Antipsychotic Polypharmacy in Older Adult Asian Patients With Schizophrenia: Research on Asian Psychotropic Prescription Pattern

Dong M 1 , Zeng LN 1 , Zhang Q 2 , Yang SY 3 , Chen LY 4 , Sim K 5 Show all authors , He YL 6 , Chiu HF 7 , Sartorius N 8 , Tan CH 9 , Chong MY 10 , Shinfuku N 11 , Lin SK 12 , Ng CH 13 , Ungvari GS 14 , Xiang YT 1

Affiliations 

  • 1 1 Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, & Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China
  • 2 3 School of Mental Health, The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
  • 3 4 Department of Pharmacy, Taipei City Hospital, Taipei, Taiwan
  • 4 5 Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
  • 5 6 Institute of Mental Health, Buangkok Green Medical Park, Singapore
  • 6 7 Department of Psychiatric Epidemiology, Shanghai Mental Health Center, Shanghai, China
  • 7 8 Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
  • 8 9 Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
  • 9 10 Department of Pharmacology, National University of Singapore, Singapore
  • 10 11 Chiayi Chang Gung Memorial Hospital and School of Medicine, Chang Gung University, Chiayi, Taiwan
  • 11 12 International Center for Medical Research, Kobe University School of Medicine, Kobe, Japan
  • 12 13 Department of Psychiatry, School of Medicine, Taipei Medical University, Taipei, Taiwan
  • 13 14 Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
  • 14 15 University of Notre Dame Australia, Fremantle, Australia
J Geriatr Psychiatry Neurol, 2019 11;32(6):304-311.
PMID: 31480982 DOI: 10.1177/0891988719862636

Abstract

BACKGROUND AND OBJECTIVE: Antipsychotic polypharmacy (APP) is a controversial topic in the treatment of older adults with schizophrenia. The objective of this study was to examine the use of APP in older adult Asian patients with schizophrenia and its associated demographic and clinical factors.

METHODS: This study was based on the fourth survey of the consortium known as the Research on Asian Psychotropic Prescription Pattern for Antipsychotics. Fifteen Asian countries/territories participated in this survey, including Bangladesh, Mainland China, Hong Kong, India, Indonesia, Japan, Korea, Malaysia, Myanmar, Pakistan, Singapore, Sri Lanka, Taiwan, Thailand, and Vietnam. Basic demographic and clinical characteristics were collected using a standardized data collection form.

RESULTS: Among the 879 older adults with schizophrenia included in the survey, the rate of APP was 40.5%. Multiple logistic regression analysis revealed that higher antipsychotic doses (P < .001, odds ratio [OR] = 1.003, 95% confidence interval [CI]: 1.002-1.003), longer duration of illness (P = .02, OR = 1.845, 95% CI: 1.087-3.132), and the prescription of anticholinergics (P < .001, OR = 1.871, 95% CI: 1.329-2.635), second-generation antipsychotics (P = .001, OR = 2.264, 95% CI: 1.453-3.529), and first-generation antipsychotics (P < .001, OR = 3.344, 95% CI: 2.307-4.847) were significantly associated with APP.

CONCLUSION: Antipsychotic polypharmacy was common in older adult Asian patients with schizophrenia. Compared to the results of previous surveys, the use of APP showed a declining trend over time. Considering the general poor health status of older patients with schizophrenia and their increased risk of drug-induced adverse events, the use of APP in this population needs careful consideration.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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