Antipsychotic treatment is a basic part of active schizophrenia treatment. Typical antipsychotics have been in use since the 1950s. In the 1990s the antipsychotics that are called atypical, with similar effectiveness and lower extrapyramidal side effects (EPS), were introduced and they have taken the place of typical antipsychotics quickly. Although there are comprehensive practice guidelines and suggestions about optimal antipsychotic prescribing, polypharmacy and the use of high doses (over a dose equivalent of 1000mg of chlorpromazine) are prevalent in clinical practice. Some clinicians propounded that using more than one antipsychotic is more effective and prescribing different antipsychotics is not wrong because of the different effects on different signs of psychosis. The objective of this study was to review the practice of antipsychotic prescribing in schizophrenia patients, compare the variation of antipsychotic prescribing over a number of years and to generate additional information for studies to understand the underlying motivations for the use of antipsychotic prescription by psychiatrists.
Five hundred and sixty patients, who applied to the psychiatry clinic of the SSK Ankara Education and Research Hospital in 2004 and were diagnosed with schizophrenia and 423 patients who presented to the same clinic (name changed to the Psychiatry Clinic of Dy?kapy Yyldyrym Beyazyd Education and Research Hospital) in 2009 and were diagnosed with schizophrenia were included in the study. The data were recorded on the data gathering form that we prepared and included socio-demographic information and details of medication use.
We determined that 77.5 percent of the schizophrenic patients were prescribed atypical antipsychotics in single or combined (typical-atypical or atypical-atypical) form in 2004. Forty-five percent of patients were using typical antipschotics as monotheraphy or in combination. In 2009, 91.7 percent of patients were using atypical antipschotics in single or combined form. Only 19.9 percent of patients were taking typical antipschotics in single or combined form. Using atypical antipsychotics reduced the use of typical antipsychotics by a significant amount ( ?2=246.26 and p<0.001) (2004), ?2=235.24 and p<0.001 (2009). While 62 percent of patients were using an antipsychotic, 36.6 percent of them had used more than one antipsychotic and 1.4 percent of them weren't take any drug in 2004. In 2009, 63.6 percent of patients were using an antipsychotic, 36.2 percent of patients were using more than one antipsychotic and 0.2 percent of patients weren't using any antypsychotics. Between the two index years there was no difference in the use of one or more than one antipsychotic. We didn't examine why some patients were not on any antipsychotics because it was out of the scope of our study.
The ratio of use of typical-atypical antipsychotics and polypharmacy was similar to the current literature in our study. We determined that the ratio of using atypical antipsychotics increased distinctively in schizophrenia treatment. In 2004, atypical antipsychotics were prescribed in single or combined form (typical-atypical or atypical-atypical) to 77.5 percent of patients, while in 2009 this ratio increased to 91.7 percent. We determined that antipsychotic polypharmacy continued in a high ratio similar to previous studies, altough there is no evidence of additional advantage, but rather an increased risk of adverse effects. More than one antipsychotics were prescribed to 36.6 percent of patients in 2004 and 36.17 percent in 2009. More large-scale studies are needed especially about the motivations that effect the practice of pharmacotherapy in schizophrenia treatment.