Prescription practices in the treatment of agitation in newly hospitalized Chinese schizophrenia patients: data from a non-interventional naturalistic study

Abstract

Background Data on the pharmacological management of acute agitation in schizophrenia are scarce. The aim of this study is to investigate the prescription practices in the treatment of agitation in Chinese patients with schizophrenia. Methods We conducted a large, multicenter, observational study in 14 psychiatry hospitals in China. Newly hospitalized schizophrenia patients with the PANSS-EC total score ≥ 14 and a value ≥4 on at least one of its five items were included in the study. Their drug treatments of the first 2 weeks in hospital were recorded by the researchers. Results Eight hundred and 53 patients enrolled in and 847 (99.30%) completed the study. All participants were prescribed antipsychotics, 40 (4.72%) were prescribed benzodiazepine in conjunction with antipsychotics and 81 were treated with modified electric convulsive therapy (MECT). Four hundred and 12 (48.64%) patients were prescribed only one antipsychotic, in the order of olanzapine (120 patients, 29.13%), followed by risperidone (101 patients, 24.51%) and clozapine (41 patients, 9.95%). About 435 (51.36%) participants received antipsychotic polypharmacy, mostly haloperidol + risperidone (23.45%), haloperidol+ olanzapine (17.01%), olanzapine+ ziprasidone (5.30%), haloperidol + clozapine (4.37%) and haloperidol + quetiapine (3.90%). Binary logistic regression analysis suggests that a high BARS score (OR 2.091, 95%CI 1.140–3.124), severe agitation (OR 1.846, 95%CL 1.266–2.693), unemployment or retirement (OR 1.614, 95%CL 1.189–2.190) and aggressiveness on baseline (OR 1.469, 95%CL 1.032–2.091) were related to an increased antipsychotic polypharmacy odds. Male sex (OR 0.592, 95%CL 0.436–0.803) and schizophrenia in older persons (age ≥ 55 years, OR 0.466, 95%CL 0.240–0.902) were less likely to be associated with antipsychotic polypharmacy. Conclusion The present study demonstrates that monotherapy and polypharmacy display equally common patterns of antipsychotic usage in managing agitation associated with schizophrenia in China. The extent and behavioral activities of agitation and several other factors were associated with polypharmacy. Electronic supplementary material The online version of this article (10.1186/s12888-019-2192-6) contains supplementary material, which is available to authorized users.

Real-World Evidence of Antipsychotic Monotherapy Versus Polypharmacy in the Treatment of Schizophrenia Spectrum Disorders

“…23 In previous studies, similar to our findings, it was concluded that antipsychotic polypharmacy did not decrease the frequency of hospitalization and ED visits. 23,[39][40][41] Moreover, we found that antipsychotic polypharmacy at discharge did not reduce rehospitalization risk over 6 months. Consistent with our results, studies reported that antipsychotic polypharmacy does not minimize rehospitalization.…”

“…Antipsychotic polypharmacy is frequently used in treating agitation/aggression in SSD patients. 41 In fact, most clinical trials have failed to show more benefits of antipsychotic polypharmacy in these patients. 42 Our findings suggest that antipsychotic polypharmacy is not advantageous over monotherapy in ED admission with agitation/aggression.…”

Agitation in schizophrenia: origins and evidence-based treatment

“…In a multicenter, observational study in 14 psychiatry hospitals in China, among 847 newly hospitalized patients with schizophrenia meeting criteria for agitation based on a rating scale, all were prescribed one or more antipsychotics in the first 2 weeks of hospitalization and 40 (4.7%) were also prescribed a benzodiazepine [23 ▪▪ ]. The most used antipsychotic was haloperidol, identified in 302 patients (36%, and all but two patients receiving the intramuscular formulation), followed by olanzapine in 276 (33%) and risperidone in 258 (30%).…”

“…The use of first-generation antipsychotics (such as intramuscular haloperidol) to manage agitation remains common [23 ▪▪ ] even though second-generation antipsychotics such ziprasidone or olanzapine (also available as short-acting intramuscular formulations) may be more suitable as they are better tolerated and are at least equally efficacious [5,7,24–26].…”

Associations of C-Reactive Protein, Free Triiodothyronine, Thyroid Stimulating Hormone and Creatinine Levels with Agitation in Patients with Schizophrenia: A Comparative Cross-Sectional Study

“… 5 Agitation is common in patients with schizophrenia, especially during an acute exacerbation of the disease. 6 , 7 Indeed, schizophrenia accounts for 47% of all episodes of psychiatric agitation in Europe. 8 The prevalence of agitation in newly hospitalized patients with schizophrenia is 47.5% in China.…”