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09-08-2011 | Mental health | Article

Hospital admissions and disease severity predict antipsychotic combination treatment


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MedWire News: Results from a Norwegian study indicate that an increased number of previous hospital admissions and greater symptom load predict the use of antipsychotic combination treatment in patients with schizophrenia.

"Although not recommended in treatment guidelines, previous studies have shown the frequent use of more than one antipsychotic agent among patients with schizophrenia," explain Albert Bolstad (Diakonhjemmet Hospital, Oslo) and team in the journal BMC Psychiatry.

To investigate factors associated with antipsychotic combination treatment among such patients, the team examined data on 329 patients with schizophrenia (64.7% men) who participated in the Thematically Organized Psychosis Study.

Information on current and previous drug treatment and previous hospitalisation rates was obtained from patient interviews and hospital records.

The patients were also assessed for disease severity using the Positive and Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF).

In total, 101 (30.7%) patients used two or more antipsychotics in combination. Of these, 61 used a combination of two second generation antipsychotics (SGAs), 37 used an SGA plus a first generation antipsychotic (FGA), and just two patients used a combination of two FGAs.

The researchers found a significant association between previous hospital admission rates and antipsychotic combination treatment. Indeed, 36.8% of patients with at least two previous hospital admissions received combination treatment compared with just 21.9% of those with one or no previous admissions, at an odds ratio of 2.4.

Patients who used two or more antipsychotics also had significantly lower average GAF-function (38.15 vs 42.32) and GAF-symptom (36.65 vs 41.51) scores and higher PANSS-positive (17.38 vs 15.81) and PANSS-negative (18.82 vs 16.16) scores than those who used one antipsychotic.

Bolstad and team conclude: "Previous hospital admissions and disease severity measured by high PANSS scores and low GAF scores, predict the use of antipsychotic combination treatment in patients with schizophrenia."

They add: "Future studies should further explore the use of antipsychotic drug treatment in clinical practice and partly based on such data establish more robust treatment guidelines for patients with persistently high symptom load."

MedWire ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Mark Cowen

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