Atypical Antipsychotic Use Among Acute Schizophrenic Inpatients

SIR: The introduction of atypical antipsychotics has triggered the reevaluation of treatment strategies in schizophrenia.^1–3 However, little information is available about the prescribing of novel antipsychotic drugs, in general or in different settings, or about the differential characteristics of patients on novel antipsychotics. The aims of this study were both to elucidate the prescribing practices for atypical antipsychotics among acute schizophrenic inpatients in Athens and to reveal the differential characteristics of schizophrenic patients on atypical antipsychotics.

The subjects of this prospective study were 63 schizophrenic patients (39 males), consecutively admitted at Eginition Hospital, Department of Psychiatry, Athens, from February 1997 to March 1998. Their mean age was 30.2±8.8 years. All patients were diagnosed on the basis of DSM-IV criteria.⁴ Written informed consent was obtained from the subjects and their relatives. All patients were assessed on admission with the Positive and Negative Syndrome Scale (PANSS)⁵ by the same psychiatrist-investigator, who was blind to the patients' antipsychotic medications. Another independent psychiatrist performed analysis of patients' case notes, surveying the prescribing of antipsychotic drugs on the first week after their admission.

Of the total 63 patients, 22 (35%) were on atypical antipsychotics; of these, 12 (54%) used atypical antipsychotics as monotherapy, and 10 (46%) used atypical antipsychotics concurrently with conventional antipsychotics. Patients on atypical antipsychotics were evenly divided between men and women (50%) and had a mean age of 32.9 years (SD=9.0). The most often used atypical antipsychotics were risperidone (54%), clozapine (23%), olanzapine (18%) and sertindole (5%). It is worth noting that risperidone and olanzapine were introduced in Greece in May 1994 and December 1997, respectively. Clozapine was reintroduced in July 1990, and sertindole was introduced in December 1997 but was withdrawn in December 1998. Quetiapine and ziprasidone were not yet available in the Greek market during the period of the study.

Patients on atypical antipsychotics (as monotherapy or in combination with conventional antipsychotics, n=22, Group A) were compared with those on conventional antipsychotics (n=41, Group B). For the statistical evaluation, Mann-Whitney U-tests, Student's t-tests, or chi-square tests were used. There were no statistically significant differences between Group A and Group B patients on many sociodemographic and clinical-psychopathological parameters such as age (32.9 vs. 30.9 years), sex (men, 50% vs. 61%), family status (single, 70% vs. 87%), duration of illness (years, 6.7 vs. 7.6), PANSS-total score (73.2 vs. 76.0), PANSS-positive subscale score (18.1 vs. 18.4), PANSS-negative subscale score (18.7 vs. 18.8), and PANSS-general psychopathology subscale score (36.3 vs. 38.3). There were no statistically significant differences between Group A and Group B patients regarding the PANSS item scores with one exception. Schizophrenic patients on atypical antipsychotics showed a trend for significantly lower scores on item G14 of the PANSS (poor impulse control, 1.5 vs. 2.2; U=168, P=0.07).

In summary, acute schizophrenic patients on atypical antipsychotics were differentiated from those on conventional antipsychotics in that they had better impulse control.