Pharmacopsychiatry 2012; 45(01): 7-12
DOI: 10.1055/s-0031-1286345
Original Paper
© Georg Thieme Verlag KG Stuttgart · New York

Antipsychotic Polypharmacy in Inpatients with Schizophrenia in Asia (2001−2009)

Y.-T. Xiang
1   Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, P. R. China
2   Beijing Anding Hospital, Capital Medical University, Beijing, P. R. China
,
C.-Y. Wang
2   Beijing Anding Hospital, Capital Medical University, Beijing, P. R. China
,
T.-M. Si
3   Peking University, Institute of Mental Health, Beijing, P. R. China
,
E.H. M. Lee
1   Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, P. R. China
,
Y.-L. He
4   Shanghai Mental Health Center, Shanghai, P. R. China
,
G. S. Ungvari
5   The University of Notre Dame Australia, Marian Centre, Perth, Australia
,
H.F. K. Chiu
1   Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, P. R. China
,
S.-Y. Yang
6   Taipei City Hospital, Taipei, Taiwan, ROC
,
M.-Y. Chong
7   Kaohsiung Chang Gung Memorial Hospital and School of Medicine, Chang Gung University, Taiwan, ROC
,
C.-H. Tan
8   National University of Singapore, Singapore
,
E.-H. Kua
8   National University of Singapore, Singapore
,
S. Fujii
9   Hyogo Institute for Traumatic Stress (HITS), Kobe, Japan
,
K. Sim
10   Institute of Mental Health, Buangkok View, Singapore, Singapore
,
K. H. Yong
10   Institute of Mental Health, Buangkok View, Singapore, Singapore
,
J. K. Trivedi
11   Department of Psychiatry, C. S. M. Medical University UP, Lucknow, Uttar Pradesh, India
,
E.-K. Chung
12   National Seoul Hospital, Seoul, Korea
,
P. Udomratn
13   Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
,
K.-Y. Chee
14   Department of Psychiatry and Mental Health, Tunku Abdul Rahman Institute of Neuroscience, Kuala Lumpur Hospital, Malaysia
,
N. Sartorius
15   Association for the Improvement of Mental Health Programs, Geneva, Switzerland
,
N. Shinfuku
16   School of Human Sciences, Seinan Gakuin University Fukuoka, Japan
› Author Affiliations
Further Information

Publication History

received 01 May 2011
revised 01 July 2011

accepted 29 July 2011

Publication Date:
11 October 2011 (online)

Abstract

Objective:

This study aimed to identify trends in the use of antipsychotic polypharmacy (APP) and their demographic and clinical correlates in the treatment of schizophrenia in Asia between 2001 and 2009.

Method:

A total of 6761 schizophrenia inpatients in 9 Asian countries and territories were examined; 2399 in 2001, 2136 in 2004, and 2226 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 APP prescription decreased from 46.8% in 2001, to 38.3% in 2004, and increased to 43.4% in 2009, with wide inter-country variations at each survey. Multiple logistic regression analysis of the whole sample revealed that patients on APP were younger, had a higher dose of antipsychotics in chlorpromazine equivalents, and more severe positive and negative symptoms. They were also more likely to receive depot and first-generation antipsychotic drugs.

Conclusions:

The frequency of APP prescription varied between countries and territories, suggesting that a host of clinical and socio-cultural factors played a role in determining APP use in Asia. To resolve the discrepancy between treatment recommendation and clinical practice, regular reviews of prescription patterns are needed.

 
  • References

  • 1 Pickar D, Vinik J, Bartko JJ. Pharmacotherapy of schizophrenic patients: preponderance of off-label drug use. PLoS ONE 2008; 3: e3150
  • 2 Remington G, Saha A, Chong SA et al. Augmentation strategies in clozapine-resistant schizophrenia. CNS Drugs 2005; 19: 843-872
  • 3 Mojtabai R, Olfson M. National trends in psychotropic medication polypharmacy in office-based psychiatry. Arch Gen Psychiatry 2010; 67: 26-36
  • 4 Nunley M. Why psychiatrists in India prescribe so many drugs. Cult Med Psychiatry 1996; 20: 165-197
  • 5 Phillips MR, Lu SH, Wang RW. Economic reforms and the acute inpatient care of patients with schizophrenia: the Chinese experience. Am J Psychiatry 1997; 154: 1228-1234
  • 6 Freudenreich O, Goff DC. Antipsychotic combination therapy in schizophrenia. A review of efficacy and risks of current combinations. Acta Psychiatr Scand 2002; 106: 323-330
  • 7 Honer WG, Thornton AE, Chen EY et al. Clozapine alone versus clozapine and risperidone with refractory schizophrenia. N. Engl J Med 2006; 354: 472-482
  • 8 Zink M, Englisch S, Meyer-Lindenberg A. Polypharmacy in schizophrenia. Curr. Opin Psychiatry 2010; 23: 103-111
  • 9 Sim K, Su A, Fujii S et al. Antipsychotic polypharmacy in patients with schizophrenia: a multicentre comparative study in East Asia. Br J Clin Pharmacol 2004; 58: 178-183
  • 10 Chong MY, Tan CH, Fujii S et al. Antipsychotic drug prescription for schizophrenia in East Asia: rationale for change. Psychiatry Clin Neurosci 2004; 58: 61-67
  • 11 Percudani M, Barbui C, Fortino I et al. Epidemiology of first- and second-generation antipsychotic agents in Lombardy, Italy. Pharmacopsychiatry 2005; 38: 128-131
  • 12 APA. Practice Guideline for the Treatment of Patients with Schizophrenia. Washington, DC: American Psychiatric Press; 1997
  • 13 Kane JM, Aguglia E, Altamura AC et al. Guidelines for depot antipsychotic treatment in schizophrenia. European Neuropsychopharmacology Consensus Conference in Siena, Italy. Eur Neuropsychopharmacol 1998; 8: 55-66
  • 14 Woods SW. Chlorpromazine equivalent doses for the newer atypical antipsychotics. J Clin Psychiatry 2003; 64: 663-667
  • 15 Ito C, Kubota Y, Sato M. A prospective survey on drug choice for prescriptions for admitted patients with schizophrenia. Psychiatry Clin Neurosci 1999; 53 (Suppl) S35-S40
  • 16 Xiang YT, Weng YZ, Leung CM et al. Clinical and social determinants of antipsychotic polypharmacy for Chinese patients with schizophrenia. Pharmacopsychiatry 2007; 40: 47-52
  • 17 Covell NH, Jackson CT, Evans AC et al. Antipsychotic prescribing practices in Connecticut’s public mental health system: rates of changing medications and prescribing styles. Schizophr Bull 2002; 28: 17-29
  • 18 Weissman EM. Antipsychotic prescribing practices in the Veterans Healthcare Administration − New York metropolitan region. Schizophr Bull 2002; 28: 31-42
  • 19 Chong SA, Sachdev P, Mahendran R et al. Neuroleptic and anticholinergic drug use in Chinese patients with schizophrenia resident in a state psychiatric hospital in Singapore. Aust N Z J Psychiatry 2000; 34: 988-991
  • 20 Chinese Medical Association. Guideline for the Prevention and Treatment of Schizophrenia in China. Beijing: Chinese Medical Association; 2003
  • 21 Lehman AF, Lieberman JA, Dixon LB et al. Practice guideline for the treatment of patients with schizophrenia, second edition. Am J Psychiatry 2004; 161: 1-56
  • 22 Miller AL, Hall CS, Buchanan RW et al. The Texas Medication Algorithm Project antipsychotic algorithm for schizophrenia: 2003 update. J Clin Psychiatry 2004; 65: 500-508
  • 23 Suppes T, Dennehy EB, Hirschfeld RM et al. The Texas implementation of medication algorithms: update to the algorithms for treatment of bipolar I disorder. J Clin Psychiatry 2005; 66: 870-886
  • 24 Sim K, Su A, Chan YH et al. Clinical correlates of antipsychotic polytherapy in patients with schizophrenia in Singapore. Psychiatry Clin Neurosci 2004; 58: 324-329
  • 25 Binder RL, Kazamatsuri H, Nishimura T et al. Tardive dyskinesia and neuroleptic-induced parkinsonism in Japan. Am J Psychiatry 1987; 144: 1494-1496
  • 26 Stahl SM. Antipsychotic polypharmacy: squandering precious resources?. J Clin Psychiatry 2002; 63: 93-94
  • 27 Barbui C, Signoretti A, Mule S et al. Does the addition of a second antipsychotic drug improve clozapine treatment?. Schizophr Bull 2009; 35: 458-468
  • 28 Cipriani A, Boso M, Barbui C. Clozapine combined with different antipsychotic drugs for treatment resistant schizophrenia. Cochrane Database Syst Rev 2009; CD006324
  • 29 Taylor D, Paton C, Kerwin R. The Maudsley Prescribing Guidelines. London: Martin Dunitz; 2003