Prescription Pattern of Antipsychotics in Patients with Schizophrenia in North West-Bank

Background: Antipsychotic prescription patterns are fundamentally different across countries and even regions due to variations in factors including health care policies, availability and cost of drugs, psychiatric training, and preferred treatment modalities. Objectives: The objectives of this study were to evaluate the prescribing pattern of antipsychotic drugs and its conformance to international treatment guidelines among patients attending governmental primary healthcare clinics. Furthermore, predictors of antipsychotic prescribing pattern are investigated. Methods: A cross sectional study at 4 governmental primary psychiatric healthcare centers in northern West-Bank, Palestine was carried out. Patients' medical files were used to obtain demographic, medication and clinical information. International guidelines for schizophrenia were used to create conformance indicators. Descriptive and statistics analysis was conducted using Statistical Package for Social Sciences SPSS 19. Results: A total of 250 patients were included in the analysis. Mean age of (mean ± SD) the patients was 41.5 ± 10.3 years. A total of 406 antipsychotic agents were used; 348 (85.7%) were form first generation antipsychotics (FGA). The prevalence of antipsychotic combination was 50.4% (n = 126). There was no significant difference in positive (P=0.3), negative (P=0.06) and psychopathology (P=0.5) scores of schizophrenia symptoms among patients on monotherapy versus those on antipsychotic combination. Furthermore, no significant difference was observed in the annual cost of antipsychotic monotherapy versus combination therapy. One hundred and five patients (42%) were using optimum dose (300 – 600 mg CPZeq) while the remaining were using sub or supra therapeutic doses. Regression analysis showed that use of depot, use of anticholinergic agents and use high CPZeq doses were significantly associated with antipsychotic combination. Discussions and Conclusions: This study indicated that antipsychotic prescribing was not in conformance with international guidelines. Antipsychotic combination was common and has no clinical benefits or economic drawbacks.