Treatment of schizophrenia with antipsychotics in Norwegian emergency wards, a cross-sectional national study

Kroken, Rune A.; Johnsen, Erik; Ruud, Torleif; Wentzel-Larsen, Tore; Jørgensen, Hugo A
January 2009
BMC Psychiatry;2009, Vol. 9, Special section p1
Academic Journal
Background: Surveys on prescription patterns for antipsychotics in the Scandinavian public health system are scarce despite the prevalent use of these drugs. The clinical differences between antipsychotic drugs are mainly in the areas of safety and tolerability, and international guidelines for the treatment of schizophrenia offer rational strategies to minimize the burden of side effects related to antipsychotic treatment. The implementation of treatment guidelines in clinical practice have proven difficult to achieve, as reflected by major variations in the prescription patterns of antipsychotics between different comparable regions and countries. The objective of this study was to evaluate the practice of treatment of schizophrenic patients with antipsychotics at discharge from acute inpatient settings at a national level. Methods: Data from 486 discharges of patients from emergency inpatient treatment of schizophrenia were collected during a three-month period in 2005; the data were collected in a large national study that covered 75% of Norwegian hospitals receiving inpatients for acute treatment. Antipsychotic treatment, demographic variables, scores from the Global Assessment of Functioning and Health of the Nation Outcome Scales and information about comorbid conditions and prior treatment were analyzed to seek predictors for nonadherence to guidelines. Results: In 7.6% of the discharges no antipsychotic treatment was given; of the remaining discharges, 35.6% were prescribed antipsychotic polypharmacy and 41.9% were prescribed at least one first-generation antipsychotic (FGA). The mean chlorpromazine equivalent dose was 450 (SD 347, range 25-2800). In the multivariate regression analyses, younger age, previous inpatient treatment in the previous 12 months before index hospitalization, and a comorbid diagnosis of personality disorder or mental retardation predicted antipsychotic polypharmacy, while previous inpatient treatment in the previous 12 months also predicted prescription of at least one FGA. Conclusion: Our national survey of antipsychotic treatment at discharge from emergency inpatient treatment revealed antipsychotic drug regimens that are to some degree at odds with current guidelines, with increased risk of side effects. Patients with high relapse rates, comorbid conditions, and previous inpatient treatment are especially prone to be prescribed antipsychotic drug regimens not supported by international guidelines.


Related Articles

  • Neuroleptic malignant syndrome--a cautionary tale and a surprising outcome. Cape, Gavin; Cape, G // British Journal of Psychiatry;Jan94, Vol. 164, p120 

    Vigilance is required in order to detect the cardinal signs of neuroleptic malignant syndrome (NMS), especially after prolonged exposure to neuroleptics. In this case, NMS was diagnosed in a 29-year-old man, who had been on fluphenazine decanoate for over one year, coinciding with a cessation of...

  • Report of a Case of Phenobarbital-Induced Dystonia. Lacayo, Alvaro; Mitra, Nirmala // Clinical Pediatrics;Apr1992, Vol. 31 Issue 4, p252 

    This article discusses a case study of acute dystonia in a child hours after an initial oral loading dose of phenobarbital was given. A 2-year-old girl was admitted to the pediatric ICU after she presented in status epilepticus and had suffered a cardiac arrest. Past medical history was...

  • The New Atypical Antipsychotics. Kerwin, R. W. // British Journal of Psychiatry;Feb94, Vol. 164, p141 

    The article comments that the introduction of remoxipride, clozapine and risperidone has awakened interest in the clinical psychopharmacology of atypical antipsychotics. Therapeutic research found that antipsychotic drugs exert their effects by the blockade of dopamine D receptors. The effort to...

  • Pharmacodynamic genetic polymorphisms affect adverse drug reactions of haloperidol in patients with alcohol-use disorder. Zastrozhin, Mikhail Sergeevich; Brodyansky, Vadim Markovich; Skryabin, Valentin Yurievich; Grishina, Elena Anatolievna; Ivashchenko, Dmitry Vladimirovich; Ryzhikova, Kristina Anatolievna; Savchenko, Ludmila Mikhaylovna; Kibitov, Alexander Olegovich; Bryun, Evgeny Alekseevich; Sychev, Dmitry Alekseevich // Pharmacogenomics & Personalized Medicine;Jul2017, Vol. 10, p209 

    Background: Antipsychotic action of haloperidol is due to blockade of D2 receptors in the mesolimbic dopamine pathway, while the adverse drug reactions are associated with striatal D2 receptor blockade. Contradictory data concerning the effects of genetic polymorphisms of genes encoding these...

  • Lithium: balancing risks and benefits. Cookson, John; Cookson, J // British Journal of Psychiatry;Aug97, Vol. 171, p120 

    The article discusses the risks and benefits of using lithium in psychiatry. Studies of lithium showed the phenomenon of lithium withdrawal mania and the recognition of permanent neurological sequelae after lithium toxicity. According to the article, adherence to treatment with lithium is low...

  • The distinction of positive and negative symptoms. The failure of a two-dimensional model. Arndt, Stephan; Alliger, Randall J.; Andreasen, Nancy C.; Arndt, S; Alliger, R J; Andreasen, N C // British Journal of Psychiatry;Mar91, Vol. 158, p317 

    The distinction of positive and negative symptoms in describing schizophrenic patients has become popular. It presupposes that symptoms cluster in two dimensions, fitting together not only theoretically but empirically. Factor analysis of three published studies of 93, 62 and 52 schizophrenic...

  • Exposure to anaesthetic agents, cognitive functioning and depressive symptomatology in the elderly. Ancelin, Marie-Laure; de Roquefeuil, Guilhem; Ledésert, Bernard; Bonnel, François; Cheminal, Jean-Claude; Ritchie, Karen; Ancelin, M L; de Roquefeuil, G; Ledésert, B; Bonnel, F; Cheminal, J C; Ritchie, K // British Journal of Psychiatry;Apr2001, Vol. 178, p360 

    Background: Anaesthesia could provoke persistent alterations in specific cognitive domains in the elderly where ageing-related neuronal changes may exacerbate pharmacotoxic effects.Aims: To evaluate anaesthesia effects on the incidence of cognitive dysfunction after...

  • Resistance to compulsory drugs reaction reports.  // Nursing Standard;2/9/2005, Vol. 19 Issue 22, p7 

    Reports on the rejection of the Ministers on the demands for compulsory reporting of adverse drug reactions in Great Britain.

  • Propensity Score Estimation to Address Calendar Time-Specific Channeling in Comparative Effectiveness Research of Second Generation Antipsychotics Dusetzina, Stacie B.; Mack, Christina D.; Stürmer, Til // PLoS ONE;May2013, Vol. 8 Issue 5, p1 

    Background: Channeling occurs when a medication and its potential comparators are selectively prescribed based on differences in underlying patient characteristics. Drug safety advisories can provide new information regarding the relative safety or effectiveness of a drug product which might...

  • The effects of antipsychotic medications on microbiome and weight gain in children and adolescents. Bretler, Tali; Weisberg, Hagar; Koren, Omry; Neuman, Hadar // BMC Medicine;6/19/2019, Vol. 17 Issue 1, pN.PAG 

    Background: Atypical antipsychotics, also known as second-generation antipsychotics, are commonly prescribed as treatment for psychotic disorders in adults, as well as in children and adolescents with behavioral problems. However, in many cases, second-generation antipsychotics have...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics