Maintenance Therapy of Psychosis Spectrum Disorders in a Real-World Setting: Antipsychotics Prescription Patterns and Long-Term Benzodiazepine Use

Nadja P Maric; Sanja Andric Petrovic; Manuela Russo; Stefan Jerotic; Ivan Ristic; Bojana Savić; Tamara Pemovska; Milos Milutinovic; Emina Ribic; Silvana Markovska-Simoska; Alma Dzubur Kulenovic; Nikolina Jovanovic

doi:10.3389/fpsyt.2022.796719

Maintenance Therapy of Psychosis Spectrum Disorders in a Real-World Setting: Antipsychotics Prescription Patterns and Long-Term Benzodiazepine Use

Front Psychiatry. 2022 Apr 7:13:796719. doi: 10.3389/fpsyt.2022.796719. eCollection 2022.

Affiliations

¹ Faculty of Medicine, University of Belgrade and Institute of Mental Health, Belgrade, Serbia.
² Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, United Kingdom.
³ Faculty of Medicine, University of Belgrade and Clinic for Psychiatry, University Clinical Centre of Serbia, Belgrade, Serbia.
⁴ University Clinic of Psychiatry, Ss. Cyril and Methodius University in Skopje, Skopje, North Macedonia.
⁵ Department of Psychiatry, Clinical Centre of the University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
⁶ Macedonian Academy of Sciences and Arts, Skopje, North Macedonia.

Abstract

Background: Maintenance therapy of patients with primary psychosis spectrum disorders (PSD) in the Western Balkans has received limited interest so far. The present study aimed to investigate long-term prescription patterns among outpatients with PSD.

Methods: Information about prescription of antipsychotics (AP), benzodiazepines (BZD) and other psychotropic medication over a 6-month period was collected from outpatients (n = 134; ICD-10 diagnosis F20-29) recruited by a larger multi-site study, to find mean daily number of psychotropic drugs, AP prescription patterns (including AP daily dose, route of administration, monotherapy vs. polypharmacy) and BZD utilization (long-term add-on BZD therapy). Additionally, sex-differences in the variables were explored.

Results: Clinically stable outpatients (age 41.7 ± 11.0; male 62.7%; duration of untreated illness 12.7 ± 8.7 years; mean number of lifetime hospitalizations 2.6 ± 0.7) were prescribed 2.8 ± 1.1 psychotropic medications daily. The mean 6-month AP dose was 14.2 ± 7.8 mg olanzapine equivalents. Long-acting injectable AP was prescribed to 25.2% of the patients. Long-term AP monotherapy was found in 52.7% patients and most of them were prescribed second generation AP (65.2%). Long-term AP polypharmacy (42.7%) was more common in males (p = 0.015). The most frequent co-prescription patterns were first generation AP plus clozapine. The highest rate of long-term AP co-prescription was found for BZD (in 42.7% cases, average 6-months daily dose of 2.8 ± 2.7 mg lorazepam equivalents) and anticholinergics (33.6%).

Conclusion: Existing appropriately designed interventions aiming to safely switch the inappropriate therapeutic regimens, i.e. very high prevalence of long-term AP polypharmacy and non-rational BZD co-prescription, should be implemented in the region of Western Balkans.

Keywords: antipsychotic; benzodiazepine; guidelines; psychosis spectrum disorders; sex-differences.