Schizophrenia Bulletin Advance Access published online on November 7, 2008
Schizophrenia Bulletin, doi:10.1093/schbul/sbn138
The Appropriateness of Routine Medication Treatment for Schizophrenia
2 Department of Veterans Affairs Desert Pacific Mental Illness Research, Education and Clinical Center, Los Angeles, CA
3 Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles
4 Greater Los Angeles VA Healthcare Center, Los Angeles, CA
5 Long Beach Veterans Affairs Healthcare Center, Long Beach, CA
1 To whom correspondence should be addressed; West Los Angeles Veterans Affairs Healthcare Center and University of California Los Angeles, MIRECC, 11301 Wilshire Boulevard (210A), Los Angeles, CA 90073; e-mail: ayoung{at}ucla.edu.
Objective: Although national guidelines specify appropriate strategies for the treatment of schizophrenia, this disorder presents challenges to clinicians and health-care organizations. To improve care, it is useful to understand how often patients receive appropriate treatment. Most research evaluating treatment was performed when first-generation antipsychotic medications were the modal treatment. Given that most prescriptions are now for second-generation medications, this study describes current clinical problems and the appropriateness of treatment in routine practice. Method: Between 2002 and 2004, a random sample of patients (n = 398) were interviewed at baseline and 1 year at 3 Department of Veterans Affairs mental health clinics. Symptoms and side effects were assessed. Analyses examined whether prescribing were consistent with guidelines in patients with significant psychosis, depression, parkinsonism, akathisia, tardive dyskinesia, or elevated weight. Results: Few patients met criteria for depression, parkinsonism, or akathisia. A total of 44% of patients had significant psychosis, 11% had tardive dyskinesia, and 46% were overweight. Medication was appropriate in 27% of patients with psychosis, 25% of patients with tardive dyskinesia, and 2% of patients with elevated weight. Management of elevated weight improved modestly over time. Treatment was more likely to improve for patients whose psychiatrists had more than 12 patients with schizophrenia in their caseload. Conclusion: Compared with the 1990s, outpatients are more likely to have significant psychosis. The rate of appropriate treatment of psychosis is unchanged. Weight gain has become a prevalent side effect, yet treatment is rarely changed in response to weight. There is a need for interventions that improve management of psychosis and weight.
Keywords: antipsychotics / community mental health / drug side effects / quality measurement / health service research / quality of care / weight management