Abstract
Background: Surveys on prescription patterns for antipsychotics in the Scandinavian public health system are
scarce despite the prevalent use of these drugs. The clinical differences between antipsychotic drugs are mainly
in the areas of safety and tolerability, and international guidelines for the treatment of schizophrenia offer rational
strategies to minimize the burden of side effects related to antipsychotic treatment. The implementation of
treatment guidelines in clinical practice have proven difficult to achieve, as reflected by major variations in the
prescription patterns of antipsychotics between different comparable regions and countries. The objective of this
study was to evaluate the practice of treatment of schizophrenic patients with antipsychotics at discharge from
acute inpatient settings at a national level.
Methods: Data from 486 discharges of patients from emergency inpatient treatment of schizophrenia were
collected during a three-month period in 2005; the data were collected in a large national study that covered 75%
of Norwegian hospitals receiving inpatients for acute treatment. Antipsychotic treatment, demographic variables,
scores from the Global Assessment of Functioning and Health of the Nation Outcome Scales and information
about comorbid conditions and prior treatment were analyzed to seek predictors for nonadherence to guidelines.
Results: In 7.6% of the discharges no antipsychotic treatment was given; of the remaining discharges, 35.6% were
prescribed antipsychotic polypharmacy and 41.9% were prescribed at least one first-generation antipsychotic
(FGA). The mean chlorpromazine equivalent dose was 450 (SD 347, range 25–2800). In the multivariate
regression analyses, younger age, previous inpatient treatment in the previous 12 months before index
hospitalization, and a comorbid diagnosis of personality disorder or mental retardation predicted antipsychotic
polypharmacy, while previous inpatient treatment in the previous 12 months also predicted prescription of at
least one FGA.
Conclusion: Our national survey of antipsychotic treatment at discharge from emergency inpatient treatment
revealed antipsychotic drug regimens that are to some degree at odds with current guidelines, with increased risk
of side effects. Patients with high relapse rates, comorbid conditions, and previous inpatient treatment are
especially prone to be prescribed antipsychotic drug regimens not supported by international guidelines.
scarce despite the prevalent use of these drugs. The clinical differences between antipsychotic drugs are mainly
in the areas of safety and tolerability, and international guidelines for the treatment of schizophrenia offer rational
strategies to minimize the burden of side effects related to antipsychotic treatment. The implementation of
treatment guidelines in clinical practice have proven difficult to achieve, as reflected by major variations in the
prescription patterns of antipsychotics between different comparable regions and countries. The objective of this
study was to evaluate the practice of treatment of schizophrenic patients with antipsychotics at discharge from
acute inpatient settings at a national level.
Methods: Data from 486 discharges of patients from emergency inpatient treatment of schizophrenia were
collected during a three-month period in 2005; the data were collected in a large national study that covered 75%
of Norwegian hospitals receiving inpatients for acute treatment. Antipsychotic treatment, demographic variables,
scores from the Global Assessment of Functioning and Health of the Nation Outcome Scales and information
about comorbid conditions and prior treatment were analyzed to seek predictors for nonadherence to guidelines.
Results: In 7.6% of the discharges no antipsychotic treatment was given; of the remaining discharges, 35.6% were
prescribed antipsychotic polypharmacy and 41.9% were prescribed at least one first-generation antipsychotic
(FGA). The mean chlorpromazine equivalent dose was 450 (SD 347, range 25–2800). In the multivariate
regression analyses, younger age, previous inpatient treatment in the previous 12 months before index
hospitalization, and a comorbid diagnosis of personality disorder or mental retardation predicted antipsychotic
polypharmacy, while previous inpatient treatment in the previous 12 months also predicted prescription of at
least one FGA.
Conclusion: Our national survey of antipsychotic treatment at discharge from emergency inpatient treatment
revealed antipsychotic drug regimens that are to some degree at odds with current guidelines, with increased risk
of side effects. Patients with high relapse rates, comorbid conditions, and previous inpatient treatment are
especially prone to be prescribed antipsychotic drug regimens not supported by international guidelines.
