CHANGE OF PRESCRIPTION FOR PATIENTS WITH SCHIZOPHRENIA DURING ADMISSION: REAL-WORLD PRESCRIBING SURVEYS FROM THE EFFECTIVENESS OF GUIDELINES FOR DISSEMINATION AND EDUCATION PSYCHIATRIC TREATMENT PROJECT
Authors: Hashimoto *Naoki , Yasui-Furukori Norio , Hasegawa Naomi , Hori Hikaru , Iida Hitoshi , Ichihashi Kayo , Miura Kenichiro , Matsumoto Junya , Numata Shusuke , Kodaka Fumitoshi , Furihata Ryuji , Inada Ken , Watanabe Koichiro , Hashimoto Ryota 
Published: February 2025

Abstract

Background
In Japan, the Effectiveness of Guidelines for Dissemination and Education (EGUIDE) psychiatric treatment project was launched in 2016. In the EGUIDE project, we developed a 2-day education course for psychiatrists to learn Japanese treatment guidelines for schizophrenia and major depressive disorder (MDD) (one day for each disorder). In this program, we also evaluated the participants’ prescribing activity (prescription at admission and discharge for patients with schizophrenia or MDD) to assess the effectiveness of our program. Our previous report showed that polypharmacy of the main treatment drug (antipsychotics in schizophrenia and antidepressants in major depressive disorder) and additional prescription of psychotropics other than the main drug were common in Japan. In the current study, by assessing changes in prescriptions during hospitalization, we aimed to identify the clues that improve pharmacological prescriptions for patients with schizophrenia.

Methods
Psychiatrists were recruited between April 2016 and September 2020. Written informed consent was obtained from all the participants after the procedures had been fully explained by a chief researcher at the facility. This study was approved by the ethics committees of the National Center of Neurology and Psychiatry (A2017-105) and each participating university, hospital, or clinic. The study was conducted in accordance with the Declaration of Helsinki. The study protocol was registered in the University Hospital Medical Information Network Registry (UMIN000022645).Data on prescriptions at admission and discharge from 2016 to 2020 were collected. We divided the patients into four groups: 1) mono_mono group, monotherapy of the main drug at admission and discharge; 2) mono_poly group, monotherapy at admission and polypharmacy at discharge; 3) poly_poly group, polypharmacy at admission and discharge; and 4) poly_mono group, polypharmacy at admission and monotherapy at discharge. We compared the changes in dosage and number of psychotropics among the four groups.

Results
For patients with schizophrenia, the patients who received monotherapy with the main drug at admission were likely to receive main drug monotherapy at discharge and vice versa. When monotherapy of main drug at admission became polypharmacy at discharge, the number of concomitant psychotropic medications also increased. On the other hand, when polypharmacy of main drug at admission became monotherapy at discharge, the number of concomitant psychotropic medications also decreased.

Conclusions
Our results showed that patients who received monotherapy with the main drug at admission were more likely to receive monotherapy at discharge and vice versa. In addition, when the main treatment involved a polypharmacy regimen, the number of psychotropic drugs prescribed besides the main treatment drug tended to increase. These results suggest that it is critical to avoid a polypharmacy regimen as the main treatment for schizophrenia. We gathered follow-up data from the same psychiatrists and assessed the changes in prescription patterns after these psychiatrists received special instructions regarding the guidelines. We expect clinicians to prescribe higher rates of monotherapy with the main drug after receiving special instructions regarding the guidelines.