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Atypical Antipsychotic Use Among Acute Schizophrenic Inpatients

Key Words: Schizophrenia • Atypical Antipsychotics

SIR: The introduction of atypical antipsychotics has triggered the reevaluation of treatment strategies in schizophrenia.^1–3 However, little information is available about the prescribing of novel antipsychotic drugs, in general or in different settings, or about the differential characteristics of patients on novel antipsychotics. The aims of this study were both to elucidate the prescribing practices for atypical antipsychotics among acute schizophrenic inpatients in Athens and to reveal the differential characteristics of schizophrenic patients on atypical antipsychotics.

The subjects of this prospective study were 63 schizophrenic patients (39 males), consecutively admitted at Eginition Hospital, Department of Psychiatry, Athens, from February 1997 to March 1998. Their mean age was 30.2±8.8 years. All patients were diagnosed on the basis of DSM-IV criteria.⁴ Written informed consent was obtained from the subjects and their relatives. All patients were assessed on admission with the Positive and Negative Syndrome Scale (PANSS)⁵ by the same psychiatrist-investigator, who was blind to the patients' antipsychotic medications. Another independent psychiatrist performed analysis of patients' case notes, surveying the prescribing of antipsychotic drugs on the first week after their admission.

Of the total 63 patients, 22 (35%) were on atypical antipsychotics; of these, 12 (54%) used atypical antipsychotics as monotherapy, and 10 (46%) used atypical antipsychotics concurrently with conventional antipsychotics. Patients on atypical antipsychotics were evenly divided between men and women (50%) and had a mean age of 32.9 years (SD=9.0). The most often used atypical antipsychotics were risperidone (54%), clozapine (23%), olanzapine (18%) and sertindole (5%). It is worth noting that risperidone and olanzapine were introduced in Greece in May 1994 and December 1997, respectively. Clozapine was reintroduced in July 1990, and sertindole was introduced in December 1997 but was withdrawn in December 1998. Quetiapine and ziprasidone were not yet available in the Greek market during the period of the study.

Patients on atypical antipsychotics (as monotherapy or in combination with conventional antipsychotics, n=22, Group A) were compared with those on conventional antipsychotics (n=41, Group B). For the statistical evaluation, Mann-Whitney U-tests, Student's t-tests, or chi-square tests were used. There were no statistically significant differences between Group A and Group B patients on many sociodemographic and clinical-psychopathological parameters such as age (32.9 vs. 30.9 years), sex (men, 50% vs. 61%), family status (single, 70% vs. 87%), duration of illness (years, 6.7 vs. 7.6), PANSS-total score (73.2 vs. 76.0), PANSS-positive subscale score (18.1 vs. 18.4), PANSS-negative subscale score (18.7 vs. 18.8), and PANSS-general psychopathology subscale score (36.3 vs. 38.3). There were no statistically significant differences between Group A and Group B patients regarding the PANSS item scores with one exception. Schizophrenic patients on atypical antipsychotics showed a trend for significantly lower scores on item G14 of the PANSS (poor impulse control, 1.5 vs. 2.2; U=168, P=0.07).

In summary, acute schizophrenic patients on atypical antipsychotics were differentiated from those on conventional antipsychotics in that they had better impulse control.

REFERENCES

1. Tamminga CA: The promise of new drugs for schizophrenia treatment. Can J Psychiatry 1997; 42:265-273[Medline]
2. Peuskens J: Good medical practice in antipsychotic pharmacotherapy. Int Clin Psychopharmacol 1998; 13 (suppl 3):S35-S41
3. Frangou S, Lewis M: Atypical antipsychotics in ordinary clinical practice: a pharmaco-epidemiologic survey in a South London service. Eur Psychiatry 2000; 15:220-226[Medline]
4. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC, American Psychiatric Association, 1994
5. Kay SR, Fiszbein A, Opler LA: The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophr Bull 1987; 13:261-267

Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Email this article to a Colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Articles & Searches Download to citation manager Citing Articles via Google Scholar Articles by KONTAXAKIS, V. P. Articles by CHRISTODOULOU, G. N. Search for Related Content PubMed Citation Articles by KONTAXAKIS, V. P. Articles by CHRISTODOULOU, G. N. Atypical Neuroleptics Schizophrenia Spectrum Disorders

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