Predictors of switching antipsychotic medications in the treatment of schizophrenia

• Published in: BMC psychiatry Vol. 10; no. 1; p. 75
• Main Authors: Nyhuis, Allen W, Faries, Douglas E, Ascher-Svanum, Haya, Stauffer, Virginia L, Kinon, Bruce J
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 28.09.2010; BioMed Central; BMC
• Subjects: Ambulatory Care; Antipsychotic Agents - administration & dosage; Antipsychotic Agents - therapeutic use; Antipsychotic drugs; Care and treatment; Clinical medicine; Cost control; Drug Administration Schedule; Female; Follow-Up Studies; Health aspects; Humans; Male; Middle Aged; Multicenter Studies as Topic - statistics & numerical data; Patient outcomes; Probability; Proportional Hazards Models; Psychiatric Status Rating Scales - statistics & numerical data; Psychiatry; Psychotropic drugs; Randomized Controlled Trials as Topic - statistics & numerical data; Schizophrenia; Schizophrenia - diagnosis; Schizophrenia - drug therapy; Schizophrenic Psychology; Severity of Illness Index; Survival Analysis; Treatment Outcome; United States
• DOI: 10.1186/1471-244X-10-75
• ISSN: 1471-244X

To identify patient characteristics and early changes in patients' clinical status that best predict subsequent switching of antipsychotic agents in the long-term treatment of schizophrenia. This post-hoc analysis used data from a one-year randomized, open-label, multisite study of antipsychotics in the treatment of schizophrenia. The study protocol permitted switching of antipsychotics when clinically warranted after the first eight weeks. Baseline patient characteristics were assessed using standard psychiatric measures and reviews of medical records. The prediction model included baseline sociodemographics, comorbid psychiatric and non-psychiatric conditions, body weight, clinical and functional variables, as well as change scores on standard efficacy and tolerability measures during the first two weeks of treatment. Cox proportional hazards modeling was used to identify the best predictors of switching from the initially assigned antipsychotic medication. About one-third of patients (29.5%, 191/648) switched antipsychotics before the end of the one-year study. There were six variables identified as the best predictors of switching: lack of antipsychotic use in the prior year, pre-existing depression, female gender, lack of substance use disorder, worsening of akathisia (as measured by the Barnes Akathisia Scale), and worsening of symptoms of depression/anxiety (subscale score on the Positive and Negative Syndrome Scale) during the first two weeks of antipsychotic therapy. Switching antipsychotics appears to be prevalent in the naturalistic treatment of schizophrenia and can be predicted by a small and distinct set of variables. Interestingly, worsening of anxiety and depressive symptoms and of akathisia following two weeks of treatment were among the more robust predictors of subsequent switching of antipsychotics.