Practice regarding antipsychotic therapy: a cross-sectional survey in two Norwegian hospitals

Since the introduction of chlorpromazine, an increasing number of drugs have been added to the list of antipsychotics (neuroleptics). These drugs can be further classified as either first-generation antipsychotics (FAPs) or second-generation antipsychotics (SAPs), depending on their ability to antagonize serotonine in addition to dopamine. The efficacy of various drugs is generally equal, whereas both pharmacological profiles and side-effects differ. Antipsychotic drug therapy recommendations are available both in Norway and internationally, and the purpose of this cross-sectional survey was to register the use of these drugs in representative mental hospitals (A and B), and compare our findings to the recommendations. Medical prescriptions were registered, and data further analysed. In hospital A, a total of 149 patients' prescriptions were registered. Antipsychotics were received voluntarily by 117 patients. Eighty-two of these used one antipsychotic drug, and in this group, 65% received SAPs. Antipsychotic combination therapy was received by 35 patients, and was associated with higher prescription rates of both anticholinergics and benzodiazepines. SAPs were not associated with increased use of benzodiazepines, compared to FAPs. Antipsychotics were frequently combined with mood stabilizers and antidepressants. Our findings in hospital A concerning therapy practices of antipsychotics, were confirmed in hospital B, where 64 patients' medical prescriptions were registered. We conclude that FAPs are still commonly prescribed. Antipsychotic combination therapy is used despite of lack of evidence for efficacy, and is associated with increased prescription rates of anticholinergics and benzodiazepines.