The characteristics of discharge prescriptions including pro re nata psychotropic medications for patients with schizophrenia and major depressive disorder from the survey of the “Effectiveness of guidelines for dissemination and education in psychiatric treatment (EGUIDE)” project
Authors: Kyou Yoshitaka , Yasui-Furukori Norio , Hasegawa Naomi , Ide Kenta , Ichihashi Kayo , Hashimoto Naoki , Hori Hikaru , Shimizu Yoshihito , Imamura Yayoi , Muraoka Hiroyuki , Iida Hitoshi , Ohi Kazutaka , Yasuda Yuka , Ogasawara Kazuyoshi , Numata Shusuke , Iga Jun-ichi , Tsuboi Takashi , Ochi Shinichiro , Kodaka Fumitoshi , Furihata Ryuji , Onitsuka Toshiaki , Makinodan Manabu , Komatsu Hiroshi , Takeshima Masahiro , Kubota Chika , Hishimoto Akitoyo , Atake Kiyokazu , Yamagata Hirotaka , Kido Mikio , Nagasawa Tatsuya , Usami Masahide , Kishimoto Taishiro , Kikuchi Saya , Matsumoto Junya , Miura Kenichiro , Yamada Hisashi , Watanabe Koichiro , Inada Ken , Hahimoto Ryota 
Published: December 2022

Abstract
Background
Several guidelines recommend monotherapy in pharmacotherapy for schizophrenia and major depressive disorder. The content of regular prescriptions has been reported in several studies, but not enough research has been conducted on the content of pharmacotherapy, including pro re nata (PRN) medications. The purpose of this study was to evaluate the content of pharmacotherapy, including PRN medications, and to clarify the relationship with regular prescriptions.

Methods
We used data from the “Effectiveness of Guidelines for Dissemination And Education in psychiatric treatment” (EGUIDE) project to investigate the presence or absence of PRN psychotropic medications at discharge for each drug category. We compared the PRN psychotropic prescription ratio at discharge by diagnosis for each drug category. The antipsychotic monotherapy ratio and no prescription ratio of other psychotropics for schizophrenia at discharge and the antidepressant monotherapy ratio and no prescription ratio of other psychotropics for major depressive disorder at discharge were calculated for each regular prescription, including PRN psychotropic medications, as quality indicators (QIs). Spearman's rank correlation test was performed for QI values of regular prescriptions and the QI ratio between regular prescriptions and prescriptions including PRN medications for each diagnosis.

Results
The PRN psychotropic prescription ratio at discharge was 28.7% for schizophrenia and 30.4% for major depressive disorder, with no significant differences by diagnosis. The prescription ratios of PRN antipsychotic medications and PRN antiparkinsonian medications were significantly higher for schizophrenia. The prescription ratios of PRN anxiolytic and hypnotic and PRN antidepressant medications were significantly higher for patients with major depressive disorder. For both schizophrenia and major depressive disorder, the QI was lower for discharge prescriptions, including PRN medications, than for regular prescriptions. QI values for regular prescriptions and the QI ratio were positively correlated.

Conclusions
Considering PRN psychotropic medications, the monotherapy ratio and no prescription ratio of other psychotropics at discharge decreased in pharmacotherapy for schizophrenia and major depressive disorder. A higher ratio of monotherapy and no prescription of other psychotropics on regular prescriptions may result in less concomitant use of PRN psychotropic medications. Further studies are needed to optimize PRN psychotropic prescriptions.