Atypical antipsychotics usage in long-term follow-up of first episode schizophrenia

Abstract

Background:It is not clear if the role of antipsychotics in long-term clinical and functional recovery from schizophrenia is correlated. The pattern of use is a major aspect of pharmacotherapy in long-term follow-ups of schizophrenia. The aim of this study was to examine patterns of antipsychotic usage in patients with longstanding psychosis and their relationship to social outcomes.Materials and Methods:We conducted a cross-sectional study on a cohort from a long-term outcome study. Participants were 116 first episode schizophrenia patients from Mumbai, India, who had more than 80% compliance, as reported by relatives. Patients were assessed on antipsychotic medication use and on clinical and functional parameters.Results:There was a high compliance rate (72%). Most patients (77%) used atypical antipsychotics; only 10 (8.6%) patients were taking typical antipsychotics. There were no among-drug differences in the percentage of patients meeting the recommended dose: Clozapine (200–500 mg), Riseperidone (4.0–6.0 mg), Olanzapine (10–20 mg), Quetiapine (400–800 mg), Aripiprazole (15–30 mg), Ziprasidone (120–160 mg); an equivalent dosage of Chlorpromazine (300–600 mg) did not differ amongst any atypical antipsychotic subgroup. Also, we did not find any significant differences in recovery on Clinical Global Impression Severity scale (CGIS), Quality of Life (QOL), or Global Assessment of Functioning (GAF) between groups of antipsychotic drugs.Conclusion:This study shows that most patients suffering from schizophrenia, in a long-term follow-up, use prescribed atypical antipsychotics within the recommended limits. Also, the chlorpromazine equivalence dosages do not differ across antipsychotic medications. The outcomes on clinical and functional parameters are also similar across all second-generation antipsychotics.

A Bibliometric Analysis of Scientific Research on Atypical Antipsychotic Drugs in India during 1998-2013

“…Database of the Research on Asian Psychotropic Prescription Patterns (REAP) study (2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009) show an increase of the use of AADs in eight Asian countries and territories including China, Hong Kong SAR, India, Japan, Korea, Malaysia, Singapore, and Taiwan [37] . It is also confirmed this evolution in specific studies on psychotropic drugs use pattern in India [16][17][18] . Grover et al, [38] in a study conducted in India, have confirmed that the most commonly prescribed antipsychotic medication is olanzapine (20.7% of patients with an organic mental disorder, 40.8% with psychotic disorder, 30.2% with bipolar disorder); quetiapine and risperidone were the other commonly prescribed antipsychotics.…”

“…As an example of this development, there was an eight-fold increase in budget for the Tenth Five-Year Plan (2002)(2003)(2004)(2005)(2006)(2007). In this sense, and in relation to the topic of our study, the proportion of prescriptions for atypical medications in India has increased markedly during the last years [16][17][18] .…”

Polypharmacy in psychiatry: A review

“…However, the total number of patients with schizophrenia in their sample was small (around 29). Even a recent cross-sectional study on a cohort from a long-term outcome study by Shrivastava et al ., (2012)[46], found that a large percentage of schizophrenia patients (30.1%) were taking more than one second-generation antipsychotic.…”

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“…32% of the patients were prescribed more two or more than antipsychotic medications which has been defined as polypharmacy 17 . This figure is less than that found in the actual survey of prescriptions done in the East Asian countries with 48% of polypharmacy, out of which Japan being the highest (79%) 18 .…”