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DOI: 10.1055/s-2007-970062
© Georg Thieme Verlag KG Stuttgart · New York
Clinical and Social Determinants of Antipsychotic Polypharmacy for Chinese Patients with Schizophrenia
Publication History
received 19. 6. 2006
accepted 8. 1. 2007
Publication Date:
19 April 2007 (online)
![](https://www.thieme-connect.de/media/pharmaco/200702/lookinside/thumbnails/10.1055-s-2007-970062-1.jpg)
Abstract
Most prescription pattern surveys have found a high rate of antipsychotic polypharmacy. To date few studies have investigated antipsychotic polypharmacy in Chinese patients with schizophrenia in general and outpatients in particular. This study examined the frequency and sociodemographic and clinical correlates of antipsychotic polypharmacy in Hong Kong (HK) and Beijing (BJ), China. Three hundred and ninety-eight clinically stable outpatients with schizophrenia were randomly selected and interviewed in HK and BJ using standardized assessment instruments. Antipsychotic polypharmacy was found in 17.6% (n=70) of the whole sample and in 28% and 7.1% of the HK and BJ samples, respectively. Polypharmacy was associated with monthly income, severity of negative symptoms and extrapyramidal side effects (EPS), use of depot antipsychotic and anticholinergic drugs, doses of antipsychotics, and the number of hospitalizations. In multiple logistic regression analysis, younger age, number of hospitalizations, site (HK vs. BJ), and the use of depot antipsychotics were all significantly associated with antipsychotic polypharmacy. Although the ethnic and clinical characteristics of the two cohorts were nearly identical, there was a wide variation in the prescription frequency of antipsychotic polypharmacy between HK and BJ, suggesting that sociocultural and economical factors and traditions of psychiatric practice all played a role in determining antipsychotic polypharmacy. Clinicians should bear in mind that, at least for clinically stable patients, no scientifically sound therapeutic principles for antipsychotic polypharmacy exist.
Key words
schizophrenia - China - antipsychotic polypharmacy - prescription patterns - outpatients
References
-
1 APA .
Diagnostic and Statistical Manual of Mental Disorders . 4th ed. Washington: American Psychiatric Association 1994 - 2 Barnes TR. A rating scale for drug-induced akathisia. Br J Psychiatry. 1989; 154 672-676
- 3 Barnes TR, Curson DA. Long-term depot antipsychotics. A risk-benefit assessment. Drug Saf. 1994; 10 464-479
- 4 Binder RL, Kazamatsuri H, Nishimura T, McNiel DE. Tardive dyskinesia and neuroleptic-induced parkinsonism in Japan. Am J Psychiatry. 1987; 144 1494-1496
- 5 Carnahan RM, Lund BC, Perry PJ, Chrischilles EA. Increased risk of extrapyramidal side-effect treatment associated with atypical antipsychotic polytherapy. Acta Psychiatr Scand. 2006; 113 135-141
- 6 Casey DE. Motor and mental aspects of acute extrapyramidal syndromes. Acta Psychiatr Scand Suppl. 1994; 380 14-20
- 7 Chan S, MacKenzie A, Ng DT, Leung JK. An evaluation of the implementation of case management in the community psychiatric nursing service. J Adv Nurs. 2000; 31 144-156
- 8 Chang IM. Anti-aging and health-promoting constituents derived from traditional oriental herbal remedies: information retrieval using the TradiMed 2000 DB. Ann N Y Acad Sci. 2001; 928 281-286
-
9 Chinese Medical Association .
Guideline for the prevention and treatment of mental disorder . Beijing: China Medical Association 2003 - 10 Chong MY, Tan CH, Fujii S, Yang SY, Ungvari GS, Si T. et al . Antipsychotic drug prescription for schizophrenia in East Asia: rationale for change. Psychiatry Clin Neurosci. 2004; 58 61-67
- 11 Chong SA, Sachdev P, Mahendran R, Chua HC. Neuroleptic and anticholinergic drug use in Chinese patients with schizophrenia resident in a state psychiatric hospital in Singapore. Aust N Z J Psychiatry. 2000; 34 988-991
-
12 Cohen J.
Statistical Power Analysis for the Behavioral Sciences . 2nd ed. New York NJ: Erlbaum Hillsdale 1988 - 13 Covell NH, Jackson CT, Evans AC, Essock SM. Antipsychotic prescribing practices in Connecticut's public mental health system: rates of changing medications and prescribing styles. Schizophr Bull. 2002; 28 17-29
- 14 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
- 15 Hao YT, Fang JQ. The introduction and usage of WHOQOL instument in Chinese. Modern rehabilitation. 2000; 4 1127-1129
- 16 Harvey PD, Keefe RS. Studies of cognitive change in patients with schizophrenia following novel antipsychotic treatment. Am J Psychiatry. 2001; 158 176-184
- 17 Huang CH, Yang SY, Yao J, Zhang YJ. Investigation on the combination of antipsychotics and artane. Health psychology journal. 2003; 11 60-61
- 18 Hugenholtz GW, Heerdink ER, Meijer WE, Stolker JJ, Egberts AC, Nolen WA. Reasons for switching between antipsychotics in daily clinical practice. Pharmacopsychiatry. 2005; 38 122-124
- 19 Humberstone V, Wheeler A, Lambert T. An audit of outpatient antipsychotic usage in the three health sectors of Auckland, New Zealand. Aust N Z J Psychiatry. 2004; 38 240-245
- 20 Ito C, Kubota Y, Sato M. A prospective survey on drug choice for prescriptions for admitted patients with schizophrenia. Psychiatry Clin Neurosci. 1999; 53 ((Suppl)) S35-S40
- 21 Karow A, Schnedler D, Naber D. What would the patient choose? Subjective comparison of atypical and typical neuroleptics. Pharmacopsychiatry. 2006; 39 47-51
- 22 Kennedy NB, Procyshyn RM. Rational antipsychotic polypharmacy. Can J Clin Pharmacol. 2000; 7 155-159
- 23 Kilian R, Angermeyer MC. The effects of antipsychotic treatment on quality of life of schizophrenic patients under naturalistic treatment conditions: an application of random effect regression models and propensity scores in an observational prospective trial. Qual Life Res. 2005; 14 1275-1289
- 24 Leucht S, Pitschel-Walz G, Abraham D, Kissling W. 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
- 25 Lobana A, Mattoo SK, Basu D, Gupta N. Quality of life in schizophrenia in India: comparison of three approaches. Acta Psychiatr Scand. 2001; 104 51-55
- 26 Nunley M. Why psychiatrists in India prescribe so many drugs. Cult Med Psychiatry. 1996; 20 165-197
- 27 Overall JE, Beller SA. The Brief Psychiatric Rating Scale (BPRS) in geropsychiatric research: I. Factor structure on an inpatient unit. J Gerontol. 1984; 39 187-193
- 28 Percudani M, Barbui C, Fortino I, Petrovich L. Epidemiology of first- and second-generation antipsychotic agents in Lombardy, Italy. Pharmacopsychiatry. 2005; 38 128-131
- 29 Phillips MR, Lu SH, Wang RW. Economic reforms and the acute inpatient care of patients with schizophrenia: the Chinese experience. Am J Psychiatry. 1997; 154 1228-1234
-
30 Phillips MR, Xiong W, Zhao ZA.
Issues Involved in the Use of Scales for the Assessment of Negative and Positive Symptoms in Psychiatric Patients . Wuhan, PRC: Hubei Science and Technology Publishing House 1990 - 31 Remington G, Saha A, Chong SA, Shammi C. Augmentation strategies in clozapine-resistant schizophrenia. CNS Drugs. 2005; 19 843-872
- 32 Rudnick A. The impact of coping on the relation between symptoms and quality of life in schizophrenia. Psychiatry. 2001; 64 304-308
- 33 Schuklenk U. Helsinki Declaration revisions. Issues Med Ethics. 2001; 9 29
- 34 Shafer A. Meta-analysis of the brief psychiatric rating scale factor structure. Psychol Assess. 2005; 17 324-335
-
35 Shen YC.
Psychiatry . Beijing: People's medical publishing house 2002 - 36 Sim K, Su A, Chan YH, Shinfuku N, Kua EH, Tan CH. Clinical correlates of antipsychotic polytherapy in patients with schizophrenia in Singapore. Psychiatry Clin Neurosci. 2004; 58 324-329
- 37 Sim K, Su A, Fujii S, Yang SY, Chong MY, Ungvari GS. et al . Antipsychotic polypharmacy in patients with schizophrenia: a multicentre comparative study in East Asia. Br J Clin Pharmacol. 2004; 58 178-183
- 38 Sim K, Su A, Leong JY, Yip K, Chong MY, Fujii S. et al . High dose antipsychotic use in schizophrenia: findings of the REAP (research on east Asia psychotropic prescriptions) study. Pharmacopsychiatry. 2004; 37 175-179
- 39 Simpson GM, Angus JW. A rating scale for extrapyramidal side effects. Acta Psychiatr Scand Suppl. 1970; 212 11-19
- 40 Song CF. Analysis the first use of antipsychotics in the outpatients with first-episode schizophrenia. Sichuan Ment Health. 2001; 14 153-155
- 41 Stahl S, Freudenreich O, Goff D. A successful antipsychotic combination trial. Quo Vadis?. Acta Psychiatr Scand. 2004; 110 241-242
- 42 Stahl SM, Grady MM. A critical review of atypical antipsychotic utilization: comparing monotherapy with polypharmacy and augmentation. Curr Med Chem. 2004; 11 313-327
-
43 Taylor D, Paton C, Kerwin R.
The Maudsley Prescribing Guidelines . London: Martin Dunitz 2003 - 44 Ungvari GS, Chiu HF, Lam LC, Pang AH, Chung DW, Li SW. et al . Gradual withdrawal of long-term anticholinergic antiparkinson medication in Chinese patients with chronic schizophrenia. J Clin Psychopharmacol. 1999; 19 141-148
- 45 Ungvari GS, Chung YG, Chee YK, Fung-Shing N, Kwong TW, Chiu HF. The pharmacological treatment of schizophrenia in Chinese patients: a comparison of prescription patterns between 1996 and 1999. Br J Clin Pharmacol. 2002; 54 437-444
- 46 Weissman EM. Antipsychotic prescribing practices in the Veterans Healthcare Administration-New York metropolitan region. Schizophr Bull. 2002; 28 31-42
- 47 Weng YZ, Xu MJ, Li DL, Guo FY, Huang Q, Fu T. Assessment of expressed emotion in family members of schizophrenic patients in Beijing. Mod Rehabil. 2001; 5 39-42
- 48 WHO . Prophylactic use of anticholinergics in patients on long-term neuroleptic treatment. A consensus statement. World Health Organization heads of centres collaborating in WHO co-ordinated studies on biological aspects of mental illness. Br J Psychiatry. 1990; 156 412
- 49 WHO . The World Health Organization Quality of Life assessment (WHOQOL): position paper from the World Health Organization. Soc Sci Med. 1995; 41 1403-1409
- 50 WHO . Development of the World Health Organization WHOQOL-BREF quality of life assessment. The WHOQOL Group. Psychol Med. 1998; 28 551-558
- 51 Woods SW. Chlorpromazine equivalent doses for the newer atypical antipsychotics. J Clin Psychiatry. 2003; 64 663-667
Correspondence
Y.-T. Xiang
Department of Psychiatry
Shatin Hospital
Shatin
N.T. Hong Kong SAR
China
Phone: +852/2636/77 48
Fax: +852/2647/53 21
Email: xyutly@cuhk.edu.hk