Changes in psychopharmacological treatment strategies in schizophrenia

Background., Despite numerous international efforts towards evidence-based guidelines for the psychopharmacological treatment of patients with schizophrenia, transfer of such guidelines into clinical practice remained unsatisfactory. Aim of the study: We evaluated whether our efforts to promote that such recommendations have led to measurable changes in treatment practice in our department by investigating 3 primary hypotheses: polypharmacy has become less common in recent years, conventional neuroleptics have been replaced by second-generation antipsychotics and dosing regimens changed towards lower doses. Results: We found significant decrease in the use of 2 or more antipsychotics given simultaneously. Increasing availability of second-generation antipsychotics led to rapid and still ongoing change from conventional (haloperidol) to novel antipsychotics, especially risperidone, which was the leading first-line treatment in 1995 and 1998. There has also been significant decrease in the use of concomitant anticholinergic medication. There was reduction of haloperidol doses from a mean of 23.9 mg/d to 10.4 mg/d from 1989 - 1998, and also risperidone doses fell from 5.8 mg/d in 1995 to 4.0mg in 1989 (p=0.015). Conclusion: Efforts towards implementation of modern psychopharmacological treatment standards of monotherapy, lower doses and use of second-generation antipsychotics have been successful.