Antipsychotic dosage at hospital discharge and outcomes among persons with schizophrenia.
OBJECTIVE
Applying the schizophrenia treatment guidelines established by the Patient Outcomes Research Team (PORT) project, this study evaluated whether antipsychotic medication dosage influenced patient outcomes in routine clinical settings.


METHODS
The associations between discharge antipsychotic medication dosage and short-term clinical, social, and service use outcomes were observed in a sample of 246 patients with schizophrenia or schizoaffective disorder.


RESULTS
Patients who were given high dosages of antipsychotic medication at hospital discharge (more than 1,000 chlorpromazine milligram equivalents) had greater severity of symptoms three months after discharge than patients who were given guideline-recommended dosages (300 to 1,000 chlorpromazine milligram equivalents) (adjusted mean Brief Psychiatric Rating Scale scores of 45 and 39, respectively). Patients who were given low dosages of antipsychotic medication at hospital discharge (less than 300 chlorpromazine milligram equivalents) were less likely to report side effects (adjusted OR=.24) and slightly more likely to be nonadherent (21 percent of those within the recommended dose range compared with 39 percent of the those with low doses, not statistically significant after Bonferroni correction). No other differences related to medication dosage were observed in patient outcomes.


CONCLUSIONS
Treatment that falls within antipsychotic medication dosage guidelines is associated with improvement in a limited, but critical, range of short-term patient outcomes in routine clinical settings.
Sohler
Nancy L
NL
Departmenmt of Epidemiology and Population Health, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA. nsohler@montefiore.edu
Walkup
Jamie
J
McAlpine
Donna
D
Boyer
Carol
C
Olfson
Mark
M
D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006302:Health Services Research; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D009515:New Jersey; D010349:Patient Compliance; D010351:Patient Discharge; D017410:Practice Guidelines as Topic; D012559:Schizophrenia / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome
D014150:Antipsychotic Agents