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Open Access Research article

Treatment of schizophrenia with antipsychotics in Norwegian emergency wards, a cross-sectional national study

Rune A Kroken1*, Erik Johnsen1, Torleif Ruud34, Tore Wentzel-Larsen5 and Hugo A Jørgensen12

Author Affiliations

1 Division of Psychiatry, Haukeland University Hospital, PO Box 23, N-5812, Bergen, Norway

2 Department of Clinical Medicine, Section Psychiatry, University of Bergen, N-5020 Bergen, Norway

3 Division of Mental Health Services, Department of Research and Development, Akershus University Hospital, 1478 Lørenskog, Norway

4 SINTEF Health Research, 0314 Oslo, Norway

5 Centre for Clinical Research, Haukeland University Hospital, N-5021 Bergen, Norway

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BMC Psychiatry 2009, 9:24  doi:10.1186/1471-244X-9-24

Published: 16 May 2009

Abstract

Background

Surveys on prescription patterns for antipsychotics in the Scandinavian public health system are scarce despite the prevalent use of these drugs. The clinical differences between antipsychotic drugs are mainly in the areas of safety and tolerability, and international guidelines for the treatment of schizophrenia offer rational strategies to minimize the burden of side effects related to antipsychotic treatment. The implementation of treatment guidelines in clinical practice have proven difficult to achieve, as reflected by major variations in the prescription patterns of antipsychotics between different comparable regions and countries. The objective of this study was to evaluate the practice of treatment of schizophrenic patients with antipsychotics at discharge from acute inpatient settings at a national level.

Methods

Data from 486 discharges of patients from emergency inpatient treatment of schizophrenia were collected during a three-month period in 2005; the data were collected in a large national study that covered 75% of Norwegian hospitals receiving inpatients for acute treatment. Antipsychotic treatment, demographic variables, scores from the Global Assessment of Functioning and Health of the Nation Outcome Scales and information about comorbid conditions and prior treatment were analyzed to seek predictors for nonadherence to guidelines.

Results

In 7.6% of the discharges no antipsychotic treatment was given; of the remaining discharges, 35.6% were prescribed antipsychotic polypharmacy and 41.9% were prescribed at least one first-generation antipsychotic (FGA). The mean chlorpromazine equivalent dose was 450 (SD 347, range 25–2800). In the multivariate regression analyses, younger age, previous inpatient treatment in the previous 12 months before index hospitalization, and a comorbid diagnosis of personality disorder or mental retardation predicted antipsychotic polypharmacy, while previous inpatient treatment in the previous 12 months also predicted prescription of at least one FGA.

Conclusion

Our national survey of antipsychotic treatment at discharge from emergency inpatient treatment revealed antipsychotic drug regimens that are to some degree at odds with current guidelines, with increased risk of side effects. Patients with high relapse rates, comorbid conditions, and previous inpatient treatment are especially prone to be prescribed antipsychotic drug regimens not supported by international guidelines.