High-dose antipsychotic use in schizophrenia: a comparison between the 2001 and 2004 Research on East Asia Psychotropic Prescription (REAP) studies.
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.
Sim
Kang
K
Institute of Mental Health/Woodbridge Hospital, Singapore. kang_sim@imh.com.sg
Su
Hsin Chuan
HC
Fujii
Senta
S
Yang
Shu-Yu
SY
Chong
Mian-Yoon
MY
Ungvari
Gabor
G
Si
Tianmei
T
He
Yan Ling
YL
Chung
Eun Kee
EK
Chan
Yiong Huak
YH
Shinfuku
Naotaka
N
Kua
Ee Heok
EH
Tan
Chay Hoon
CH
Sartorius
Norman
N
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*
D014150:Antipsychotic Agents