Prescription practices in the treatment of first-episode schizophrenia spectrum disorders: data from the national RAISE-ETP study.
OBJECTIVE
Treatment guidelines suggest distinctive medication strategies for first-episode and multiepisode patients with schizophrenia. To assess the extent to which community clinicians adjust their usual treatment regimens for first-episode patients, the authors examined prescription patterns and factors associated with prescription choice in a national cohort of early-phase patients.


METHODS
Prescription data at study entry were obtained from 404 participants in the Recovery After an Initial Schizophrenia Episode Project's Early Treatment Program (RAISE-ETP), a nationwide multisite effectiveness study for patients with first-episode schizophrenia spectrum disorders. Treatment with antipsychotics did not exceed 6 months at study entry.


RESULTS
The authors identified 159 patients (39.4% of the sample) who might benefit from changes in their psychotropic prescriptions. Of these, 8.8% received prescriptions for recommended antipsychotics at higher than recommended dosages; 32.1% received prescriptions for olanzapine (often at high dosages), 23.3% for more than one antipsychotic, 36.5% for an antipsychotic and also an antidepressant without a clear indication, 10.1% for psychotropic medications without an antipsychotic, and 1.2% for stimulants. Multivariate analysis showed evidence for sex, age, and insurance status effects on prescription practices. Racial and ethnic effects consistent with effects reported in previous studies of multiepisode patients were found in univariate analyses. Despite some regional variations in prescription practices, no region consistently had different practices from the others. Diagnosis had limited and inconsistent effects.


CONCLUSIONS
Besides prescriber education, policy makers may need to consider not only patient factors but also service delivery factors in efforts to improve prescription practices for first-episode schizophrenia patients.
From the Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, N.Y.; the Departments of Psychiatry and Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, N.Y.; Psychiatry Research, Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, N.Y.; SUNY Downstate Medical Center, New York; Albert Einstein College of Medicine, Bronx, N.Y.; Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Canada; Geisel School of Medicine, Dartmouth, N.H.; the Departments of Social Medicine and Psychology, University of North Carolina, Chapel Hill; the Center for Psychiatric Rehabilitation, Departments of Occupational Therapy, Psychiatry, and Psychology, Boston University, Boston; the Nathan S. Kline Institute for Psychiatric Research, Orangeburg, N.Y.; the Department of Psychiatry and Adolescent and Child Psychiatry, New York University Langone Medical Center, New York; the Departments of Psychiatry and Epidemiology and Public Health, Yale School of Medicine, New Haven, Conn.; and NIMH, Bethesda, Md.
Delbert G
DG
Robinson
Nina R
NR
Schooler
Majnu
M
John
Christoph U
CU
Correll
Patricia
P
Marcy
Jean
J
Addington
Mary F
MF
Brunette
Sue E
SE
Estroff
Kim T
KT
Mueser
David
D
Penn
James
J
Robinson
Robert A
RA
Rosenheck
Joanne
J
Severe
Amy
A
Goldstein
Susan
S
Azrin
Robert
R
Heinssen
John M
JM
Kane
D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003695:Delivery of Health Care / Q000379:methods / Q000592:standards; D017050:Episode of Care; D005260:Female; D006801:Humans; D007341:Insurance; D008297:Male; D054539:Medication Therapy Management; D020380:Needs Assessment; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011569:Psychiatric Status Rating Scales; D012111:Residence Characteristics; D012559:Schizophrenia / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics; D012959:Socioeconomic Factors
D000928:Antidepressive Agents; D014150:Antipsychotic Agents