Magazine article Clinical Psychiatry News

Polypharmacy, Atypicals Top Pick for Schizophrenia

Magazine article Clinical Psychiatry News

Polypharmacy, Atypicals Top Pick for Schizophrenia

Article excerpt

Polypharmacy rates ranged from 11% to 29% in the N. Y. Veterans Affairs region.

PHOENIX, ARIZ. - Analysis of data from several large public mental health programs suggests that atypical antipsychotics are becoming the agents of choice for schizophrenia and that polypharmacy and the use of depot medication are widespread.

But speakers at a meeting of the New Clinical Drug Evaluation Unit sponsored by the National Institute of Mental Health noted wide variation in prescribing practices among individual sites and clinicians and raised questions about the rationale behind these differences.

Susan M. Essock, Ph.D., of Mount Sinai School of Medicine, New York, and. the Bronx (N.Y.) Veterans Affairs Medical Center, cited data on Medicaid prescriptions throughout the country that reflected a rapid rate of change in antipsychotic prescribing practices.

Between 1998 and 1999, the proportion of antipsychotic prescriptions for conventional agents dropped from 42% to 34%, and those for clozapine dropped from 15% to 11%. Prescriptions for the first-line atypical antipsychotics risperidone, olanzapine, and quetiapine rose from 23% to 27%, from 18% to 23%, and from 1% to 5% percent, respectively.

Patterns were similar in some states, including New York, California, Ohio, and Connecticut, she said.

Conventional antipsychotic use declined even more sharply in the New York region VA Health Care System from 64% to 44% between 1998 and 2000, Dr. Ellen Weissman said. Prescriptions for risperidone, olanzapine, and quetiapine rose, while those for clozapine declined from 6% to 4%.

This last trend raises some questions, said Dr. Weissman of Mount Sinai School of Medicine, New York, and the Bronx (N.Y.) VA Medical Center. The VA treats many chronically ill, treatment-resistant patients. If clozapine is most effective for this population, "are patients getting [appropriate] access to it?" she asked.

Figures from the VA system also showed substantial and increasing recourse to polypharmacy Between January 2000 and January 2001, the numbers of patients receiving two or more oral antipsychotics rose from 15% to 17%. The figure would be 5%-6% higher if depot medications were included. …

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