title: High-dose antipsychotic use in schizophrenia: a comparison between the 2001 and 2004 Research on East Asia Psychotropic Prescription (REAP) studies.
abstract: OBJECTIVE
  We aimed to examine the frequency of high-dose (defined as mean chlorpromazine mg equivalent doses above 1000) antipsychotic prescriptions in schizophrenia and their clinical correlates in the context of a comparison between studies in 2001 and 2004 within six East Asian countries and territories.
  
  
  METHODS
  Prescriptions of high-dose antipsychotic for a sample of 2136 patients with schizophrenia from six countries and territories (mainland China, Hong Kong, Korea, Japan, Taiwan and Singapore) were evaluated in 2004 and compared with data obtained for 2399 patients in 2001.
  
  
  RESULTS
  Overall, the comparison between 2001 and 2004 showed a significant decrease in high-dose antipsychotic use from 17.9 to 6.5% [odds ratio (OR) 0.32, 95% confidence interval (CI) 0.26, 0.39, P < 0.001]. Patients who received high-dose antipsychotics were significantly more likely to have multiple admissions (OR 1.96, 95% CI 1.16, 3.33, P = 0.009), more positive psychotic symptoms such as delusions (OR 2.05, 95% CI 1.38, 3.05, P < 0.001) and hallucinations (OR 1.85, 95% CI 1.30, 2.64, P = 0.001), but less likely to have negative symptoms (OR 0.58, 95% CI 0.40, 0.82, P = 0.002). Multivariate regression analyses revealed that prescription of high-dose antipsychotics was also predicted by younger age (P < 0.001), time period of study (2001; P < 0.001), use of first-generation antipsychotic (P < 0.001) and depot antipsychotics (P < 0.001) as well as antipsychotic polytherapy (P < 0.001).
  
  
  CONCLUSIONS
  We identified the clinical profile and treatment characteristics of patients who are at risk of receiving high antipsychotic doses. These findings should provide impetus for clinicians to constantly monitor the drug regimes and to foster rational, evidence-based prescribing practices.
authors.affiliation: Institute of Mental Health/Woodbridge Hospital, Singapore. kang_sim@imh.com.sg
authors.forename: Kang
authors.initials: K
authors.lastname: Sim
authors.forename: Hsin Chuan
authors.initials: HC
authors.lastname: Su
authors.forename: Senta
authors.initials: S
authors.lastname: Fujii
authors.forename: Shu-Yu
authors.initials: SY
authors.lastname: Yang
authors.forename: Mian-Yoon
authors.initials: MY
authors.lastname: Chong
authors.forename: Gabor
authors.initials: G
authors.lastname: Ungvari
authors.forename: Tianmei
authors.initials: T
authors.lastname: Si
authors.forename: Yan Ling
authors.initials: YL
authors.lastname: He
authors.forename: Eun Kee
authors.initials: EK
authors.lastname: Chung
authors.forename: Yiong Huak
authors.initials: YH
authors.lastname: Chan
authors.forename: Naotaka
authors.initials: N
authors.lastname: Shinfuku
authors.forename: Ee Heok
authors.initials: EH
authors.lastname: Kua
authors.forename: Chay Hoon
authors.initials: CH
authors.lastname: Tan
authors.forename: Norman
authors.initials: N
authors.lastname: Sartorius
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage*; D003430:Cross-Sectional Studies; D005202:Asia, Eastern; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D055656:Prescriptions; D012559:Schizophrenia / Q000188:drug therapy*
chemical_list: D014150:Antipsychotic Agents