Prescribing for inpatients with schizophrenia: an international multi-center comparative study

Area of Science:

• Psychiatry
• Pharmacology
• Health Services Research

Background:

• Compares prescription practices for acute schizophrenia inpatients across six academic departments in China, Japan, Hungary, and the U.S.
• Examines variations in drug selection and dosage for schizophrenia treatment.

Purpose of the Study:

• To investigate and compare antipsychotic and psychotropic drug prescription patterns for schizophrenia inpatients across diverse international academic centers.
• To identify variations in prescribing practices, including drug type, dosage, and combinations, and assess adherence to treatment guidelines.

Main Methods:

• Collected prescription data from 429 inpatients meeting DSM-IV schizophrenia criteria with at least two years of illness.
• Data collected on a single census day from six academic departments across four countries.
• Analyzed prescription variables including antipsychotic type, dose, combinations, and other psychotropic drug use.

Main Results:

• Significant variation in prescription patterns (antipsychotic type, dose, combinations) observed among centers, even within countries.
• Differences persisted after adjusting for patient demographics (age, sex) and illness duration.
• Antipsychotics commonly prescribed in divided doses with other psychotropic drugs; anticholinergic use higher with typical antipsychotics.
• Lowest atypical antipsychotic use and highest mean daily antipsychotic dose noted in the Japanese center.

Conclusions:

• Prescription patterns for schizophrenia treatment do not consistently follow established guidelines across the studied centers.
• Confirms significant international and inter-center variability in schizophrenia prescribing practices.
• Commonly observed pattern includes atypical antipsychotics combined with other psychotropic medications (anticholinergics, hypnotics, anticonvulsants, benzodiazepines) in multiple daily doses.