Abstract
Objective: A brief file and medication chart review was undertaken to examine the ‘real world’ treatment of schizophrenia, with a particular focus on long-term treatment strategies that extend beyond existing evidence-based guidelines.
Method: Treatment strategies were identified through an audit of patient files and their medication charts for patients admitted 2–5 years in a non-acute psychiatric hospital.
Results: Twenty-nine file reviews and 20 medication chart audits were conducted. High levels of diagnostic heterogeneity were identified with the presence of psychosis and mood-related diagnoses (primarily schizophrenia and schizoaffective disorder) and high rates of comorbidity (86%). Functional impairment, poor insight and high levels of risk were present in most patients. Treatments largely consisted of combination strategies with 75% of patients prescribed two or more antipsychotics and an average of 3.4 psychotropic medications in total. While clozapine was commonly prescribed (65%), this was often in combination with, on average, two other psychotropic agents.
Conclusions: Notwithstanding the limited sample, these findings provide a valuable glimpse into the management strategies employed in the long-term management of schizophrenia. Evidence-based guidelines are largely of limited value for this cohort that often has complex presentations and further research is urgently needed to provide guidance into management strategies that extend beyond 5 years, with particular emphasis on the utility of medication combinations.
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ACKNOWLEDGEMENTS
The authors acknowledge the NHMRC Program Grant (510135) for essential financial support. The authors would also like to thank Juelyn Ireland, Ann Fioritto and Michael Herman for their assistance in the collation and entry of data.
DISCLOSURES
Gin Malhi has served on a number of international and national pharmaceutical advisory boards, received funding for research and has been in receipt of honoraria for talks at sponsored meetings worldwide involving the following companies: AstraZeneca, Eli Lilly, Jansen-Cilag, Organon, Pfizer, and Wyeth. Danielle Adams has received honoraria from Eli Lilly for a speaking engagement. Roger Mulder received honoraria for speaking and travel assistance from Douglas Pharmaceuticals, Janssen-Cilag and AstraZeneca. Garry Walter has received educational grants from Eli Lilly, Janssen-Cilag and Pfizer, and travel assistance and an honorarium for a talk from Eli Lilly. Elsa Bernardi, Marta Miller and Brendan Smith have no competing interest.