Predictors of switching antipsychotic medications in the treatment of schizophrenia

BMC Psychiatry

Research Article

Haya Ascher-Svanum¹  Allen W Nyhuis¹  Virginia L Stauffer¹  Douglas E Faries¹  Bruce J Kinon¹ 

[1] Eli Lilly and Company, Indianapolis, IN, USA;

关键词: Schizophrenia;    Olanzapine;    Antipsychotic Medication;    Medication Discontinuation;    Baseline Body Weight;   

DOI  :  10.1186/1471-244X-10-75

 received in 2010-03-04, accepted in 2010-09-28,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundTo identify patient characteristics and early changes in patients' clinical status that best predict subsequent switching of antipsychotic agents in the long-term treatment of schizophrenia.MethodsThis post-hoc analysis used data from a one-year randomized, open-label, multisite study of antipsychotics in the treatment of schizophrenia. The study protocol permitted switching of antipsychotics when clinically warranted after the first eight weeks. Baseline patient characteristics were assessed using standard psychiatric measures and reviews of medical records. The prediction model included baseline sociodemographics, comorbid psychiatric and non-psychiatric conditions, body weight, clinical and functional variables, as well as change scores on standard efficacy and tolerability measures during the first two weeks of treatment. Cox proportional hazards modeling was used to identify the best predictors of switching from the initially assigned antipsychotic medication.ResultsAbout one-third of patients (29.5%, 191/648) switched antipsychotics before the end of the one-year study. There were six variables identified as the best predictors of switching: lack of antipsychotic use in the prior year, pre-existing depression, female gender, lack of substance use disorder, worsening of akathisia (as measured by the Barnes Akathisia Scale), and worsening of symptoms of depression/anxiety (subscale score on the Positive and Negative Syndrome Scale) during the first two weeks of antipsychotic therapy.ConclusionsSwitching antipsychotics appears to be prevalent in the naturalistic treatment of schizophrenia and can be predicted by a small and distinct set of variables. Interestingly, worsening of anxiety and depressive symptoms and of akathisia following two weeks of treatment were among the more robust predictors of subsequent switching of antipsychotics.

【 授权许可】

Unknown   
© Nyhuis et al; licensee BioMed Central Ltd. 2010. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.