title: Naturalistic pharmacotherapy of acute episodes of schizophrenic disorders in comparison to treatment guidelines.
abstract: BACKGROUND
  This study was designed to investigate to what extent guidelines regarding the pharmacological treatment of patients suffering from schizophrenia-like psychosis are adopted in a naturalistic treatment setting.
  
  
  METHODS
  Medical records of n=819 patients undergoing inpatient treatment for schizophrenia-like psychosis in 11 psychiatric hospitals in northwestern Germany were retrospectively analyzed and findings were compared to current schizophrenia guideline recommendations.
  
  
  RESULTS
  The prescription rate of second generation antipsychotics increased from 47.1% on admission to 62.5% at discharge. Only half the patients (52.3%) received antipsychotic monotherapy while 47.7% took between 2 and 4 antipsychotic substances at a time. Dosage increases occurred most frequently (in 60%) within the first week of inpatient treatment, 16.6% experienced an elevation between days 15 and 29. A change within the atypical medication was found in 19.3%. Clozapine prescriptions increased throughout the treatment but were combined with other antipsychotic substances in the majority of cases.
  
  
  CONCLUSIONS
  Under naturalistic conditions guideline recommendations for treatment of schizophrenia-like psychosis are adhered to only partially. Combination therapy with 2 or more antipsychotic drugs is quite common despite a clear recommendation for monotherapy.
authors.affiliation: Department of Psychiatry, University Hospital Münster, Münster, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Stein
authors.forename: D E
authors.initials: DE
authors.lastname: Dietrich
authors.forename: M W
authors.initials: MW
authors.lastname: Agelink
authors.forename: W
authors.initials: W
authors.lastname: Becker
authors.forename: C
authors.initials: C
authors.lastname: Chrysanthou
authors.forename: M
authors.initials: M
authors.lastname: Driessen
authors.forename: G
authors.initials: G
authors.lastname: Kruse
authors.forename: W
authors.initials: W
authors.lastname: Machleidt
authors.forename: T
authors.initials: T
authors.lastname: Reker
authors.forename: U
authors.initials: U
authors.lastname: Schneider
authors.forename: H
authors.initials: H
authors.lastname: Schulze Mönking
authors.forename: H M
authors.initials: HM
authors.lastname: Emrich
authors.forename: V
authors.initials: V
authors.lastname: Arolt
authors.forename: M
authors.initials: M
authors.lastname: Rothermundt
mesh_terms: D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects; D001480:Basal Ganglia Diseases / Q000139:chemically induced / Q000517:prevention & control; D004334:Drug Administration Schedule; D004347:Drug Interactions; D004359:Drug Therapy, Combination / Q000009:adverse effects / Q000706:statistics & numerical data; D017723:Drug Utilization Review / Q000706:statistics & numerical data; D017050:Episode of Care; D019983:Guideline Adherence / Q000592:standards / Q000706:statistics & numerical data; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects; D007297:Inpatients / Q000706:statistics & numerical data; D008499:Medical Records / Q000706:statistics & numerical data; D054539:Medication Therapy Management / Q000592:standards; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D012189:Retrospective Studies; D012559:Schizophrenia / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*
chemical_list: D014150:Antipsychotic Agents; D006993:Hypnotics and Sedatives