Choosing antipsychotic maintenance therapy--a naturalistic study

Antipsychotic maintenance treatment is essential for preventing relapses of schizophrenia, but the variety of available antipsychotics may complicate the choice of drug. The aim of our naturalistic one-year follow-up study was to find out the factors predicting the choice of antipsychotics in discharged patients with schizophrenia or schizoaffective disorder and the predictors of one-year rehospitalization. The patients were receiving oral or depot classical antipsychotics or atypical agents clozapine or risperidone. Symptoms were assessed with Present State Examination. Included were 447 patients (202 males and 245 females) with a mean age of 39.1 years and 5.9 previous hospitalizations. The majority of patients (n = 322) were receiving depot antipsychotics and 43 were prescribed atypical agents. Two predictive models were built using the logistic regression analysis. Previously prescribed depot antipsychotics were positively related to further depot use, while patients who left the hospital against medical advice and those with slowness of speech at admission were less likely to receive depot drugs. On the other hand, previously used atypical antipsychotics and longer hospitalization predicted further use of atypical agents while patients discharged to community care facilities or nursing homes and those with more frequent previous hospitalizations were less likely to receive atypical agents. The Cox survival analysis showed the following one-year rehospitalization risk factors: diagnosis of schizoaffective disorder, frequent previous hospitalizations, inappropriate behavior, and oral classical antipsychotics versus depot or atypical agents. This study may yield some insight into the decision-making process in everyday clinical work regarding the choice of antipsychotic maintenance medication and its influence on rehospitalization rate.