Prescribing Trends for the Same Patients with Schizophrenia Over 20 Years

Abstract

Background: Recent pharmacoepidemiology data show an increase in the proportion of patients receiving second-generation antipsychotic (SGA) monotherapy, but no studies have analyzed the same patients over a long period of time. Therefore, in this study, we retrospectively evaluated schizophrenia patients with available data for 20 years to determine whether the drug treatments in the same patients have changed in the past 20 years. Methods: The study began in April 2021 and was conducted in 15 psychiatric hospitals in Japan. Schizophrenia patients treated in the same hospital for 20 years were retrospectively examined for all prescriptions in 2016, 2011, 2006, and 2001 (ie, every 5 years). Results:The mean age of the 716 patients surveyed in 2021 was 61.7 years, with 49.0% being female. The rate of antipsychotic monotherapy use showed a slight increasing trend over the past 20 years; the rate of SGA use showed a marked increasing trend from 28.9% to 70.3% over the past 20 years, while the rate of SGA monotherapy use showed a gradual increasing trend over the past 20 years. The rates of concomitant use of anticholinergics, antidepressants, anxiolytics/sleep medications, and mood stabilizers showed decreasing, flat, flat, and flat trends over the past 20 years, respectively. Conclusion:The results of this study showed a slow but steady substitution of SGAs for first-generation antipsychotics (FGAs) over time, even in the same patients.

Factors associated with the initiation of laxative use in the same patients with schizophrenia over a 20‐year period: Retrospective cohort study

“… 3 The biperiden equivalent of total anticholinergic drug in 2021 was smaller than that in 2001, as we previously reported. 11 There was no significance between the initiation of laxative use and the daily dose of anticholinergic drugs in 2021 or 2001. This is not consistent with a previous study by Lin and their colleagues who reported that a higher dose of anticholinergic drugs was associated with increasing laxative use.…”

“…Previously in this survey, we reported a slow but steady substitution of SGAs for FGAs over time. 11 Since many guidelines recommend that monotherapy with SGAs is the first‐line treatment for schizophrenia, 22 , 23 , 24 polytherapy with benzodiazepine and mood stabilizers, including lithium and carbamazepine, should be minimized. In Japan, the Effectiveness of Guidelines for Dissemination and Education (EGUIDE) psychiatric treatment project, which aims to disseminate the guidelines that present the treatments for schizophrenia and major depressive disorder via education programs for psychiatrists, was reported to be effective.…”

“…This study was initiated in April 2021 and was conducted in 14 psychiatric hospitals. 11 Participants were selected based on the consecutive sampling method. To obtain an equivalent number of participants from each site, we set the number ( n = 70) due to the feasibility.…”

Plasmatic Levels and Response to Variable Doses of Monthly Aripiprazole and Three-Month Paliperidone in Patients with Severe Schizophrenia. Treatment Adherence, Effectiveness, Tolerability, and Safety

“…Antipsychotic medications (AP) are an effective maintenance treatment for schizophrenia [1][2][3][4] and clearly reduce the risk of relapse and hospitalization. [5][6][7][8][9][10] The lack of adherence is associated with relapse and (re)admission, [10][11][12][13] and risk of suicide. [14][15][16] It has been suggested that second-generation antipsychotics (SGAs) are more effective than first-generation antipsychotics and are also better tolerated and safer, [3][4][5][6][7] which is why their use is already widespread.…”

“…[14][15][16] It has been suggested that second-generation antipsychotics (SGAs) are more effective than first-generation antipsychotics and are also better tolerated and safer, [3][4][5][6][7] which is why their use is already widespread. 1,3,6,8,12,[17][18][19] However, there is still debate about the use of oral or injectable long-acting (LAI) SGAs to improve adherence and treatment outcomes. [18][19][20][21][22][23][24] LAI antipsychotics have shown to improve compliance [10][11][12][13] and to reduce relapses and hospital admissions [25][26][27][28][29][30][31][32] better than oral formulations, [18][19][20][21][22][23][24][25][26][27] thus being recommended in recent years, especially in patients with poor adherence, with multiple relapses and hospitalizations, or with greater severity.…”