, which was 44 percent for newer atypical users versus 31 percent for typical users. The lowest antidepressant use was among clozapine users (28%). Atypical users were more likely to be younger Caucasian men with higher use of inpatient and ambulatory mental health services compared to those on typical medications. The newer antipsychotic medications appear to be displacing traditional medications; however, contrary to what the literature suggests, duration is shorter and switching behavior and concurrent use of antidepressants is higher than in typical users.
    Schizophrenia Bulletin 02/2003; 29(3):531-40. DOI:10.1093/oxfordjournals.schbul.a007025 · 8.45 Impact Factor
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