10‐Year trends in the treatment and outcomes of patients with first‐episode schizophrenia

Abstract

Nielsen J, le Quach P, Emborg C, Foldager L, Correll CU. 10‐Year trends in the treatment and outcomes of patients with first‐episode schizophrenia. Objective: The first episode of schizophrenia is a critical period for illness course and outcomes. We aimed to investigate treatments and outcomes during the first year after the diagnosis of schizophrenia. Method: Pharmacoepidemiologic inception cohort study of all newly diagnosed patients with schizophrenia in Denmark (n = 13 600) 1996–2005. Results: From 1996 to 2005, the mean age at first diagnosis decreased significantly (29.2–26.1 years), more patients received antipsychotics (67.2–80.7%, annual OR = 1.07, CI: 1.06–1.09, P < 0.001) and antipsychotic polypharmacy for >4 months (16.7–37.1%, OR = 1.14, CI: 1.12–1.57, P < 0.001). The antipsychotic defined daily dosage (DDD) doubled (150–332 DDD, P < 0.001), use of antidepressants (24.3–40.6%, P < 0.001). Bed days [89.9 days (CI: 81.8–98.8) to 71.8 days, CI: 63.7–80.8, P < 0.0001] decreased, whereas outpatient contacts [10.2 (CI: 9.5–11.0) to 21.4 (CI: 19.9–21.0), P < 0.0001] doubled. Conclusion: Between 1996 and 2005, there was an earlier recognition of schizophrenia, intensified outpatient treatment, increased use and dosing of antipsychotics and antidepressants, but also more antipsychotic polypharmacy.

Frequency and correlates of antipsychotic polypharmacy among patients with schizophrenia in Denmark: A nation-wide pharmacoepidemiological study

“…Antipsychotic polypharmacy was defined as treatment with at least two antipsychotics during a four month period (i.e., at least two renewals of each antipsychotic prescription). This definition, which has been employed previously (Nielsen et al, 2010b), was used in order to exclude patients switching antipsychotic medication by the cross-tapering method. The four-month period was chosen, as the largest pack size, i.e., 100 tablets, would have been used within that period.…”

“…Despite this, several studies have shown that around 20% of patients with schizophrenia are treated with APP (Gallego et al, 2012a;Kim et al, 2014;Nielsen et al, 2010b). Moreover, prior studies have indicated that APP is related to greater illness severity and chronicity, psychiatric comorbidity and that there are substantial variations across centers, countries, time periods and populations (Gallego et al, 2012b).…”

Antipsychotic polypharmacy: never say never, but never say always

“…Never say never to polypharmacy ⁄ combinations Rank and file psychiatrists seem to have ignored the call for Ôalways say monotherapyÕ as the data show that antipsychotic polypharmacy ⁄ combination use is growing and is higher than ever, overtaking monotherapy (11), and seemingly impervious to educational and administrative interventions to reduce polypharmacy (12,17). Although some believe these trends reflect substandard care, the shift toward more antipsychotic polypharmacy ⁄ combinations may actually be due to something else, namely, the growing gap between evidence-based practice and practicebased evidence, at least for certain patient populations receiving antipsychotics.…”

Resilience Improves Neurocognition and Treatment Outcomes in Schizophrenia: A Hypothesis

“…Other contributing factors appear to be lack of opportunity for employment and work, leading to lack of satisfaction, stigma and being seen as a burden on the family, at least in a few cases [46]. However persistence of symptoms, suicidality, limited functioning, inability for independent living, and inability to resume work in large number of patients does bring out limited success with contemporary therapy [47]. In another study which compared rates hospitalization between 1994 and 2004, authors highlighted admission rates of 50% and 85% on first generation antipsychotic drugs and 51 and 81% on second generation antipsychotic drugs respectively.…”