Initial Schizophrenia Prescriptions Aren't Always Accurate

Many psychotropic medications prescribed to patients with first-episode schizophrenia do not comply with current treatment guidelines.

Many psychotropic medications prescribed to patients with first-episode schizophrenia do not comply with current treatment guidelines, according to findings published in The American Journal of Psychiatry.

Researchers from the Feinstein Institute for Medical Research in Manhasset, New York, observed 404 patients enrolled in the Recovery After an Initial Schizophrenia Episode Project’s Early Treatment Program (RAISE-ETP), which tested the effectiveness of various medications for first-episode schizophrenia spectrum disorders.

The investigators attempted to assess the extent to which community clinicians adjust their typical treatment regimens for first-episode psychosis patients. To do so, they analyzed patterns in prescriptions and the factors associated with prescription choice in the RAISE-ETP cohort.

In that cohort, the researchers identified 159 patients (39.4%) who they believed would benefit from a change in medication. The following adjustments were made, though some of the patients met multiple categories:

- Received prescriptions for recommended antipsychotics at higher doses: 8.8%

- Received prescriptions for olanzapine, often at higher doses: 32.1%

- Received prescription for more than one antipsychotic: 23.3%

- Received prescription for psychotropic medications without an antipsychotic: 10.1%

- Received prescription for stimulants: 1.2%

In light of their results, the authors recommended additional education for health care professionals who prescribe medications for first-episode psychosis patients. They highlighted the importance of prescribing a recommended medication early on, as it can lead to better health outcomes and minimize uncomfortable side effects.

“Community mental health clinicians usually have extensive experience treating individuals with multi-episode psychosis, (but) the challenge for the field is to develop ways to transmit the specialized knowledge about first episode treatment to busy community clinicians,” said study author Delbert Robinson, MD, in a press release.