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Antipsychotic Treatment Within a Naturalistic Trial—How Are We Treating Schizophrenia Patients in the “Real-World”?

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Polypharmacy in Psychiatry Practice, Volume I

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Abstract

Current treatment guidelines recommend antipsychotic monotherapy in schizophrenia patients. However, in contrast several researchers find a high prevalence of polypharmacy in schizophrenia patients either to enhance antipsychotic efficacy or when specific syndromes (e.g. anxiety, depression) are present. It has been reported that clinicians are aware of guideline recommendations, yet not basing their treatment decisions on them. But understanding treatment decisions in every-day care has important implications by mirroring the patients’ needs, the clinicians’ challenges which in turn can influence treatment guidelines, research projects and health politics. A way of better understanding such treatment decisions is by analyzing data of naturalistic trials. Therefore, in order to shed more light on the “real-world” prescribing pattern in patients suffering from a schizophrenia spectrum disorder the pharmacological profile of patients treated within a naturalistic multicenter study by the German Research Network on Schizophrenia was evaluated in terms of the antipsychotic compounds and treatment regimes applied. Two hundred fifty two patients were examined within the present analysis. At discharge, 81.7% of the patients received one antipsychotic compound with mainly atypical antipsychotics being prescribed. In terms of antipsychotic combination treatment, the concurrent prescription of an atypical and typical was the most frequent strategy. The most common prescribed compounds at discharge were risperidone, amisulpride, olanzapine and clozapine. Despite the high number of patients receiving only one antipsychotic, a considerable proportion of patients was also treated with psychotropic drugs besides antipsychotics (42% of the patients). 15.9% of the patients were additionally treated with antidepressants, 13.5% with anticholinergics, 13.1% with mood stabilizers, and 12.7% of the cases with tranquilizers/hypnotics. Generally, polypharmacy was associated with greater risk of side effects. On the background of the naturalistic design of this study we are not able to draw any causal conclusion in terms of the clinicians’ rationale resulting in the observed prescribing profile. In agreement with other studies we found around 40% of the patients to be discharged receiving more than one psychotropic drug suggesting that in everyday care polypharmacy is believed to be effective. Future studies are warranted in order to help indentifying patients who might profit form polypharmaceutical treatment regimes on the background of gaining evidence that in the “real-world” monotherapy might not be effective enough in a considerable number of patients suffering from schizophrenia.

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Abbreviations

APA:

American Psychiatric Association

BMBF:

German Federal Ministry of Education and Research

CATIE:

Clinical Antipsychotic Trials of Intervention Effectiveness

DDD:

Defined daily doses

DGPPN:

German Society of Psychiatry Psychotherapy and Nervous Diseases

FES:

First-episode schizophrenia

IC-SOHO:

Intercontinental Schizophrenia Outpatient Health Outcomes

NICE:

National Institute for Health and Clinical Excellence

PORT:

Schizophrenia Patient Outcomes Research Team

RCT:

Randomized controlled trials

TMAP:

Texas Medication Algorithm Project

UKU:

Udvalg for Kliniske Undersogelser—Side Effect Rating Scale

WFSBP:

World Federation of Societies of Biological Psychiatry

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Acknowledgements

The study was performed within the framework of the German Research Network on Schizophrenia which is funded by the German Federal Ministry for Education and research BMBF (grant 01 GI 0233). The authors thank all those who were involved in the study, especially the colleagues at the psychiatric hospitals the study was conducted at.

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Authors and Affiliations

  1. Department of Psychiatry and Psychotherapy, Faculty of Medicine, Ludwig-Maximilians-University, Munich, Germany

    Rebecca Schennach M.D., Michael Obermeier, Florian Seemüller M.D., Daniela Krause M.D., Richard Musil M.D., Ilja Spellmann M.D., Hans-Jürgen Möller M.D. & Michael Riedel M.D.

  2. Vincent-von-Paul-Hospital, Rottweil, Germany

    Michael Riedel M.D.

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  1. Rebecca Schennach M.D.
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  2. Michael Obermeier
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  3. Florian Seemüller M.D.
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Correspondence to Rebecca Schennach M.D. .

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  1. Sha'ar Menashe Mental Health Center, Hadera, 38814, Israel

    Michael S. Ritsner

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Schennach, R. et al. (2013). Antipsychotic Treatment Within a Naturalistic Trial—How Are We Treating Schizophrenia Patients in the “Real-World”?. In: Ritsner, M. (eds) Polypharmacy in Psychiatry Practice, Volume I. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-5805-6_7

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