Prescribing trends in treatment-resistant schizophrenia

Figures & data

Table 1 . Type of intervention.

Medication change made to address treatment resistance (N:207)	N	%
Monotherapy (switching to a different antipsychotic)	83	40.1
Combination therapy with two or more antipsychotics	84	40.6
Augmentation therapy	10	4.8
High-dose antipsychotic	3	1.4
Two different methods	27	13.1
Clozapine treatment^a	100	48.3

^aAs a monotherapy or part of any of the interventions above.

Table 2. Characteristics of psychiatrists who managed patients with treatment-resistant schizophrenia by either monotherapy or combination treatment.

	Monotherapy (N: 83)			Combination (N: 84)
Psychiatrist’ characteristics	Total N	N	%	Total N	N	%	Test statistics	df	p
Demographic and practice characteristics
Age (M ± SD)	36.04 ± 9.86			36.17 ± 8.61			t = −0.09	162	.93
Gender (Female)	83	47	56.6	84	45	53.6	X^2= 0.16	1	.81
Years in clinical practice	9.57 ± 9.08			8.28 ± 7.54			t = 0.99	161	.70
Professional position
Academic	82	17	20.7	84	13	15.5	X^2= 0.77	1	.50
Non-academic		65	79.3		71	84.5
Main setting of work:
Inpatient	83	10	12	84	6	7.1	X^2= 1.28	2	.53
Outpatient		41	49.4		46	54.8
Both inpatient and outpatient		32	38.6		32	38.1
Case load of patients with schizophrenia (M ± SD)	21.52 ± 24.07			17.78 ± 17.11			t = 1.15	162	.25
Monthly number of hours spent for professional development(M ± SD)	26.76 ± 26.09			21.08 ± 16.33			t = 1.67	135.5	.10
Weekly number of meetings with pharmaceutical representatives (M ± SD)	5.73 ± 4.04			6.62 ± 5.35			t = -1.19	161	.23
Number of pharmaceutical industry-sponsored education programmes attended in the previous year (M ± SD)	2.96 ± 4.09			2.88 ± 2.83			t = 0.15	160	.88
Familiarity with practice guidelines (M ± SD)
TPD	3.30 ± 1.37			3.22 ± 1.12			t = 0.42	152.2	.67
APA	2.63 ± 1.44			2.68 ± 1.20			t = −0.24	153.1	.81
NICE/BAP	2.12 ± 1.56			2.27 ± 1.36			t = −0.63	149	.53
CPA	1.83 ± 1.53			1.84 ± 1.54			t = −0.04	152	.97

Table 3. Socio-demographic and clinical characteristics of patients whose treatment-resistant schizophrenia was managed by monotherapy or combination treatment.

Patient’ characteristics	Switch (N:8 3)			Combination (N:8 4)
	Total N	N	%	Total N	N	%	Test Statistic	df	p
Demographics
Age (M ± SD)	35.28 ± 9.64			37.23 ± 9.94			t = −1.27	161	.21
Gender (Female)	83	32	38.6	84	31	36.9	X^2 = 0.05	1	.95
Marital Status (Never married)	82	57	69.5	84	52	61.9	X^2 = 1.07	1	.39
Employment Status (Not employed)	83	71	85.5	84	76	90.5	X^2 = 0.96	1	.46
Clinical characteristics
Lifetime psychiatric comorbidity	78	53	67.9	81	57	70.4	X^2 = 0.11	1	.87
Major depression	80	24	30.0	82	31	37.8	X^2 = 1.10	1	.38
Anxiety disorder	80	15	18.8	82	18	22.0	X^2 = 0.26	1	.76
Obsessive Compulsive disorder	80	10	12.5	82	11	13.4	X^2 = 0.03	1	.86
Substance Use Disorder	80	14	17.5	82	10	12.2	X^2 = 0.90	1	.47
Suicide attempt	82	13	15.9	84	18	21.4	X^2 = 0.85	1	.47
Psychiatric hospitalization	83	74	89.2	84	67	79.8	X^2 = 2.80	1	.14
Duration of treatment with the psychiatrist (month) (M ± SD)	18.4 ± 13.44			21.02 ± 25.14			t = −0.94	122	.35

Table 4. Effectiveness of interventions.^a

Overall effectiveness of the type of medication change on Global Assessment of Functioning(GAF) scores^b
	Pre-intervention GAF score	Post-intervention GAF score	ANCOVA, F	p
Monotherapy (n: 81)	33.54 (13.55)	59.51 (16.15)	0.19	.66
Combination (n: 77)	35.58(13.23)	59.61 (12.72)
Overall effectiveness of the type of medication change in suppressing positive psychotic symptoms^c
	Mean	SD	t (df)	p
Switch (n: 83)	3.35	0.99	0.53 (162)	.60
Combination (N: 81)	3.27	0.90

^aData are weighted to account for survey non-response. Numbers vary because of missing data.

^bPossible scores range from 1 to 100, with lower scores indicating more severe impairment.

^cAs measured by a Likert scale. Possible scores range from 1 to 5, with higher scores indicating greater effectiveness.