What is important for doctor’s drug decision-making for the patient with acute schizophrenia?

Abstract

IntroductionIn spite of the long history of antipsychotic treatment there are still no clear criteria, which can be robust support for drug decision-making.ObjectivesTo determine the important hallmarks of patient’s current state, life span and history of illness defining the doctor’s decision about the type of antipsychotic to be chosen.MethodsThe data from the case charts of 275 patients with episodic schizophrenia and rather benign course of the disease were analyzed.ResultsThe group included: male 62%, mean age 33 (SD 11), education 10 years 23%, 13 years 27%, 16 years 29%, disability - 51%, number of hospitalizations due to psychotic episodes in the past 7 (SD 6). The symptoms of the current episode varied from patient to patient: delusions and hallucinations, symptoms of disorganization, negative symptoms of different severity were registered Atypical antipsychotics were more often than typical prescribed to the patients with developmental problems: traumatic obstetric complications (p=0,009), poor somatic health in the childhood (p= 0,02), cognitive dysfunction during school years (p=0,04), and quality of first remission – presence of residual symptoms in the first remission (p=0.005). Good compliance in the past was one more important factor for choosing a atypical antipsychotic for a patient (p=0.05). It appeared that the most important for the decision-making was the specific features of the patient’s development and early period of the disease, but not the specific signs of current psychotic state.ConclusionsDoctor’s decision upon the type of antipsychotics in this category of patients is most probably based on other than current clinical symptoms signs.