Prescription of Anticholinergic Drugs in Patients With Schizophrenia: Analysis of Antipsychotic Prescription Patterns and Hospital Characteristics

Hikaru Hori; Norio Yasui-Furukori; Naomi Hasegawa; Jun-Ichi Iga; Shinichiro Ochi; Kayo Ichihashi; Ryuji Furihata; Yoshitaka Kyo; Yoshikazu Takaesu; Takashi Tsuboi; Fumitoshi Kodaka; Toshiaki Onitsuka; Tsuyoshi Okada; Atsunobu Murata; Hiroko Kashiwagi; Hitoshi Iida; Naoki Hashimoto; Kazutaka Ohi; Hisashi Yamada; Kazuyoshi Ogasawara; Yuka Yasuda; Hiroyuki Muraoka; Masahide Usami; Shusuke Numata; Masahiro Takeshima; Hirotaka Yamagata; Tatsuya Nagasawa; Hiromi Tagata; Manabu Makinodan; Mikio Kido; Eiichi Katsumoto; Hiroshi Komatsu; Junya Matsumoto; Chika Kubota; Kenichiro Miura; Akitoyo Hishimoto; Koichiro Watanabe; Ken Inada; Hiroaki Kawasaki; Ryota Hashimoto

doi:10.3389/fpsyt.2022.823826

Prescription of Anticholinergic Drugs in Patients With Schizophrenia: Analysis of Antipsychotic Prescription Patterns and Hospital Characteristics

Front Psychiatry. 2022 May 17:13:823826. doi: 10.3389/fpsyt.2022.823826. eCollection 2022.

Authors

Hikaru Hori¹, Norio Yasui-Furukori², Naomi Hasegawa³, Jun-Ichi Iga⁴, Shinichiro Ochi⁴, Kayo Ichihashi⁵, Ryuji Furihata⁶, Yoshitaka Kyo⁷, Yoshikazu Takaesu⁸, Takashi Tsuboi⁹, Fumitoshi Kodaka¹⁰, Toshiaki Onitsuka¹¹, Tsuyoshi Okada¹², Atsunobu Murata³, Hiroko Kashiwagi^{3

13}, Hitoshi Iida¹, Naoki Hashimoto¹⁴, Kazutaka Ohi¹⁵, Hisashi Yamada^{3

16}, Kazuyoshi Ogasawara¹⁷, Yuka Yasuda^{3

18}, Hiroyuki Muraoka¹⁹, Masahide Usami²⁰, Shusuke Numata²¹, Masahiro Takeshima²², Hirotaka Yamagata²³, Tatsuya Nagasawa²⁴, Hiromi Tagata²⁵, Manabu Makinodan²⁶, Mikio Kido^{27

28}, Eiichi Katsumoto²⁹, Hiroshi Komatsu³⁰, Junya Matsumoto³, Chika Kubota¹³, Kenichiro Miura³, Akitoyo Hishimoto³¹, Koichiro Watanabe⁹, Ken Inada¹⁹, Hiroaki Kawasaki¹, Ryota Hashimoto³

Affiliations

¹ Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
² Department of Psychiatry, Dokkyo Medical University School of Medicine, Tochigi, Japan.
³ National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan.
⁴ Department of Neuropsychiatry Molecules and Function, Ehime University Graduate School of Medicine, Matsuyama, Japan.
⁵ Department of Neuropsychiatry, University of Tokyo Hospital, Tokyo, Japan.
⁶ Agency for Student Support and Disability Resources, Kyoto University, Kyoto, Japan.
⁷ Department of Psychiatry, School of Medicine, Kitasato University, Tokyo, Japan.
⁸ Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan.
⁹ Department of Neuropsychiatry, Kyorin University School of Medicine, Mitaka, Japan.
¹⁰ Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan.
¹¹ Department of Neuroimaging Psychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
¹² Department of Psychiatry, Jichi Medical University, Tochigi, Japan.
¹³ Department of Psychiatry, National Center of Neurology and Psychiatry Hospital, Kodaira, Japan.
¹⁴ Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
¹⁵ Department of Psychiatry, Gifu University Graduate School of Medicine, Gifu, Japan.
¹⁶ Department of Neuropsychiatry, Hyogo College of Medicine, Nishinomiya, Japan.
¹⁷ Center for Postgraduate Clinical Training and Career Development, Nagoya University Hospital, Nagoya, Japan.
¹⁸ Life Grow Brilliant Mental Clinic, Medical Corporation Foster, Osaka, Japan.
¹⁹ Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan.
²⁰ Department of Child and Adolescent Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa, Japan.
²¹ Department of Psychiatry, Graduate School of Biomedical Science, Tokushima University, Tokushima, Japan.
²² Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan.
²³ Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University School of Medicine, Yamaguchi, Japan.
²⁴ Department of Neuropsychiatry, Kanazawa Medical University, Uchinada, Japan.
²⁵ Department of Neuropsychiatry, Toho University Graduate School of Medicine, Tokyo, Japan.
²⁶ Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan.
²⁷ Toyama City Hospital, Toyama, Japan.
²⁸ Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan.
²⁹ Katsumoto Mental Clinic, Oosaka, Japan.
³⁰ Department of Psychiatry, Tohoku University Hospital, Sendai, Japan.
³¹ Department of Psychiatry, Yokohama City University Graduate School of Medicine, Yokohama, Japan.

Abstract

In several clinical guidelines for schizophrenia, long-term use of anticholinergic drugs is not recommended. We investigated the characteristics of the use of anticholinergics in patients with schizophrenia by considering psychotropic prescription patterns and differences among hospitals. A cross-sectional, retrospective prescription survey at the time of discharge was conducted on 2027 patients with schizophrenia from 69 Japanese hospitals. We examined the relations among psychotropic drug prescriptions regarding anticholinergic prescription. We divided the hospitals into three groups-low rate group (LG), medium rate group (MG), and high rate group (HG)-according to their anticholinergic prescription rates, and analyzed the relationship between anticholinergic prescription rates and antipsychotic prescription. Anticholinergic drugs were prescribed to 618 patients (30.5%), and the prescription rates were significantly higher for high antipsychotic doses, antipsychotic polypharmacy, and first-generation antipsychotics (FGAs) use. The anticholinergic prescription rate varied considerably among hospitals, ranging from 0 to 66.7%, and it was significantly higher in patients with antipsychotic monotherapy, antipsychotic polypharmacy, and normal and high doses of antipsychotics in HG than in those LG and MG. The anticholinergics prescription rate in patients with second-generation antipsychotic monotherapy in HG was also significantly higher than in those LG and MG; however, the difference was no longer significant in patients with FGA monotherapy. Conclusively, in addition to high antipsychotic doses, antipsychotic polypharmacy, and FGA use, hospital characteristics influence the prescribing of anticholinergic drugs.

Keywords: anticholinergic drugs; antipsychotic monotherapy; antipsychotic polypharmacy; first-generation antipsychotics; schizophrenia; second-generation antipsychotic (SGA).

Copyright © 2022 Hori, Yasui-Furukori, Hasegawa, Iga, Ochi, Ichihashi, Furihata, Kyo, Takaesu, Tsuboi, Kodaka, Onitsuka, Okada, Murata, Kashiwagi, Iida, Hashimoto, Ohi, Yamada, Ogasawara, Yasuda, Muraoka, Usami, Numata, Takeshima, Yamagata, Nagasawa, Tagata, Makinodan, Kido, Katsumoto, Komatsu, Matsumoto, Kubota, Miura, Hishimoto, Watanabe, Inada, Kawasaki and Hashimoto.