[Measures to reduce high-dose multiple antipsychotics in Japan]

In Japan, multiple antipsychotic drugs are administered at a high dose to schizophrenia patients, which is rare in other countries. Many of such patients suffer from side effects, among which extrapyramidal and autonomic side effects frequently occur. Many anticholinergic agents and cathartics are concomitantly used for schizophrenia patients, and their vital prognoses are likely to be poor. With this background, we suggest a method in which antipsychotic drugs are slowly reduced as follows: for low potency drugs, the dose is decreased with 25 mg or lower of chlorpromazine equivalent dose per week, and, for high potency ones, the dose is decreased with 50 mg or lower of chlorpromazine equivalent dose per week. In February 2009, the author's patients with schizophrenia, who had been undergoing the slow reduction of antipsychotic drugs for a few years, showed an average number of antipsychotics being 1.26 (SD: 0.50), with the average dose being equivalent to 527 mg of chlorpromazine (SD: 297 mg), and the rate of achieving monotherapy was 70%. A randomized controlled trial involving the National Mental Sanatoriums and a private hospital demonstrated that antipsychotic drugs can be reduced with relative safety according to our method. Currently, prescription reform is being conducted in many hospitals, while prescription as practiced in the previous century still continues in some hospitals. It is considered that the problems regarding high-dose administration of multiple drugs can possibly be solved if many centers employ our method.