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Pharmacopsychiatry 2004; 37(4): 175-179
DOI: 10.1055/s-2004-827174
Original Paper
© Georg Thieme Verlag KG Stuttgart · New York

High Dose Antipsychotic Use in Schizophrenia: Findings of the REAP (Research on East Asia Psychotropic Prescriptions) Study

K. Sim1 , A. Su1 , J. Y. Leong1 , K. Yip1 , M.-Y. Chong2 , S. Fujii3 , S. Yang2 , G. S. Ungvari4 , T. Si5 , E. K. Chung6 , H.-Y. Tsang2 , N. Shinfuku3 , E. H. Kua7 , C. H. Tan7
  • 1Institute of Mental Health/Woodbridge Hospital, Singapore
  • 2Kaohsiung Medical University, Kaohsiung, Taiwan
  • 3Kobe University, Kobe, Japan
  • 4Chinese University of Hong Kong, Hong Kong
  • 5Peking University, Beijing, China
  • 6Seoul National Hospital, Seoul, Korea
  • 7National University of Singapore, Singapore
Further Information

Publication History

Received: 12.2.2003 Revised: 9.5.2003

Accepted: 3.7.2003

Publication Date:
01 July 2004 (online)

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Background: High-dose antipsychotic regimes (defined as the prescription of more than 1000 chlorpromazine-equivalents milligrams of antipsychotic per day) in the management of patients with schizophrenia are not uncommon, but most reports are from western countries. Recent functional neuroimaging studies have found that the previous notion concerning the use of antipsychotic medication, especially in high doses, was unsupported and untenable. Methods: This international study examined the use of high dose antipsychotic medication and its clinical correlates in schizophrenia patients within six East Asian countries/territories. Results: Within the study group (n = 2399), 430 patients (17.9 %) were prescribed high dose antipsychotics. Antipsychotic use varied significantly between countries, with Japan, Korea, and Singapore using higher doses than the other countries. High dose antipsychotic use was associated with younger age in Japan (p < 0.001), longer duration of admission (p < 0.001), duration of illness (p < 0.001, particularly in Korea and Taiwan), positive psychotic symptoms (p < 0.001, particularly in Japan and Korea), and aggression (p < 0.05, particularly in Japan), and also with a higher likelihood of extrapyramidal and autonomic adverse effects (p < 0.05, particularly in China). Country, younger age, the presence of delusions and disorganized speech, polypharmacy, and receiving depot medication but not atypical antipsychotic drugs were important predictors of high antipsychotic use.
Conclusions: This survey revealed that high antipsychotic dosing is not an uncommon practice in East Asia. It behooves the prescribing clinicians to constantly reevaluate the rationale for such a practice.

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Dr Kang Sim, MBBS (Melbourne), M. Med. (Psychiatry)

Woodbridge Hospital/Institute of Mental Health

10 Buangkok View

Singapore 539747

Phone: +65 6385 0411

Fax: +65 63892963

Email: kang_sim@imh.com.sg