A survey of antipsychotics combination therapy and its related factors in China 2006

Abstract

Objective To investigate the status quo of the antipsychotics combination therapy application in schizophrenia in China and to identify its influencing factors. Methods Ten provinces and municipal cities were selected based on the same sampling ratio from all provinces that were classified into five economic levels according to per capita gross national product. The investigation was conducted during 22-28th May 2006, using the self-compiled questionnaire. Results A total of 5898 patients was recruited from 41 psychiatric hospitals or the department of psychiatry in general hospitals. Among all the patients, 4306 (73.0%) were treated with one antipsychotic medication, including typical 1237 (21.0%), atypical 2995 (50.8%), and depot antipsychotics 74(1.2%). A total of 1541 (26.1%) patients was prescribed at least two antipsychotics, with 291 (4.9%) on a combination of long-acting and short-acting antipsychotics and 1250（21.2%）on a combination of two or more than two types of short-acting antipsychotics. Within the same group of patients on combination therapy, a total of 159 (2.7%) was prescribed at least two types of typical short-acting antipsychotics, 741 (12.6%) a combination of typical and atypical antipsychotics and 350 (5.9%) two or more than two types of atypical drugs. Besides, the incidences of adverse events were found to be significantly higher in the combination therapy group than the monotherapy group (P<0.05), including tremor, akathisia, somnolence, constipation, drooling, dry mouth, orthostatic hypotension, weight change and liver dysfunction. Moreover, logistic regression analysis identified the following factors to be significantly associated with combination therapy, i.e., outpatient or inpatient treatment, region, age, duration of illness, clinic visits, negative symptoms, affective symptoms, flight of thought, increased speech activity, aggressive behaviors and disease severity. Conclusion In China, antipsychotic monotherapy still predominates in the treatment of schizophrenia. The incidence of adverse events is relatively higher in the combination therapy and hence caution should be taken for the indications of the combination therapy. Moreover, the combination therapy could be influenced by a variety of factors. Key words: Antipsychotic agents; Drug therapy, combination; Schizophrenia; Sampling studies