[Prescription practices of antipsychotic medication in early psychosis: a two-year follow-up survey of subjects admitted in two psychiatric hospitals of South-Western France]
L'Encéphale. 2007-06-01; 33(3): 326-331
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1. Encephale. 2007 May-Jun;33(3 Pt 1):326-31. doi: 10.1016/s0013-7006(07)92046-1.
[Prescription practices of antipsychotic medication in early psychosis: a
two-year follow-up survey of subjects admitted in two psychiatric hospitals of
[Article in French]
Grolleau A(1), Cougnard A, Parrot M, Kalmi E, Desage A, Misdrahi D,
Brun-Rousseau H, Verdoux H.
(1)Université Victor-Segalen Bordeaux 2, Bordeaux, France.
OBJECTIVES: The aims of this pharmacoepidemiological study were to describe the
antipsychotic medication received during the first admission and over a two-year
follow-up in subjects with a first episode of psychosis, and to assess whether
the prescriptions in naturalistic conditions were in adequacy with guidelines.
METHOD: All first-admitted patients, less than 50 years old, consecutively
hospitalised in 10 acute wards of two psychiatric hospitals serving Bordeaux’s
catchment area were included over a period of one year, if they presented with
at least one overt psychotic symptom during the last month. Information on
psychotropic medication received during the first admission was collected in
medical records, and that received after the first admission was collected at
the end of a two-year follow-up using multiple sources of information.
RESULTS: Of the 86 patients included in the cohort, 53 presented with broadly
defined schizophrenia and 33 with psychotic mood disorder. All except two
subjects were prescribed at least one neuroleptic drug. Antipsychotic drugs
(amisulpride, olanzapine, risperidone, clozapine) were the most frequently
prescribed drugs during the first admission and over the two-year follow-up. If
sedative neuroleptics were excluded, antipsychotic drugs were the first
prescribed neuroleptic drugs in a large proportion (80%) of patients. Although
few patients were first prescribed a conventional neuroleptic, the proportion of
subjects treated with these drugs increased over the next prescriptions, and one
out of three patients was prescribed at least one of these drugs during the
follow-up. The mean dose of antipsychotic drugs at first discharge was higher
than that recommended in first episode patients (amisulpride 616 mg, olanzapine
13 mg, risperidone 7 mg). Coprescription of neuroleptic drugs, found in one
third of patients at all times of assessment, was especially due to
coprescription of a sedative neuroleptic to a conventional or an antipsychotic
one. Nearly half of the patients did not take any psychotropic medication at the
end of the follow-up.
CONCLUSION: The main recommendation specifying that the first neuroleptic
treatment in subjects with a first episode of psychosis should use antipsychotic
drugs instead of conventional neuroleptics was generally respected in this
cohort of first-admitted subjects with psychosis. However, conventional
neuroleptics were found in first or second rank prescriptions, although they
should not be used before at least the third rank. The recommendations that the
initial neuroleptic dose should be lower in subjects with a first episode, and
that coprescription of neuroleptics should be avoided, were frequently not
respected. This study highlights the fact that international guidelines should
be better applied in naturalistic conditions, and that clinicians have to be
better informed about these recommendations.
PMID: 17675930 [Indexed for MEDLINE]