Adjunctive Mood Stabilizer and Benzodiazepine Use in Older Asian Patients with Schizophrenia, 2001–2009

Abstract

Objective:

This study surveyed the use of adjunctive mood stabilizers (MS) and benzodiazepines (BZD) in older Asian schizophrenia patients and examined their demographic and clinical correlates.

Method:

Information on hospitalized schizophrenia patients aged 55 years or more were extracted from the database of the Research on Asian Psychotropic Prescription Patterns (REAP) study. A total of 1 452 patients from 9 Asian countries and territories was included in the study. The patients’ sociodemographic and clinical characteristics and the prescriptions of antipsychotics, MS and BZD were recorded using a standardized protocol and data collection procedure.

Results:

The frequency of MS prescription was 26.7% in the pooled sample, with 25.5% in 2001, 26.9% in 2004 and 27.7% in 2009. The corresponding figures for BZD were 20.7%, 20.2%, 18.4% and 23.1%, respectively. Multiple logistic regression analysis of the whole sample revealed that patients on MS were younger and more likely to be men and to have extrapyramidal side effects (EPS) and a longer duration of illness. Compared to patients in China, those in Japan were more likely to receive MS, while Korean patents were prescribed less MS. In contrast, there were no significant sociodemographic or clinical correlates of BZD use. Compared to patients in China, their Korean and Singaporean counterparts were more likely to be on BZD.

Conclusions:

The use of MS and BZD is not uncommon in older Asian patients with schizophrenia. Given the paucity of empirical data on the efficacy of these agents in individuals with schizophrenia of any age and concerns about added side effects in older patients in particular, the rationale for the prescription of these agents in this population warrants further examination.

Key words

schizophrenia - prescription patterns - mood stabilizers - benzodiazepines - older patients - Asia

• References

• 1 Citrome L. Use of lithium, carbamazepine, and valproic acid in a state-operated psychiatric hospital. J Pharm Technol 1995; 11: 55-59
• 2 Parepally H, Chakravorty S, Levine J et al. The use of concomitant medications in psychiatric inpatients treated with either olanzapine or other antipsychotic agents: a naturalistic study at a state psychiatric hospital. Prog Neuropsychopharmacol Biol Psychiatry 2002; 26: 437-440
• 3 Buchanan RW, Kreyenbuhl J, Kelly DL et al. The 2009 schizophrenia PORT psychopharmacological treatment recommendations and summary statements. Schizophr Bull 2010; 36: 71-93
• 4 Citrome L, Levine J, Allingham B. Changes in use of valproate and other mood stabilizers for patients with schizophrenia from 1994 to 1998. Psychiatr Serv 2000; 51: 634-638
• 5 Xiang YT, Weng YZ, Leung CM et al. Clinical and social determinants of long-term use of benzodiazepines and its impact on quality of life of Chinese schizophrenia patients. Pharmacopsychiatry 2007; 40: 269-274
• 6 Gillies D, Beck A, McCloud A et al. Benzodiazepines alone or in combination with antipsychotic drugs for acute psychosis. Cochrane Database Syst Rev 2005; CD003079
• 7 Tor PC, Ng TP, Yong KH et al. Adjunctive benzodiazepine treatment of hospitalized schizophrenia patients in Asia from 2001 to 2008. Int J Neuropsychopharmacol 2011; 14: 735-745
• 8 Volz HP, Nenadic I, Gaser C et al. Time estimation in schizophrenia: an fMRI study at adjusted levels of difficulty. Neuroreport 2001; 12: 313-316
• 9 Kohen I, Lester PE, Lam S. Antipsychotic treatments for the elderly: efficacy and safety of aripiprazole. Neuropsychiatr Dis Treat 2010; 6: 47-58
• 10 Ungvari GS, Chow LY, Chiu HF et al. Modifying psychotropic drug prescription patterns: a follow-up survey. Psychiatry Clin Neurosci 1997; 51: 309-314
• 11 An FR, Xiang YT, Wang CY et al. Change of psychotropic drug prescription for schizophrenia in a psychiatric institution in Beijing, China between 1999 and 2008. Int J Clin Pharmacol Ther 2010; 48: 270-274
• 12 Chong MY, Tan CH, Fujii S et al. Antipsychotic drug prescription for schizophrenia in East Asia: rationale for change. Psychiatry Clin Neurosci 2004; 58: 61-67
• 13 APA . Practice Guideline for the Treatment of Patients with Schizophrenia. Washington, DC: American Psychiatric Press; 1997
• 14 Kane JM, Aguglia E, Altamura AC et al. Guidelines for depot antipsychotic treatment in schizophrenia. European Neuropsychopharmacology Consensus Conference in Siena, Italy. Eur Neuropsychopharmacol 1998; 8: 55-66
• 15 Woods SW. Chlorpromazine equivalent doses for the newer atypical antipsychotics. J Clin Psychiatry 2003; 64: 663-667
• 16 Shinfuku N, Tan CH. Pharmacotherapy for schizophrenic inpatients in East Asia − changes and challenges. Int Rev Psychiatry 2008; 20: 460-468
• 17 WHO. Collaborating Centre for Drug Statistic Methodology: Guidelines for ATC Index with DDDs. Oslo: WHO; 2002
• 18 Chong MY, Tan CH, Shinfuku N et al. Prescribing antipsychotic drugs for inpatients with schizophrenia in Asia: Comparison of REAP-2001 and REAP-2004 studies. Asia-Pacific Psychiatry 2010; 2: 77-84
• 19 Sapra M, Vahia IV, Reyes PN et al. Subjective reasons for adherence to psychotropic medication and associated factors among older adults with schizophrenia. Schizophr Res 2008; 106: 348-355
• 20 Uchida H, Pollock BG, Bies RR et al. Predicting age-specific dosing of antipsychotics. Clin Pharmacol Ther 2009; 86: 360-362
• 21 Castle D, Morgan V, Jablensky A. Antipsychotic use in Australia: the patients’ perspective. Aust NZ J Psychiatry 2002; 36: 633-641
• 22 Ayuso-Mateos JL, Gutierrez-Recacha P, Haro JM et al. Estimating the prevalence of schizophrenia in Spain using a disease model. Schizophr Res 2006; 86: 194-201
• 23 Xiang YT, Weng YZ, Leung CM et al. Long-term use of mood stabilizers and its impact on the quality of life of chinese patients with schizophrenia. Clin Neuropharmacol 2009; 32: 16-21
• 24 Binder RL, Kazamatsuri H, Nishimura T et al. Tardive dyskinesia and neuroleptic-induced parkinsonism in Japan. Am J Psychiatry 1987; 144: 1494-1496
• 25 Pickar D, Vinik J, Bartko JJ. Pharmacotherapy of schizophrenic patients: preponderance of off-label drug use. PLoS ONE 2008; 3: e3150
• 26 Alexopoulos GS, Streim J, Carpenter D et al. Using antipsychotic agents in older patients. J Clin Psychiatry. 2004; 65 (Suppl. 02) 5-99 discussion 100–102; quiz 103–104
• 27 Chai HX, Du JH, Wu ZJ. A study of additive effect of sodium valproate in the treatment of schizophrenia (in Chinese). J Clin Psychol Med 2004; 14: 151-152
• 28 Wang CY, Luo XN, Liu RG et al. The influence of violent behavior on patients with psychiatric disorder (in Chinese). Health Psychol 1995; 3: 21-22
• 29 Miller DS, Yatham LN, Lam RW. Comparative efficacy of typical and atypical antipsychotics as add-on therapy to mood stabilizers in the treatment of acute mania. J Clin Psychiatry 2001; 62: 975-980