Global Neuropsychopharmacological Prescription Trends in Adults with Schizophrenia, Clinical Correlates and Implications for Practice: A Scoping Review

Ying, Jiangbo; Chew, Qian Hui; Wang, Yuxi; Sim, Kang

doi:10.3390/brainsci14010006

Cited by 3 publications

(1 citation statement)

References 135 publications

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“…Additionally, across all dose levels, antidepressant exposure is linked to a reduction in CVD mortality in this geriatric population. Combining antipsychotics with antidepressants is a frequently used clinical approach to address symptoms in individuals with schizophrenia [ 19 ]. Tiihonen et al found a decline in all-cause mortality among schizophrenia patients receiving antidepressant treatment compared to those without exposure to antidepressants, aligning with our own findings [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Medication Dosage Impact on Mortality in Old-Age Individuals with Schizophrenia: A National Cohort Study

Li,

Yeh,

Lin

et al. 2024

Pharmaceuticals

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As the prevalence of old-age individuals with schizophrenia (OAS) increases in a society undergoing demographic aging, the exploration of medication choices becomes increasingly crucial. Due to the current scarcity of literature on OAS, this study seeks to examine how the utilization and cumulative dosages of psychotropic medications influence both overall and cause-specific mortality risks within this population. A national cohort of 6433 individuals diagnosed with OAS was followed up for 5 years. This study involved comparing the mortality rates associated with low, moderate, and high dosages of antipsychotics, antidepressants, mood stabilizers, and sedative/hypnotic drugs against the ‘no exposure’ category, based on individual dosages. Cox regression was employed for survival analyses to compare overall mortality and specific-cause mortality across various dosage groups. The exposure variable examined was the dosage of a specific psychotropic medication. Covariates were adjusted accordingly. The analysis revealed that patients on low/moderate antipsychotic doses had improved survival compared to non-exposed individuals. Moderate antipsychotic use corresponded to reduced cardiovascular disease mortality risk. Similarly, those exposed to antidepressants had enhanced survival in low and moderate doses. Sedative-hypnotic exposure was linked to decreased mortality risk in low doses. This study observed that low/moderate antipsychotic doses in older adults with schizophrenia were associated with decreased all-cause mortality, emphasizing the significance of precise medication selection and dosing. It underscores the need for vigilant polypharmacy management and tailored medication strategies in addressing the complexities of treating OAS.

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Section: Discussionmentioning

confidence: 99%

Medication Dosage Impact on Mortality in Old-Age Individuals with Schizophrenia: A National Cohort Study

Li,

Yeh,

Lin

et al. 2024

Pharmaceuticals

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Initiation of Antipsychotics During the First Year After First‐Episode Psychosis: A Population‐Based Study

Odsbu,

Hamina,

Hjellvik

et al. 2024

Acta Psychiatr Scand

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BackgroundAntipsychotics are recommended after first‐episode psychosis. Knowledge on the current use patterns in real‐world settings is thus important to inform clinical practice. We aimed to describe antipsychotic initiation during 1 year after first‐episode psychosis and its associated factors.MethodsPopulation‐based cohort study using linked nationwide health and population registers from Norway. The study population comprised 8052 persons aged 16–45 years with first‐episode psychosis diagnosed in secondary care (ICD‐10 F20, F22–F29) in the period 2011–2019. Initiation of antipsychotic use was defined as being dispensed antipsychotics (ATC N05A, excl. lithium) at least once from −90 to +365 days from secondary care diagnosis of first‐episode psychosis. Antipsychotic polypharmacy during follow‐up was defined as having at least 90 days with overlapping drug use periods modeled using the Prescriptions to Drug Use Periods method. Adjusted risk ratios (aRRs) with 95% confidence intervals (CIs) for the association between socioeconomic and clinical factors and initiation of antipsychotic use were calculated using modified Poisson regression.ResultsIn total, 4413 persons (54.8%) initiated antipsychotic use after first‐episode psychosis with proportions ranging from 45.5% in 2012 to 62.1% in 2019. Oral formulations of olanzapine (34.9%), quetiapine (21.2%), and aripiprazole (11.6%) were most common at initiation, whereas long‐acting injectables (LAIs) and clozapine were rarely used. Among the initiators, 13.8% started a polypharmacy period lasting more than 90 days. Factors associated with antipsychotic initiation were lower age (aRR 1.14, 95% CI 1.08–1.21; 26–35 years vs. 36–45 years), higher education (1.11, 1.05–1.18), being employed (1.04, 1.00–1.09), being hospitalized (1.13, 1.09–1.18), being diagnosed late in the study period (1.16, 1.11–1.22; 2017–2019 vs. 2011–2013), or with previously diagnosed bipolar disorder, depression, or anxiety disorders.ConclusionsThe antipsychotic use pattern is largely within the current clinical guideline. Primary non‐compliance and disease severity may explain the socioeconomic and clinical differences related to initiation of antipsychotic use.

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Antipsychotic Prescribing Practices for In-patients with Schizophrenia

Sofronov,

Dobrovolskaya,

Gvozdetckii

et al. 2024

Psychiatry

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Results: consumption of antipsychotics in hospital for the period 2015–2022 characterized by a decrease in the proportion of typical antipsychotics (TA) to 12.8% due to an increase in the proportion of atypical antipsychotics (AA) to 61.0% and long-acting antipsychotics (LA) to 26.2%. The administration of antipsychotics by hospital treatment units was relatively uniform. Clozapine (26.9%), zuclopenthixol (20.0%), haloperidol (10.3%), olanzapine (10.3%), risperidone (9.3%), quetiapine (8.2%), paliperidone (4.1%) accounted for 89.1% of all antipsychotics consumed. The total proportion of cariprazine, pericyazine, aripiprazole, ziprasidone, levomepromazine, chlorprothixene, chlorpromazine, tiapride and trifluoperazine, sertindole, lurasidone, sulpiride, flupenthixol and brexpiprazole was 10.9%. Among the medications prescribed to patients with schizophrenia, the leading ones were risperidone (36.2%), haloperidol (17.1%), olanzapine (15.6%), and clozapine (10.8%). The frequency of prescription of other drugs was less than 10.0%. The share of TA was 26.3%, AA — 73.7%. In the vast majority of cases (98.1%), patients received monotherapy. Conclusion: the data obtained on the structure of antipsychotic prescriptions indicate that our approaches correspond to the global trend of the predominant use of second-generation antipsychotics in the in-patient treatment of schizophrenia.

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Global Neuropsychopharmacological Prescription Trends in Adults with Schizophrenia, Clinical Correlates and Implications for Practice: A Scoping Review

Cited by 3 publications

References 135 publications

Medication Dosage Impact on Mortality in Old-Age Individuals with Schizophrenia: A National Cohort Study

Medication Dosage Impact on Mortality in Old-Age Individuals with Schizophrenia: A National Cohort Study

Initiation of Antipsychotics During the First Year After First‐Episode Psychosis: A Population‐Based Study

Antipsychotic Prescribing Practices for In-patients with Schizophrenia

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