Comparison of polypharmacy in schizophrenia and other psychotic disorders in outpatient and inpatient treatment periods: a naturalistic one year follow-up study

摘要

Objective: Polypharmacy of antipsychotic drugs has been increasing although there are not enough evidence based data and recommendations in the treatment algorithms. The current study differs from cross-sectional studies as it aimed at observing the same patient population during their in- and out-patient periods for one year follow-up and investigated the frequency of polypharmacy and related factors in terms of clinical correlates and equivalent doses. Method: The patients admitted to Psychiatry Service of D??kap? Y?ld?r?m Beyaz?t Trainig and Research Hospital, Ankara in the 2008-09 period with the diagnosis of schizophrenia and other psychotic disorders (n=261) were reviewed and patients with regular follow up visits in the outpatient clinic (n=192) were included in the study. At the end of the first year, participants were evaluated for their treatment compliance, use of polypharmacy, drug doses, and severity of the disorder. Results: The rate of polypharmacy was 52.1% (n=100) at the time of discharge from hospital while it was 44.3% (n=85) during the one year-follow up visit (χ2=2.97, df=1, p=0.001). The polypharmacy and monotherapy groups were not statistically different in terms of comorbidity, disorder and treatment duration, number of previous hospitalizations, type of admission, and general medical condition. However, the monotherapy and polypharmacy groups were statistically different in terms of the use of antipsychotic type. The ratio of patients with severe disorder was statistically higher in the inpatient group. While the clinical severity impression (CGI) of patients in remission did not change during the follow-up period, the moderate to severe patient groups’ severity increased during that time. Drug compliance of the polypharmacy group was statistically lower than the monotherapy group both in the inpatient (χ2 =12.99; df=1; p=0.001) and outpatient (χ2 =12.81; df=1; p=0.001) periods. Adverse event frequency was the same for both groups. Adverse events and lack of efficacy were the most frequent reasons for drug prescription change. Both inpatients and outpatients receiving antipsychotic combination therapy had statistically higher equivalent antipsychotic drug doses. Severity scores of inpatients receiving combination therapy were higher than the patients receiving other drug regimens Conclusion: Use of polypharmacy is limited in good clinical practice guidelines but surveys on clinical practices show that the use of polypharmacy is more frequent than the suggested levels in the guidelines. On the other hand, use of clozapine and long-term effective antipsychotics are below the incidence of suggested groups. In order to guide clinicians better, schizophrenia treatment algorithms need to emphasize the use of clozapine and long acting antipsychotics more.