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
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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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    • "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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    • "Antipsychotic polypharmacy occurs frequently within clinical practice, with rates ranging from 5-18% in outpatients and up to 50% or more in inpatients (Wang et al. 2000). This practice has been criticized as unjustified, too expensive and based on insufficiently performed clinical trials (Ananth et al. 2004, Stahl et al. 2004). "
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    ABSTRACT: Background: Therapeutic options for patients with treatment-resistant schizophrenia are limited. In such cases, a combination of atypical antipsychotic drugs is an often used strategy. We tested the hypothesis that the combination of amisulpride and clozapine would lead to long-term improvement in this patient group. Objective: 15 patients with treatment-resistant schizophrenia participated in this open clinical trial and received a combination of amisulpride and clozapine. Patients had to have remained on a stable dose of clozapine for at least 6 months in order to ensure a reasonable opportunity to respond to clozapine monotherapy. Clinical status was evaluated at baseline, and 3, 6 and 12 months' follow-up, using the Brief Psychiatric Rating Scale (BPRS). Results: All patients completed 12 months' combination treatment. The mental state of 11 patients (73.3%) was im-proved and there was a significant reduction in the mean BPRS score over the 12 months of combination treatment. The augmentation of amisulpride in clozapine treated patients did not result in a corresponding increase in side effects. The combination allowed a mean reduction of 12.8% of the daily clozapine dose. Conclusions: The combined application of clozapine and amisulpride follows a neurobiological rationale and appears to be safe and well tolerated, without increasing the risk of side effects (German J Psychiatry 2006; 9: 17-21).
    German Journal of Psychiatry 01/2006; 9(1).
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