Drugs Used in the Treatment of Schizophrenia over the Years 2000 to 2006– an Analysis of the AGATE Data Bases

The working group pharmacotherapy in psychiatry (AGATE, Arbeitsgemeinschaft Arzneimitteltherapie bei psychiatrischen Erkrankungen) is a joint venture of currently 39 psychiatric community hospitals to ensure a high level of quality in all areas of drug application. In 1992, AGATE started out with the documentation and evaluation of severe adverse drug effects. Since 1995, data are collected on drug prescription to all patients hospitalized on two census days per year in the cooperating hospitals [Haen E (2004): AGATE: Qualitätssicherung in der Psychopharmakotherapie. Neurotransmitter 15 (Heft 7/8), 34–43]. In the following, these data are evaluated for any switch in drugs used for treatment of schizophrenia (F20.0-F29.9) over the years 2000 (when AGATE started to code the diagnoses according to ICD10) to 2006.

With 56.7% of all patients the male gender slightly predominates among the patients. There was an age plateau in the fourth to sixth decade in both sexes. More than half of the diagnoses were paranoid schizophrenia (F20.0) with the other diagnoses being less than 10% each of all diagnoses. Over all years, only 26.1% of all patients had no more than one drug prescribed; there was a marked gender difference in monotherapy with 31.7% of all male patients versus just 16.9% of all female patients. 17% of all patients had more than 5 different drugs prescribed (psychoactive as well as non-psychoactive drugs). There was also a marked age difference in monotherapy with 34.4% of all patients aged 21–30 versus 10.4% of all patients aged 61–70. Over the years the percentage of monotherapy gradually sank from 31% of all patients in 2000 to 22%. Lorazepam was most often combined with olanzapine (5.6% of all patients.

The drug most often prescribed over all years was lorazepam with 7.6% of all prescriptions to 24.4% of all patients in 2000 to 7.2% of all prescriptions to 26.0% of all patients in 2006; lorazepam was almost twice as often prescribed to women (21.8% of all women) than to men (12.6% of all men). On rank 2 risperidone followed with 5.3% of all prescriptions to 17.3% of all patients in 2000 to 5.0% of all prescriptions to 17.9% of all patients in 2006; however, there was an increase in prescription of risperidone up to a peak in 2003 with 7.0% of all prescriptions to 21.1% of all patients. The same trend is to be seen in olanzapine prescriptions which was as often prescribed as risperidone. The thyroid hormone levothyroxine (rank 18) was the non-psychoactive drug most often prescribed to schizophrenic patients (1.4% of all prescriptions to 4.8% of all patients), directly followed by omeprazole (rank 19, 1.4% of all prescriptions to 4.7% of all patients) and metoprolol (rank 20, 1.3% of all prescriptions to 4.6% of all patients).

An interesting aspect is the different drug treatment in males and females with a trend to more sedative drugs in females.

Nevertheless, the most intriguing trend in drug treatment of schizophrenia over the last years is the increase in combination therapy possibly highlighting the need for managing various symptoms in the patients that may not be affected by just one drug.