Are patients with schizophrenia under-treated with second-generation antipsychotics? A pilot study of the prescription practices of German psychiatrists

Pharmacopsychiatry. 2003 Nov;36(6):309-12. doi: 10.1055/s-2003-45119.

Abstract

Introduction: Patients' and relatives' associations, psychiatrists, and pharmaceutical companies are complaining about a deficiency in the care of psychiatric patients with innovative medications in Germany. They estimate that only about 10- 30 % of all patients with schizophrenia receive second-generation antipsychotics, a figure that lies significantly below the international average.

Methods: In order to determine the frequency of use of second-generation antipsychotics in the actual care of schizophrenic patients, we conducted the following investigations:--Discharge papers of schizophrenic inpatients from a university hospital and from a district hospital were studied with regard to the antipsychotic discharge medication.--Practicing psychiatrists were contacted and asked whether during the first 3 months after discharge they had continued the antipsychotic discharge medication that was proposed by the hospital.

Results: The investigation of a total of 200 discharge papers and the subsequent questioning of the psychiatrists who carried out the follow-up treatment showed that 166 patients (83 %) received a second-generation antipsychotic upon discharge. Only 5 % of these patients were switched to conventional antipsychotics in the outpatient treatment. Thus, contrary to our expectations, there was no noteworthy change from second-generation to classical antipsychotics.

Discussion: Therefore, in the sample analyzed the second-generation antipsychotics were far more frequently prescribed than would have been expected according to general estimates, and it was not possible to verify the often-heard complaints of an under-treatment with second generations in this study. Our findings suggest, however, that only 60 % of the patients still receive their discharge medication 3 months after discharge from the hospital. This raises the important question as to how continuity of the antipsychotic treatment could be better ensured.

MeSH terms

  • Adult
  • Antipsychotic Agents / therapeutic use*
  • Drug Prescriptions / statistics & numerical data*
  • Female
  • Germany
  • Hospitals, District / statistics & numerical data
  • Hospitals, University / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Pilot Projects
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Psychiatry / statistics & numerical data*
  • Retrospective Studies
  • Schizophrenia / drug therapy*

Substances

  • Antipsychotic Agents