Coprescription of mood stabilizers in schizophrenia, dosing, and clinical correlates: An international study

Lim WK 1 , Chew QH 1 , He YL 2 , Si TM 3 , Chiu FH 4 , Xiang YT 5 Show all authors , Kato TA 6 , Kanba S 6 , Shinfuku N 7 , Lee MS 8 , Park SC 9 , Park YC 10 , Chong MY 11 , Lin SK 12 , Yang SY 12 , Tripathi A 13 , Avasthi A 14 , Grover S 14 , Kallivayalil RA 15 , Udomratn P 16 , Chee KY 17 , Tanra AJ 18 , Rabbani MG 19 , Javed A 20 , Kathiarachchi S 21 , Waas D 21 , Myint WA 22 , Sartorius N 23 , Tran VC 24 , Nguyen KV 24 , Tan CH 25 , Baldessarini RJ 26 , Sim K 1

Affiliations 

  • 1 Institute of Mental Health, Singapore, Singapore
  • 2 Department of Psychiatric Epidemiology, Shanghai Mental Health Center, Shanghai, China
  • 3 Institute of Mental Health, Peking University, Beijing, China
  • 4 Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China
  • 5 Faculty of Health Sciences, University of Macau, Macau, China
  • 6 Department of Neuropsychiatry, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
  • 7 Department of Psychiatry, Kobe University, Kobe, Japan
  • 8 Department of Psychiatry, College of Medicine, Korea University, Seoul, South Korea
  • 9 Department of Psychiatry, Inje University Haeundae Paik Hospital, Busan, South Korea
  • 10 Department of Psychiatry, Hanyang University, Seoul, South Korea
  • 11 Department of Psychiatry, Kaoshiung Chang Gung Memorial Hospital and Chang Gung University School of Medicine, Kaohsiung, Taiwan
  • 12 Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
  • 13 Department of Psychiatry, King George's Medical University, Lucknow, India
  • 14 Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
  • 15 Pushpagiri Institute of Medical Sciences, Tiruvalla, India
  • 16 Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
  • 17 Department of Psychiatry & Mental Health, Tunku Abdul Rahman Institute of Neurosciences, Kuala Lumpur, Malaysia
  • 18 Department of Psychiatry, Hasanuddin University Faculty of Medicine, Makassar, Indonesia
  • 19 Bangladesh Association of Psychiatrists, Bangladesh, Bangladesh
  • 20 Pakistan Psychiatric Research Center, Fountain House, Lahore, Pakistan
  • 21 Department of Psychiatry, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
  • 22 Mental Health Society, Myanmar Medical Association, Yangon, Myanmar
  • 23 Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
  • 24 Vietnam Psychiatric Association (VPA), Hanoi, Vietnam
  • 25 Department of Pharmacology, National University Hospital, Singapore, Singapore
  • 26 International Consortium for Mood & Psychotic Disorder Research, McLean Hospital, Belmont, Massachusetts, USA
Hum Psychopharmacol, 2020 11;35(6):1-7.
PMID: 32738085 DOI: 10.1002/hup.2752

Abstract

OBJECTIVE: Studies examining coprescription and dosages of mood stabilizers (MSs) with antipsychotics for psychotic disorders are infrequent. Based on sparse extant data and clinical experience, we hypothesized that adjunctive MS use would be associated with certain demographic (e.g., younger age), clinical factors (e.g., longer illness duration), and characteristics of antipsychotic treatment (e.g., multiple or high antipsychotic doses).

METHODS: Within an Asian research consortium focusing on pharmaco-epidemiological factors in schizophrenia, we evaluated rates of MS coprescription, including high doses (>1000 mg/day lithium-equivalents) and clinical correlates.

RESULTS: Among 3557 subjects diagnosed with schizophrenia in 14 Asian countries, MSs were coprescribed with antipsychotics in 13.6% (n = 485) of the sample, with 10.9% (n = 53) on a high dose. Adjunctive MS treatment was associated (all p < 0.005) with demographic (female sex and younger age), setting (country and hospitalization), illness (longer duration, more hospitalizations, non-remission of illness, behavioral disorganization, aggression, affective symptoms, and social-occupational dysfunction), and treatment-related factors (higher antipsychotic dose, multiple antipsychotics, higher body mass index, and greater sedation). Patients given high doses of MSs had a less favorable illness course, more behavioral disorganization, poorer functioning, and higher antipsychotic doses.

CONCLUSIONS: Schizophrenia patients receiving adjunctive MS treatment in Asian psychiatric centers are more severely ill and less responsive to simpler treatment regimens.

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

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