Open Access Research article

Previous hospital admissions and disease severity predict the use of antipsychotic combination treatment in patients with schizophrenia

Albert Bolstad1*, Ole A Andreassen23, Jan I Røssberg23, Ingrid Agartz12, Ingrid Melle23 and Lars Tanum34

Author Affiliations

1 Department of Psychiatry Research, Diakonhjemmet Hospital, P.O. Box 85 Vinderen, Oslo 0319, Norway

2 Section of Psychosis Research, Clinic of Mental Health and Addiction, Oslo University Hospital, Ullevål Hospital, P.O. Box 4956 Nydalen, Oslo 0424, Norway

3 Institute of Clinical Medicine, University of Oslo, P.O. Box 1171 Blindern, Oslo 0318, Norway

4 Department of Psychiatric Research and Development, Akershus University Hospital and University of Oslo, Lørenskog 1478, Norway

For all author emails, please log on.

BMC Psychiatry 2011, 11:126  doi:10.1186/1471-244X-11-126

Published: 3 August 2011

Abstract

Background

Although not recommended in treatment guidelines, previous studies have shown a frequent use of more than one antipsychotic agent among patients with schizophrenia. The main aims of the present study were to explore the antipsychotic treatment regimen among patients with schizophrenia in a catchment area-based sample and to investigate clinical characteristics associated with antipsychotic combination treatment.

Methods

The study included 329 patients diagnosed with schizophrenia using antipsychotic medication. Patients were recruited from all psychiatric hospitals in Oslo. Diagnoses were obtained by use of the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). Additionally, Global Assessment of Functioning (GAF), Positive and Negative Syndrome Scale (PANSS) and number of hospitalisations and pharmacological treatment were assessed.

Results

Multiple hospital admissions, low GAF scores and high PANSS scores, were significantly associated with the prescription of combination treatment with two or more antipsychotics. The use of combination treatment increased significantly from the second hospital admission. Combination therapy was not significantly associated with age or gender. Regression models confirmed that an increasing number of hospital admission was the strongest predictor of the use of two or more antipsychotics.

Conclusions

Previous hospital admissions and disease severity measured by high PANSS scores and low GAF scores, predict the use of antipsychotic combination treatment in patients with schizophrenia. Future studies should further explore the use of antipsychotic drug treatment in clinical practice and partly based on such data establish more robust treatment guidelines for patients with persistently high symptom load.