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Comparing the Use and Discontinuation of Antipsychotics in Clinical Practice: An Observational Study

Mark Taylor, F.R.A.N.Z.C.P.; Polash Shajahan, M.R.C.Psych.; and Stephen M. Lawrie, M.D.

Background: There are few independent studies comparing atypical or second-generation antipsychotics (SGAs).

Objective: To compare the patterns of use and discontinuation of commonly used SGAs.

Method: Retrospective review of 11,250 case records (2002-2005) of all mental health care contacts in a discrete geographical setting in Scotland. Patterns of use, mean dose, psychotropic co-prescription, duration of treatment, discontinuation rates, and admission rates were examined for amisulpride, clozapine, olanzapine, quetiapine, and risperidone.

Results: Clozapine had a significantly lower discontinuation rate in individuals with schizophrenia, compared to the other 4 SGAs. Off-license prescribing and polypharmacy were common.

Conclusion: SGAs are variously used for schizophrenia and mood disorder and have heterogeneous outcomes, with clozapine being most effective in this study. Independent observational studies such as this complement randomized controlled trials.

 

(J Clin Psychiatry 2008;69:240-245; online ahead of print January 9, 2008)

Received Feb. 2, 2007; accepted May 22, 2007. From Springpark Centre, Glasgow (Dr. Taylor); Airbles Road Centre, Motherwell (Dr. Shajahan); and the Department of Psychiatry, University of Edinburgh, Edinburgh (Dr. Lawrie), United Kingdom.

No external funding was received for this study.

The authors are indebted to Muhammed Bashir, M.B.B.S.; Rebecca Carleton, M.R.C.Psych.; Claire Davey, M.B.Ch.B.; Aarohee Desai, M.B.B.S.; Norberto Fernandez-Rodriguez, M.B.B.S.; Chetan Majjiga, M.R.C.Psych.; and Angela Wilson, M.R.C.Psych., for their help with data collection. All of the acknowledged individuals have received hospitality, unrelated to the current study, from Bristol-Myers Squibb, Eli Lilly, Janssen Cilag, and Wyeth.

All of the authors have accepted unrelated hospitality and/or fees from pharmaceutical firms, including Astra-Zeneca, Eli-Lilly, and Janssen-Cilag. Dr. Taylor has received honoraria from Bristol-Myers Squibb and has participated in speakers/advisory boards for Janssen-Cilag, Eli Lilly, and Bristol-Myers Squibb. Dr. Shajahan has received honoraria from Eli Lilly, Bristol-Myers Squibb, and Janssen and has participated in speakers/advisory boards for Janssen. Dr. Lawrie has received grant/research support from Wyeth and honoraria from Eli Lilly and Janssen.

Corresponding author and reprints: Mark Taylor, F.R.A.N.Z.C.P., Springpark Centre, Glasgow G22 5EU, United Kingdom (e-mail: mark.taylor@glacomen.scot.nhs.uk).

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