(P-398) Treatment Patterns and Appropriateness of Antipsychotic Prescriptions in Patients with Schizophrenia

Background: Schizophrenia is a chronic mental condition presenting a wide range of symptoms. Although this mental disorder has a relatively low prevalence in comparison to other mental conditions, it has a negative impact on social and occupational functioning.

Objectives: This study is aimed to assess the inappropriateness of antipsychotic medication among schizophrenic patients and describe current patterns in schizophrenia treatments.

Methods: -

Design: A retrospective cohort study was conducted of all patients aged 15 and older with an active diagnosis of schizophrenia and treated with antipsychotics between 2008 and 2013 in the Spanish National Health System, specifically in the population of the Valencia region.
- Setting:The study has been carried out for the population covered by the Valencia Health Agency (VHA), about 97% of the 5 million inhabitants of the Valencia region. The exclusion criteria were patients with a first diagnosis of schizophrenia after the age of 65, people without pharmaceutical coverage by the VHA and people not registered in the municipal census.
- Exposures or interventions: Treatment initation with antipsychotics.
- Outcome measures: The main outcome measure was the inappropriateness of the pharmacotherapeutic management in patients receiving an antipsychotic treatment for schizophrenia.
- Statistical analysis: The cohort was stratified in prevalent and new users and by age. Descriptive analysis and stepwise logistic regression models were used to perform the statistical analysis.

Results: The main outcome was inappropriateness of the pharmacotherapeutic management, including polypharmacy use: 30.4% of patients received antipsychotic polypharmacy (6.8% were prescribed 3 or more antipsychotics); overdosage: a total of 318 individuals (1.6%) exceeded the maximum daily doses; and use of concomitant psychotropics without an associated diagnosis: 21.5% of patients received psychotropic drugs concomitantly without associated psychiatric diagnoses. Overall, females and those who had a comorbid condition, such as anxiety or depression, were less likely to receive antipsychotic polypharmacy. In contrast, concomitant treatment with other psychoactive drugs, such as antiparkinson drugs, anxiolytics and hypnotics and more visits to mental health hospital increased the risk of polypharmacy use.

Conclusions: In conclusion, a high level of inappropriateness has been detected among antipsychotic prescriptions. Practitioners should follow guidelines recommendations whenever possible in order to obtain the maximum benefit of antipsychotic medications without an increased risk of adverse effects in patients.