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Antipsychotic dosing patterns for schizophrenia in three treatment settings
G Remington1, C M Shammi, R Sethna
1Department of Psychiatry, University of Toronto, Ontario, Canada. gary_remington@camh.net
Psychiatric Services (Washington, D.C.)
|January 6, 2001
Summary
Daily antipsychotic dosages for schizophrenia patients were reviewed. Doses were significantly higher in provincial hospitals compared to community or academic settings, indicating varied adherence to lower dosing guidelines.
Area of Science:
- Psychiatry
- Pharmacology
- Health Services Research
Background:
- Current guidelines recommend lower antipsychotic dosages for schizophrenia treatment.
- Adherence to these lower dosing guidelines may vary across different clinical settings.
Purpose of the Study:
- To evaluate daily antipsychotic medication dosages in outpatients with schizophrenia.
- To determine if current lower dosing guidelines are being followed in practice.
- To compare dosing practices across different hospital settings.
Main Methods:
- A chart review was conducted on 163 outpatients diagnosed with schizophrenia.
- Data were collected from three distinct outpatient hospital settings: community, provincial, and academic teaching hospitals.
- Daily dosages were calculated using chlorpromazine equivalents.
Main Results:
- The provincial hospital exhibited significantly higher daily antipsychotic dosages (773.8 mg chlorpromazine equivalents) compared to the community (355 mg) and academic (424.8 mg) hospitals.
- A higher proportion of patients at the provincial hospital received conventional antipsychotics over novel or depot formulations.
- Polypharmacy (more than one antipsychotic) was more common in the provincial hospital setting.
Conclusions:
- Antipsychotic dosing practices for schizophrenia vary significantly across different hospital settings.
- Provincial hospitals may be less adherent to lower dosing guidelines, potentially using older medication types and polypharmacy more frequently.
- Further research is needed to understand the reasons behind these dosing discrepancies and their clinical implications.