BackgroundAnalysis of the prescribing patterns of antipsychotic drugs can improve therapeutic outcomes. The purpose of this study was to evaluate the prescribing pattern of antipsychotics and its conformance to international treatment guidelines.MethodsA cross sectional study at primary psychiatric centers was carried out. Patients’ medical files were used to obtain demographic, medication and clinical information. International guidelines for schizophrenia were used to create conformance indicators. All statistical analyses were conducted using Statistical Package for Social Sciences.Results250 patients were included in this study. A total of 406 antipsychotic agents were used; 348 (85.7%) were first generation antipsychotics (FGA). The prevalence of antipsychotic combination was 50.4% (n=126). There was no significant difference in positive (p=0.3), negative (p=0.06) and psychopathology (p=0.5) scores of schizophrenia symptoms among patients on monotherapy versus those on antipsychotic combination. Furthermore, no significant difference was observed in the annual cost of antipsychotic monotherapy versus combination therapy. One hundred and five patients (42%) were using optimum dose of (300 – 600 mg CPZeq) while the remaining were using sub or supra therapeutic doses. Analysis showed that use of depot, use of anticholinergic agents and increasing amount of total CPZeq were significant factors associated with antipsychotic combination.ConclusionsThis study indicated that antipsychotic prescribing was not in conformance with international guidelines with respect to maintenance dose and combination therapy. Type of antipsychotic treatment regimen, combination versus monotherapy, was not associated with better clinical or economic outcome.

The objective of this paper was to study antipsychotic medication use in the outpatient psychiatry department in Palestine. Methodology: This is a cross sectional study carried out in Palestine on schizophrenic patients aged between 20 -65 whose medications have not been changed in the past six months and they did not have an acute attack in the last year. Information regarding antipsychotic medications use was obtained from patients' medical files; patients' psychiatric symptoms were evaluated using the Expanded Brief Psychiatric Rating Scale (BPRS-E).Results: More than half (53.1%) of 150 patients were on antipsychotic polypharmacy (APP) with average daily dose of 546.9 ± 254.9 mg chlorpromazine equivalents. The average number (mean ± SD) of medications a patient received was 1.7 ± 0.7. One third of patients on APP regimen received atypical antipsychotic and all of them received at least one conventional antipsychotic. Factors significantly and positively associated with APP were: use of anticholinergic agents (P<0.001), conventional antipsychotics (P<0.001), depot formulations (P<0.001) and prescribing higher doses of antipsychotics (P<0.001). Discussion and Conclusion: Antipsychotic polypharmacy in this study was common. Adherence to international guidelines in the treatment of schizophrenia is recommended.