Switching Antipsychotics in Inpatient Schizophrenia Care: Predictors and Outcomes

Stefan Weinmann, M.D., Dr.P.H.; Birgit Janssen, M.D.; and Wolfgang Gaebel, M.D.

Background: Within a pharmacoepidemiologic study, characteristics of patients with schizophrenia switched from first- to second-generation antipsychotics (FGAs and SGAs, respectively) or to antipsychotic polypharmacy were compared with those of patients maintained on treatment with FGAs. The primary aim was to assess factors associated with antipsychotic switching and to compare disease course with regard to mental state and social functioning.

Method: Adult inpatients with an ICD-10 diagnosis of schizophrenia or schizoaffective disorder were assessed in 7 psychiatric hospitals. Data were collected between 2001 and 2002. For those patients (N = 847) with an antipsychotic prescription at discharge, t tests and covariance and logistic regression analyses were used to evaluate the relationship between demographic and clinical characteristics and antipsychotic switching.

Results: Patients switched from FGAs to SGAs had fewer previous psychiatric admissions, a shorter illness duration, fewer substance disorders, and a higher probability of working in a competitive setting but more pronounced symptoms than those maintained on treatment with FGAs. Mental state and social functioning after case-mix adjustment were more favorable in the group switched to SGA monotherapy but not in those patients administered FGAs and SGAs concurrently at discharge. Logistic regression controlling for demographic and clinical variables revealed that a short disease duration (p < .05), fewer previous psychiatric hospitalizations (p < .01), voluntary admission (p < .05), and pronounced thought disorder (p < .05) were significantly associated with switching from FGAs to SGAs. Hospital differences were also observed.

Conclusion: Remaining on FGAs or switching to SGAs in schizophrenia care depends strongly on institutional practices in addition to the previous disease course and health care utilization.

(J Clin Psychiatry 2004;65:1099-1105)

Received Oct. 27, 2003; accepted Feb. 2, 2004. From the Department of Psychiatry and Psychotherapy, Heinrich Heine University Duesseldorf, Duesseldorf, Germany.

This research was funded by the German Federal Ministry of Education and Research, Bonn, Germany (grant 01 GI 9932/7) on behalf of the Research Network in Schizophrenia, Duesseldorf, Germany (Dr. Gaebel).

The authors thank the inpatient staff involved in the study and the patients who participated, as well as all contributors to the Research Network in Schizophrenia. The authors also thank Alex Horne, M.D., and 2 anonymous reviewers for valuable suggestions and comments.

The perspective and conclusions presented in this article are solely those of the authors and should not be construed as representative of the German Federal Ministry of Education and Research.

Corresponding author and reprints: Stefan Weinmann, M.D., Dr.P.H., Department of Psychiatry and Psychotherapy, Heinrich Heine University Duesseldorf, Bergische Landstr. 2, D-40629 Duesseldorf, Germany (e-mail: Stefan.Weinmann@gmx.de).