Prescribing for Inpatients with Schizophrenia: An International Multi-Center Comparative Study

I. Bitter; J. C.-Y. Chou; G. S. Ungvari; W. K. Tang; Z. Xiang; A. Iwanami; P. Gaszner

doi:10.1055/s-2003-41199

Pharmacopsychiatry, Table of Contents

Pharmacopsychiatry 2003; 36(4): 143-149
DOI: 10.1055/s-2003-41199

Original Paper

Prescribing for Inpatients with Schizophrenia: An International Multi-Center Comparative Study

I. Bitter¹ , J. C.-Y. Chou² , G. S. Ungvari³ , W. K. Tang³ , Z. Xiang⁴ , A. Iwanami⁵ , P. Gaszner⁶

¹Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
²Department of Psychiatry, New York University Medical Center, Bellevue Hospital Center, New York, NY, Nathan Kline Institute, Orangeburg, NY, USA;
³Department of Psychiatry, the Chinese University of Hong Kong, Hong Kong, China
⁴Mental Health Institute and Second Medical University, Shanghai, China
⁵Department of Psychiatry, Showa University Karasuyama Hospital, Tokyo, Japan
⁶Department of Clinical Psychopharmacology, National Institute of Psychiatry and Neurology, Budapest, Hungary

Abstract

Background: This study compares prescription practices for acute inpatients with schizophrenia among six academic departments located in China, Japan, Hungary, and the U.S.

Methods: Prescription data for a sample of 429 inpatients from six academic departments were collected on a randomly chosen census day. All patients met criteria for schizophrenia according to DSM-IV and had a length of illness of at least two years.

Results: While patients at the different centers varied in their demographic and clinical characteristics, i. e., age, sex, and length of illness, a great variation in prescription patterns for antipsychotic and other psychotropic drugs among centers was observed even within the same country for all the variables studied (i. e., number and dose antipsychotics, atypical and depot antipsychotics, other psychotropic drugs, multiple antipsychotics, and daily dose) except antidepressant use. In most cases these differences persisted even after adjusting for demographic and clinical characteristics (age, sex, and length of illness) of the subjects. Antipsychotics were usually prescribed in divided daily doses in combination with one or more other psychotropic drugs, including anticholinergics, anticonvulsants, benzodiazepines, and non-benzodiazepine hypnotics. Anticholinergic use was more common with typical antipsychotics. Rates of atypical antipsychotic drug use were lowest in the Japanese center. The Japanese center had by far the highest mean daily dose of antipsychotics.

Conclusions: The results indicate that prescription patterns in different centers do not follow any specific guidelines for the treatment of schizophrenia. The results also confirm previous findings that prescribing practices for schizophrenia vary greatly among centers and countries. A common prescribing pattern found was the use of atypical antipsychotic drugs in combination with psychotropic drugs, such as anticholinergics, hypnotics, anticonvulsants, and benzodiazepines, administered in multiple daily doses.

Key words

Schizophrenia - prescription pattern - antipsychotic drugs

Full Text

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Istvan Bitter, M.D., Ph. D.

Area Medical Center Vienna

Eli Lilly Regional Operations GmbH

Barichgasse 40-42

1030 Wien

Austria (since November 2000)