Antipsychotic Prescribing Practices at BKH Augsburg

Abstract

Antipsychotic prescriptions were extracted from basic documentation (“BADO“) at a regional psychiatric hospital (BKH Augsburg). Schizophrenic patients (ICD-10: F20.x) with admission dates in 2002 and 2005 were targeted. Descriptive statistics were used to show prescription patterns. Suggested ongoing medication after discharge was assumed to reflect practitioners' intent to treat. Evaluation included, among numerous other parameters, absolute medication counts as well as counts of individual combinations. Dosage information was not available. Combination strategies with other psychotropic medication (including antidepressants, anxiolytics, hypnotics, and mood stabilizers) were common. Simultaneous use of more than one antipsychotic agent was observed in 28% to 43% of cases. With regard to antipsychotic substances only, monotherapy with second-generation antipsychotics was the most frequently observed regimen but decreased in frequency from 59% in 2002 to 41% in 2005. Pickup of aripiprazole was quick with 13.5% of all schizophrenic patients receiving the new substance in 2005. Combinations with either second or first-generation antipsychotics occurred in up to 20% of cases. The most frequent combination prescriptions included clozapine with amisulpride, risperidone, aripiprazole, or haloperidol; olanzapine with risperidone; risperidone with quetiapine and combinations of oral and depot antipsychotics. Antipsychotic treatment strategies were associated with a number of significant differences in patient history, therapy, and outcome. However, most of these had rather low effect sizes below 0.3. This study suggests that in contrast to best current practice guidelines, and as observed by a number of previous studies, combination of antipsychotics is a common treatment strategy which needs to be further evaluated.