Time to 'get real': preliminary insights into the long-term management of schizophrenia.
OBJECTIVE
A brief file and medication chart review was undertaken to examine the 'real world' treatment of schizophrenia, with a particular focus on long-term treatment strategies that extend beyond existing evidence-based guidelines.


METHODS
Treatment strategies were identified through an audit of patient files and their medication charts for patients admitted 2-5 years in a non-acute psychiatric hospital.


RESULTS
Twenty-nine file reviews and 20 medication chart audits were conducted. High levels of diagnostic heterogeneity were identified with the presence of psychosis and mood-related diagnoses (primarily schizophrenia and schizoaffective disorder) and high rates of comorbidity (86%). Functional impairment, poor insight and high levels of risk were present in most patients. Treatments largely consisted of combination strategies with 75% of patients prescribed two or more antipsychotics and an average of 3.4 psychotropic medications in total. While clozapine was commonly prescribed (65%), this was often in combination with, on average, two other psychotropic agents.


CONCLUSIONS
Notwithstanding the limited sample, these findings provide a valuable glimpse into the management strategies employed in the long-term management of schizophrenia. Evidence-based guidelines are largely of limited value for this cohort that often has complex presentations and further research is urgently needed to provide guidance into management strategies that extend beyond 5 years, with particular emphasis on the utility of medication combinations.
Malhi
Gin
G
Discipline of Psychiatry, University of Sydney, NSW, Australia. ginmalhi@gmail.com
Adams
Danielle
D
Bernardi
Elsa
E
Miller
Marta
M
Mulder
Roger
R
Walter
Garry
G
Smith
Brendan
B
D000203:Activities of Daily Living; D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage*; D004359:Drug Therapy, Combination / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008134:Long-Term Care / Q000706:statistics & numerical data*; D008297:Male; D019964:Mood Disorders / Q000150:complications; D017410:Practice Guidelines as Topic; D011618:Psychotic Disorders / Q000150:complications; D012559:Schizophrenia / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*
D014150:Antipsychotic Agents