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Pharmacopsychiatry 2012; 45(05): 189-195
DOI: 10.1055/s-0031-1301286
Original Paper
© Georg Thieme Verlag KG Stuttgart · New York

Naturalistic Pharmacotherapy of Acute Episodes of Schizophrenic Disorders in Comparison to Treatment Guidelines

M. Stein
1   Department of Psychiatry, University Hospital Münster, Münster, Germany
,
D. E. Dietrich
2   Department for Clinical Psychiatry and Psychotherapy, Medizinische Hochschule Hannover, Hannover, Germany
,
M. W. Agelink
3   Department of Psychiatry, Psychotherapy and Psychosomatics, Herford, Germany
,
W. Becker
4   Psychiatric Hospital Wahrendorff, Sehnde, Germany
,
C. Chrysanthou
5   LWL Hospital Lengerich, Lengerich, Germany
,
M. Driessen
6   Department of Psychiatry and Psychotherapy, Bethel, Germany
,
G. Kruse
7   Department of Psychiatry and Psychotherapy, Langenhagen, Germany
,
W. Machleidt
8   Department for Social Psychiatry and Psychotherapy, Medizinische Hochschule Hannover, Hannover, Germany
,
T. Reker
9   LWL Hospital Münster, Münster, Germany
,
U. Schneider
10   Department of Psychiatry, Psychotherapy and Psychosomatics, Lübbecke, Germany
,
H. Schulze Mönking
11   St. Rochus-Hospital, Telgte, Germany
,
H. M. Emrich
2   Department for Clinical Psychiatry and Psychotherapy, Medizinische Hochschule Hannover, Hannover, Germany
,
V. Arolt
1   Department of Psychiatry, University Hospital Münster, Münster, Germany
,
M. Rothermundt
1   Department of Psychiatry, University Hospital Münster, Münster, Germany
12   Department of Psychiatry, Psychotherapy and Psychosomatics, Evangelisches und Johanniter Klinikum Niederrhein, Oberhausen, Germany
› Institutsangaben
Weitere Informationen

Publikationsverlauf

received 17. August 2009
revised 15. Dezember 2011

accepted 22. Dezember 2011

Publikationsdatum:
28. März 2012 (online)

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Abstract

Introduction:

This study was designed to investigate to what extent guidelines regarding the pharmacological treatment of patients suffering from schizophrenia-like psychosis are adopted in a naturalistic treatment setting.

Methods:

Medical records of n=819 patients undergoing inpatient treatment for schizophrenia-like psychosis in 11 psychiatric hospitals in northwestern Germany were retrospectively analyzed and findings were compared to current schizophrenia guideline recommendations.

Results:

The prescription rate of second generation antipsychotics increased from 47.1% on admission to 62.5% at discharge. Only half the patients (52.3%) received antipsychotic monotherapy while 47.7% took between 2 and 4 antipsychotic substances at a time. Dosage increases occurred most frequently (in 60%) within the first week of inpatient treatment, 16.6% experienced an elevation between days 15 and 29. A change within the atypical medication was found in 19.3%. Clozapine prescriptions increased throughout the treatment but were combined with other antipsychotic substances in the majority of cases.

Conclusion:

Under naturalistic conditions guideline recommendations for treatment of schizophrenia-like psychosis are adhered to only partially. Combination therapy with 2 or more antipsychotic drugs is quite common despite a clear recommendation for monotherapy.

Key words

schizophrenia - medication - pharmacotherapy - guideline - naturalistic treatment
 

  • References

  • 1 Goldner EM, Hsu L, Waraich P et al. Prevalence and incidence studies of schizophrenic disorders: a systematic review of the literature. Can J Psychiatry 2002; 47: 833-843
    PubMedSuche in Google Scholar
  • 2 McIntyre JS. Usefulness and limitations of treatment guidelines in psychiatry. World Psychiatry Oct 2002; 1 (03) 186-189
    PubMedSuche in Google Scholar
  • 3 Miller AL, Crismon ML, Rush J et al. The Texas medication algorithm project: clinical results for schizophrenia. Schizophr Bull 2004; 30: 627-647
    CrossrefPubMedSuche in Google Scholar
  • 4 Janssen B, Weinmann S, Berger M et al. Leitlinienkonformität und Behandlungsergebnisse in der stationären Schizophreniebehandlung. Ein Klinikvergleich. Nervenarzt 2005; 76: 315-326
    CrossrefPubMedSuche in Google Scholar
  • 5 Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde (DGPPN) . Praxisleitlinien in Psychiatrie und Psychotherapie. Red.: Gaebel W, Falkai P. eds. Band 1: Behandlungsleitlinie Schizophrenie. Steinkopff Verlag, Darmstadt; 2006
    Suche in Google Scholar
  • 6 American Psychiatric Association . Practice guidelines for the treatment of patients with schizophrenia. Washington, DC: 2004
    Suche in Google Scholar
  • 7 National Institute of Clinical Excellence (NICE) . Clinical Guideline 82. Schizophrenia: Core Interventions in the Treatment and Management of Schizophrenia in Primary and Secondary Care. London: NICE; 2009
    Suche in Google Scholar
  • 8 Leucht S, Pitschel-Walz G, Abraham D et al. Efficacy and extrapyramidal side-effects of the new antipsychotics olanzapine, quetiapine, risperidone, and sertindole compared to conventional antipsychotics and placebo. A meta-analysis of randomized controlled trials. Schizophr Res 1999; 35: 51-68
    PubMedSuche in Google Scholar
  • 9 Lehman AF, Lieberman JA, Dixon LB et al. Practice guideline for the treatment of patients with schizophrenia, second edition. Am J Psychiatry 2004; 161 (Suppl. 02) 1-56
    Suche in Google Scholar
  • 10 Lehman AF, Steinwachs DM. and PORT Co-investigators. Translating research into practice: the Schizophrenia Patient Outcomes Research Team (PORT) treatment recommendations. Schizophr Bull 1998; 24: 1-10
    CrossrefPubMedSuche in Google Scholar
  • 11 Chakos M, Lieberman J, Hoffman E et al. Effectiveness of second-generation antipsychotics in patients with treatment-resistant schizophrenia: a review and meta-analysis of randomized trials. Am J Psychiatry 2001; 158: 518-526
    Suche in Google Scholar
  • 12 Günther W, Noegel T, Trapp W et al. Verordnungsgewohnheiten von Psychopharmaka an deutschen psychiatrischen Krankenhäusern. Psychopharmakotherapie 2008; 15: 202-208
    PubMedSuche in Google Scholar
  • 13 Gaebel W, Riesbeck M, Janssen B et al. Atypical and typical neuroleptics in acute schizophrenia and related delusional disorders. Drug choice, switching and outcome under naturalistic treatment conditions. Eur Arch Psychiatry Clin Neurosci 2003; 253: 175-184
    CrossrefPubMedSuche in Google Scholar
  • 14 Centorrino F, Goren JL, Hennen J et al. Multiple versus single antipsychotic agents for hospitalized psychiatric patients: case-control study of risks versus benefits. Am J Psychiatry 2004; 161: 700-706
    CrossrefPubMedSuche in Google Scholar
  • 15 Faries D, Ascher-Svanum H, Zhu B et al. Antipsychotic monotherapy and polypharmacy in the naturalistic treatment of schizophrenia with atypical antipsychotics. BMC Psychiatry 2005; 5: 26
    CrossrefPubMedSuche in Google Scholar
  • 16 Freudenreich O, Goff DC. Antipsychotic combination therapy in schizophrenia. A review of efficacy and risks of current combinations. Acta Psychiatr Scand 2002; 106: 323-330
    CrossrefPubMedSuche in Google Scholar
  • 17 Messer T, Tiltscher C, Schmauss M. Polypharmazie in der Behandlung der Schizophrenie. Fortschr Neurol Psychiat 2006; 74: 377-391
    Thieme ConnectPubMedSuche in Google Scholar
  • 18 Miller AL, Craig CS. Combination antipsychotics: pros, cons and questions. Schizophr Bull 2002; 28: 105-109
    CrossrefPubMedSuche in Google Scholar
  • 19 Correll CU, Rummel-Kluge C, Corves C et al. Antipsychotic combinations vs monotherapy in schizophrenia: a meta-analysis of randomized controlled trials. Schizophr Bull 2009; 35: 443-457
    Suche in Google Scholar
  • 20 Clark RE, Bartels SJ, Mellman TA et al. Recent trends in antipsychotic combination therapy of schizophrenia and schizoaffective disorder: implications for state mental health policy. Schizophr Bull 2002; 28: 75-84
    CrossrefPubMedSuche in Google Scholar
  • 21 Rittmannsberger H, Meise U, Schauflinger K et al. Polypharmacy in psychiatric treatment. Patterns of psychotropic drug use in Austrian psychiatric clinics. Eur Psychiatry 1999; 14: 33-40
    CrossrefPubMedSuche in Google Scholar
  • 22 Sim K, Su A, Fujii S et al. Antipsychotic polypharmacy in patients with schizophrenia: a multicentre comparative study in East Asia. Br J Clin Pharmacol 2004; 58: 178-183
    CrossrefPubMedSuche in Google Scholar
  • 23 Rittmannsberger H. Kombinationstherapie mit Antipsychotika: Wie ist die Evidenz?. J Neurolog Neurochir Psychiatrie 2008; 9: 33-41
    PubMedSuche in Google Scholar
  • 24 Hamann J, Ruppert A, Auby P et al. Antipsychotic prescribing patterns in Germany: a retrospective analysis using a large outpatient prescription database. Int Clin Psychopharmacol 2003; 18: 237-242
    CrossrefPubMedSuche in Google Scholar
  • 25 Benkert O, Hippius H. Kompendium der Psychiatrischen Pharmakotherapie. 7. Auflage Springer Berlin: 2008
    Suche in Google Scholar
  • 26 Correll CU, Malhotra AK, Kaushik S et al. Early prediction of antipsychotic response in schizophrenia. Am J Psychiatry 2003; 160: 2063-2065
    CrossrefPubMedSuche in Google Scholar
  • 27 Lerner V, Libov I, Kotler M et al. Combination of “atypical” antipsychotic medication in the management of treatment-resistant schizophrenia and schizoaffective disorder. Prog Neuropsychopharmacol Biol Psychiatry 2004; 28: 89-98
    CrossrefPubMedSuche in Google Scholar
  • 28 Adesanya A, Pantelis CC. Adjunctive risperidone treatment in patients with “clozapine-resistant schizophrenia”. Aust N Z J Psychiatry 2000; 34: 533-534
    CrossrefPubMedSuche in Google Scholar
  • 29 Henderson DC, Goff DC. Risperidone as an adjunct to clozapine therapy in chronic schizophrenics. J Clin Psychiatry 1996; 57: 395-397
    PubMedSuche in Google Scholar
  • 30 Josiassen RC, Joseph A, Kohegyi E et al. Clozapine augmented with risperidone in the treatment of schizophrenia: a randomized, double-blind, placebo-controlled trial. Am J Psychiatry 2005; 162: 130-136
    Suche in Google Scholar
  • 31 McCarthy RH, Terkelsen KG. Risperidone augmentation of clozapine. Pharmacopsychiatry 1995; 28: 61-63
    Thieme ConnectPubMedSuche in Google Scholar
  • 32 Morera AL, Barreiro P, Cano-Munoz JL. Risperidone and clozapine combination for the treatment of refractory schizophrenia. Acta Psychiatr Scand 1999; 99: 305-306
    CrossrefPubMedSuche in Google Scholar
  • 33 Patel JK, Salzman C, Green AI et al. Chronic schizophrenia: response to clozapine, risperidone and paroxetine. Am J Psychiatry 1997; 154: 543-546
    CrossrefPubMedSuche in Google Scholar
  • 34 Raju KR, Khanna S. Clozapine-risperidone combination in treatment-resistant schizophrenia. Aust N Z J Psychiatry 2001; 35: 543
    PubMedSuche in Google Scholar
  • 35 Raskin S, Katz G, Zislin Z et al. Clozapine and risperidone: combination/augmentation treatment of refractory schizophrenia: a preliminary observation. Acta Psychiatr Scand 2000; 101: 334-336
    PubMedSuche in Google Scholar
  • 36 Taylor CG, Flynn SW, Altman S et al. An open trial of risperidone augmentation of partial response to clozapine. Schizophr Res 2001; 48: 155-158
    CrossrefPubMedSuche in Google Scholar
  • 37 Tyson SC, Devane CL, Risch SC. Pharmacocinetic interaction between risperidone and clozapine. Am J Psychiatry 1995; 152: 1401-1402
    PubMedSuche in Google Scholar
  • 38 Gupta S, Sonnenberg SJ, Frank B. Olanzapine augmentation of clozapine. Ann Clin Psychiatry 1998; 10: 113-115
    CrossrefPubMedSuche in Google Scholar
  • 39 Rhoads E. Polypharmacy of 2 atypical antipsychotics. J Clin Psychiatry 2000; 61: 678-680
    PubMedSuche in Google Scholar
  • 40 Meltzer HY, Bobo WV. Interpreting the efficacy findings in the CATIE study: what clinicians should know. CNS Spectr 2006; 11 (Suppl. 07) 14-24
    PubMedSuche in Google Scholar