The Study Of Antipsychotic Polypharmacy Investigation And Its Influencing Factors In Inpatients With Schizophrenia

Bcckground: Schizophrenia is a common and severe mental disease with chronic,recurrent and intractable characteristics,which are associated with high rate of hospitalization.During the hospitalization,the main treatment of schizophrenia is drug therapy.Most guidelines for the treatment of schizophrenia suggest that antipsychotic monopharmacy(AMP)should be preferred.Nevertheless,antipsychotic polypharmacy(APP)is common in clinical practice.So far,the previous studies have found that the influencing factors of APP in patients include their social demographic characteristics,clinical features and the type of payment.Moreover,they also demonstrated that the usage of APP was different in different region.The related studies conducted in China were limited and the results of them were inconsistant.Therefore,investing the pattern and the trend of APP in inpatients with schizophrenia,then exploring the influencing fators of APP may be helpful to improve the quality of clinical services.Objective: Investigating and describing the pattern of APP and its changing trend in recent years;Then exploring the factors associated with APP among inpatients of schizophrenia.Method: The first part: using the electronic medical record system of Guangzhou Huiai Hospital to recruit 2121 schizophrenia inpatients who discharged in 2012,2014 and 2016.Then using self-made scale to record inpatients' social demographic data,clinical features and prescription on the day when they discharged.Describing the current pattern and the trend of antipsychotic drugs in inpatients of schizophrenia.The second part: using the electronic medical record system to respectively rectuit schizophrenia inpatients who discharged during 2016 from of The Third People's Hospital of Foshan and Wuzhongpei Memorial Hospital.Combining with the inpatients who discharged in 2016 from Guangzhou Huiai Hospital,total 1725 inpatients were recruited.Then describing the pattern of APP in inpatients with schizophrenia and exploring its influencing factors among these three mental hospitals.Results: 1.From Guangzhou Huiai Hospital,we recruited 539 schizophrenic inpatients who discharge in 2012,801 in 2014 and 781 in 2016,total 2121.The utilization rate of APP is 43.6% in average.Our study reveals that the utilized rate of APP was rising year by year,from 36.9% in 2012 to 45.4% in 2014,then rising to 46.2% in 2016.The difference among them is not statistically significance.(X2=13.073,P<0.001)2.Among the schizophrenic inpatients(total 2121)of Guangzhou Huiai Hospital who discharge in 2012,2014 and 2016,the combined using rate of FGAs is low in the total prescription and the APP prescription.And the combined using rate of SGAs is high in total prescription and APP prescription.The average utilized rate of risperidone in the total prescription during these three years is 36.8%,the average utilized rate of risperidone in the APP prescription during these three years is 45.6%;Olanzapine are 32.4% and 45.9% respectively;Clozapine are 26.7% and 38.0% respectively.The using rate of these three drug are on top three in the total prescription and the APP prescription.3.Among the schizophrenic inpatients(total 2121)of Guangzhou Huiai Hospital who discharge in 2012,2014 and 2016,the using rate of combination between second generation antipsychotics and second generation antipsychotics(SGAs + SGAs)is increasing year by year.Our study reveals that from 63.3% in 2012 to 78.3% in 2014,then rising to 85.9% in 2016.(X2=36.355,P<0.001)Our study also find that the combination of two different types antipsychotic drugs is in highest proportion: it was 96.0% in 2012,97.3% in 2014,then 97.3% in 2016,the difference is not statistically significant.(X2=1.689,P=0.793)The top six combinations are risperidone and clozapine,risperidone and olanzapine,olanzapine and clozapine,olanzapine and aripiprazole,clozapine and aripiprazole,risperidone and quetiapine.4.Among the schizophrenic inpatients(total 1725)of Guangzhou Huiai Hospital,The Third People's Hospital of Foshan and Wuzhongpei Memorial Hospital in 2016,the using rate of APP respectly are 46.2%,43.3% and 45.5%.The result indicates that the difference of the using rate of APP among these three hospitals is not statistically significant.(X2=1.304,P=0.521)5.Among the schizophrenic inpatients(total 1725)of Guangzhou Huiai Hospital,The Third People's Hospital of Foshan and Wuzhongpei Memorial Hospital in 2016,the difference between AMP group and APP group by age,sex,the degree of education,cigarette using or not,family history and the type of payment are not statistically significant(P>0.05);But the difference in the marriage status(X2=18.362,P<0.001),the working status(X2=9.826,P=0.002),the onset age(t= 9.226,P<0.001),the total duration(Z=0.8077,P<0.001),the hospitalization time(Z=12.641,P<0.001),the length of stay(LOS)(Z=8.750,P<0.001),the combined using of ? blockers or not(X2=30.581,P<0.001),the combined using of benzodiazepines or not(X2=16.904,P<0.001),the using of FGAs or not(X2=68.262,P<0.001)and the using of SGAs or not(X2=22.377,P<0.001)are statistically significant.6.Among the schizophrenic inpatients(total 1725)of Guangzhou Huiai Hospital,The Third People's Hospital of Foshan and Wuzhongpei Memorial Hospital in 2016,the statistical Regression analysis results shows that the onset age of disease,the length of stay,the previous hospitalizations,whether using ? blockers,benzodiazepines and FGAs are the influencing factors of APP in schizophrenic inpatients.(P < 0.05)Conclusion: 1.The using rate of APP in inpatients with schizophrenia is rising year by year,the difference of using rate of APP among three mental hospital is not statistically significant,and the average using rate of APP is 44.9%.2.In the total prescription and the APP prescription survey among the inpatients with schizophrenia,the using rate of risperidone,olanzapine and clozapine are on top three.The combination of SGAs + SGAs is in the highest utilized rate in the APP prescription survey.And the top six combinations are risperidone and clozapine,risperidone and olanzapine,olanzapine and clozapine,olanzapine and aripiprazole,clozapine and aripiprazole,risperidone and quetiapine.3.Mutiple logistic regression analysis of the whole sample from these three mental hospitals reveals that the onset age,the hospitalization time,the length of stay,whether using of ? blockers,benzodiazepines or FGAs is the influencing factors of APP in hospitalized patients with schizophrenia.And the early onset age,more previous hospitalizations,longer length of stay,the more combined using of ? blockers and FGAs,the less combined using of benzodiazepines are the risk factors for inpatients with schizophrenia to use APP.