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Atypical antipsychotics in ordinary clinical practice: a pharmaco-epidemiologic survey in a south London service

Published online by Cambridge University Press:  16 April 2020

S. Frangou  and
M. Lewis
S. Frangou
Affiliation:
Department of Psychological Medicine, Institute of Psychiatry, De Crespigny Park,London, SE5 8AF, UK
M. Lewis*
Affiliation:
Department of Psychological Medicine, Institute of Psychiatry, De Crespigny Park,London, SE5 8AF, UK
*
*Correspondence and reprints: Dr Sophia Frangou, Senior Lecturer, Division of Psychological Medicine, Section of the Neurobiology of Psychosis, Institute of Psychiatry, De Crespigny Park, London, SE5 8AF, UK.
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Summary

The introduction of atypical antipsychotics has triggered a reevaluation of treatment strategies in schizophrenia. Although research findings inform about the efficacy and safety of drugs, it is the decisions made daily in ordinary practice that affect the vast majority of patients. The aim of this paper was to examine the use of atypical antipsychotics in clinical care, by means of a survey of prescribing practices for clozapine, risperidone, olanzapine, sertindole and quetiapine for all patients treated for DSM-IV schizophrenia within a psychiatric service. Seventy-five (26%) of the 286 patients identified were on atypical antipsychotics. Patients on clozapine were mostly male, had more than 15 years of contact with psychiatric services and were poor responders. Patients prescribed other atypicals had responded to prior treatment with typical neuroleptics and had less than five years of contact with psychiatric services. Gender distribution was equal in this group. The use of research criteria for treatment resistance identified only one patient, as prolonged use of high-dose neuroleptics was uncommon. The new atypical antipsychotics appear to be replacing older neuroleptics as the first-line treatment of schizophrenia while clozapine is mostly reserved for poor responders. Clinicians' definition of treatment resistance was variable and below the threshold used in research.

Keywords

antipsychoticspharmaco-epidemiologyprescribingschizophrenia
Type
Original Article
Information
European Psychiatry , Volume 15 , Issue 3 , May 2000 , pp. 220 - 226
Copyright
Copyright © Éditions scientifiques et médicales Elsevier SAS 2000

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References

American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders. 4th ed Washington DCAPA 1994Google Scholar
Baldessarini, R.JKando, J.CCentorrino, FHospital use of antipsychotic agents in 1989 and 1993: stable dosing with decreased length of stay Am J Psychiatry 152 1995 1038–1044Google ScholarPubMed
Drug Information Quarterly, Bethlem and Maudsley NHS Trust Drugs and Therapeutics Committee 1998 Maudsley LondonGoogle Scholar
Bondolfi, GDufour, HPatris, MMay, J.PBilleter, UEap, C.B et al. Risperidone versus clozapine in treatment-resistant chronic schizophrenia: a randomized double-blind study. The Risperidone Study Group Am J Psychiatry 155 1998 499–504CrossRefGoogle ScholarPubMed
Conley, R.RTamminga, C.ABartko, J.JRichardson, CPeszke, MLingle, J et al. Olanzapine compared with chlorpromazine in treatment-resistant schizophrenia Am J Psychiatry 155 1998 914–920CrossRefGoogle ScholarPubMed
Farde, LHall, HEhrin, ESedvall, GQuantitative analysis of D2 dopamine receptor binding in the living human brain by PET Science 231 1989 258–261CrossRefGoogle Scholar
Farde, LNordstrom, A.LWiesel, F.APauli, SHalldin, CSedvall, GPositron emission tomographic analysis of central D1 and D2 dopamine receptor occupancy in patients treated with classical neuroleptics and clozapine: relation to extrapyramidal side effects Arch Gen Psychiatry 49 1992 538–544CrossRefGoogle ScholarPubMed
Flynn, S.WMacewan, G.WAltman, SKopala, L.CFredrikson, D.HSmith, G.N et al. An open comparison of clozapine and risperidone in treatment-resistant schizophrenia Pharmacopsychiatry 31 1998 25–29CrossRefGoogle ScholarPubMed
Frangou, SMurray, R.MAntipsychotic drugsSchizophrenia LondonMartin Dunitz 1996 34–46Google ScholarPubMed
Galletly, C.AAntipsychotic drug doses in a schizophrenia inpatient unit Aust N Z J Psychiatry 26 1992 574–576CrossRefGoogle Scholar
Heinrich, KKlieser, ELehmann, EKinzler, EHruschka, HRisperidone versus clozapine in the treatment of schizophrenic patients with acute symptoms: a double blind, randomized clinical trial Prog Neuropsychopharmacol Biol Psychiatry 18 1994 129–137CrossRefGoogle Scholar
Henderson, D.CGoff, D.CRisperidone as an adjunct to clozapine therapy in chronic schizophrenics J Clin Psychiatry 57 1996 395–397Google ScholarPubMed
Jeffreys, S.EHarvey, C.AMc Naught, A.SQuayle, A.SKing, M.BBird, A.SThe Hampstead Schizophrenia Survey 1991. I: Prevalence and service use comparisons in an inner London health authority, 1986-1991 Br J Psychiatry 170 1997 301–306CrossRefGoogle Scholar
Kane, JHonigfeld, GSinger, JMeltzer, HClozapine for the treatment resistant schizophrenic: a double blind comparison with chlorpromazine Arch Gen Psychiatry 45 1988 789–796CrossRefGoogle ScholarPubMed
Leucht, SPitschel-Walz, GAbraham, DKissling, WEfficacy and extrapyramidal side-effects of the new antipsychotics olanzapine, quetiapine, risperidone, and sertindole compared to conventional antipsychotics and placebo. A meta-analysis of randomized controlled trials Schizophr Res 35 1999 51–68CrossRefGoogle ScholarPubMed
Lindenmayer, J.PIskander, APark, MApergi, F.SCzobor, PSmith, R et al. Clinical and neurocognitive effects of clozapine and risperidone in treatment-refractory schizophrenic patients: a prospective study J Clin Psychiatry 59 1998 521–527CrossRefGoogle ScholarPubMed
Martin, JGomez, J.CGarcia-Bernardo, ECuesta, MAlvarez, EGurpegui, MOlanzapine in treatment-refractory schizophrenia: results of an open-label study. The Spanish Group for the Study of Olanzapine in Treatment-Refractory Schizophrenia Clin Psychiatry 58 1997 479–483CrossRefGoogle Scholar
Meltzer, H.YBurnett, SBastani, BRamirez, L.FEffect of six months of clozapine treatment on the quality of life of chronic schizophrenic patients Hosp Community Psychiatry 41 1990 892–897Google ScholarPubMed
Peralta, VCuesta, M.JCaro, FMartinez-Larrea, ANeuroleptic dose and schizophrenic symptoms. A survey of prescribing practices Acta Psychiatr Scand 90 1994 354–357CrossRefGoogle ScholarPubMed
Reardon, G.TRifkin, ASchwartz, AMyerson, ASiris, S.GChanging patterns of neuroleptic dosage over a decade Am J Psychiatry 146 1989 726–729Google ScholarPubMed
Remington, G.JPrendergast, PBezchlibnyk-Butler, K.ZNeuroleptic dosing in chronic schizophrenia: a 10-year follow-up Can J Psychiatry 42 1997 53–57CrossRefGoogle ScholarPubMed
Shiloh, RZemishlany, ZAizenberg, DRadwan, MSchwartz, BDorfman-Etrog, P et al. Sulpiride augmentation in people with schizophrenia partially responsive to clozapine. A double-blind, placebo-controlled study Br J Psychiatry 171 1997 569–573CrossRefGoogle ScholarPubMed
Smith, R.CChua, J.WLipetsker, BBhattacharyya, AEfficacy of risperidone in reducing positive and negative symptoms in medication-refractory schizophrenia: an open prospective study J Clin Psychiatry 5 1996 460–466CrossRefGoogle Scholar
Taylor, DKerwin, RMaudsley prescribing guidelines LondonMaudsley 1999Google Scholar
Zimbroff, D.LKane, J.MTamminga, C.ADaniel, D.GMack, R.JWozniak, P.J et al. Controlled, dose-response study of sertindole and haloperidol in the treatment of schizophrenia. Sertindole Study Group Am J Psychiatry 154 1997 782–791Google ScholarPubMed
Zito, J.MCraig, T.JWanderling, JSiegel, CPharmaco-epidemiology in 136 hospitalized schizophrenic patients Am J Psychiatry 144 1987 778–782Google ScholarPubMed
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