Use of second-generation antipsychotics in the acute inpatient management of schizophrenia in the Middle East

Sulaiman Alkhadhari 1, Nasser Al Zain 2, Tarek Darwish 3, Suhail Khan 4, Tarek Okasha 5, Hisham Ramy 5, Talaat Matar Tadros 6

Affiliations

01 April 2015

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doi: 10.2147/NDT.S78788

Abstract

Background: Management of acute psychotic episodes in schizophrenic patients remains a significant challenge for clinicians. Despite treatment guidelines recommending that second-generation antipsychotics (SGAs) should be used as monotherapy, first-generation antipsychotics, polypharmacy, and lower than recommended doses are frequently administered in clinical practice. Minimal data exist regarding the use of SGAs in the Middle East. The objective of this study was to examine the discrepancies between current clinical practice and guideline recommendations in the region.

Methods: RECONNECT-S Beta was a multicenter, noninterventional study conducted in Egypt, Kuwait, Saudi Arabia, and the United Arab Emirates to observe the management of schizophrenic patients who were hospitalized due to an acute psychotic episode. Patients underwent one visit on the day of discharge. Demographic and medical history, together with data on antipsychotic treatment and concomitant medication during the hospitalization period and medication recommendations at discharge were recorded.

Results: Of the 1,057 patients, 180 (17.0%) and 692 (65.5%) received SGAs as monotherapy and in combination therapy, respectively. Overall, the most frequently administered medications were given orally, and included risperidone (40.3%), olanzapine (32.5%), and quetiapine (24.6%); the doses administered varied between countries and deviated from the recommended guidelines. Upon discharge, 93.9% of patients were prescribed SGAs as maintenance therapy, and 84.8% were prescribed the same medication(s) as during hospitalization.

Conclusion: Current clinical practice in the Middle East differs from guideline recommendations. Patients frequently received antipsychotics in combination therapy, by various methods of administration, and at doses above and below the recommended guidelines for the management of their acute psychotic episodes.

Keywords: Middle East; acute psychotic episode; schizophrenia; second-generation antipsychotic; treatment guidelines.

Figures

Figure 1 Study design. Notes: Patients made one visit on the day of their discharge after hospitalization due to an acute psychotic episode; during this visit, data on demographics, diagnosis, and medical history were recorded. In addition, data on antipsychotic treatment and concomitant medication were collected for the hospitalization period, together with the recommendation at discharge. Any patients who met the enrolment criteria (≥18 years and met the diagnostic criteria for schizophrenia stated in Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) and had signed a written informed consent form were included in the study.

Figure 1 Study design. Notes: Patients made one visit on the day of their discharge after hospitalization due to an acute psychotic episode; during this visit, data on demographics, diagnosis, and medical history were recorded. In addition, data on antipsychotic treatment and concomitant medication were collected for the hospitalization period, together with the recommendation at discharge. Any patients who met the enrolment criteria (≥18 years and met the diagnostic criteria for schizophrenia stated in Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) and had signed a written informed consent form were included in the study.

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