Abstract
Objective: To identify updated trends in antipsychotic prescribing patterns in patients with schizophrenia in East Asia. Methods: Using the data from the 2001, 2004, and 2008 Research on East Asia Psychotropic Prescription (REAP) studies, we compared the proportions of acute inpatients (stay <6 months), new long-stay patients (6 months to 3 years), and old long-stay patients (≥3 years), the rates of excessive dosing (more than chlorpromazine 1,000 mg equivalent) and polypharmacy (the coprescription of more than 1 antipsychotic). Findings: While the proportion of long-term inpatients increased over time in Chinese mainland and Taiwan, it decreased in Japan, Singapore and Hong Kong. The proportion of acute inpatients receiving more than one drug was highest in Singapore, followed by Japan, Korea and Chinese Mainland. Two-drug combination therapy was especially high in Singapore. Korea had the highest rate of excessive dosing followed by Japan and Hong Kong. While the rates of both polypharmacy and excessive dosing decreased significantly over time in Japan, polypharmacy increased significantly in Chinese Mainland and Taiwan and excessive dosing increased significantly in Korea and Hong Kong. Conclusion: Our results suggest that the change in antipsychotic prescribing patterns, including excessive dosing and polypharmacy, varied among the participating East Asian countries/areas.
Highlights
Antipsychotic polypharmacy, the prescribing of more than one antipsychotic drug concurrently, is a common prescription pattern in clinical practice [1]
Using the data from the 2001, 2004, and 2008 Research on East Asia Psychotropic Prescription (REAP) studies, we compared the proportions of acute inpatients, new long-stay patients (6 months to 3 years), and old long-stay patients (≥3 years), the rates of excessive dosing and polypharmacy
While the proportion of long-term inpatients increased over time in Chinese mainland and Taiwan, it decreased in Japan, Singapore and Hong Kong
Summary
Antipsychotic polypharmacy, the prescribing of more than one antipsychotic drug concurrently, is a common prescription pattern in clinical practice [1]. The prevalence of anitipsychotic polypharmacy varies, the results from most studies ranged between 10% and 30% [2]. Polypharmacy may result exceed the total dose of antipsychotics [3], and may cause increases in admissions to hospital [4] and mortality [5]. Polypharmacy was frequently observed in patients with severe conditions [4,6]. Long-stay patients are likely to be severe and treatment-resistant; they are at risk of polypharmacy. Recent studies showed that the length of stay of patients receiving antipsychotic polypharmacy was longer than that of patients receiving monotherapy [7,8]. The probability of the prescription of high-dose antipsychotics is increased by polypharmacy [1]
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