Effect of pharmacist intervention on physician prescribing in patients with chronic schizophrenia: a descriptive pre/post study.

BACKGROUND: Although pharmacotherapy is one of the most important treatments for schizophrenia, the prominent levels of antipsychotic polypharmacy and high-dose regimens used in Japan are thought to be inconsistent with treatment regimens used in other countries. In this study, we evaluated the effect of pharmacist intervention on physician prescribing in patients with chronic schizophrenia. METHODS: Participants comprised 52 inpatients at Sawa Hospital (Osaka, Japan), treated with at least one antipsychotic agent, who received pharmacist intervention for 1 year (2012). We compared the dose and the number of antipsychotics prescribed, and the rate of concurrent prescribing of anti-Parkinson, benzodiazepine and mood-stabilizer medication, pre- and post-pharmacist intervention. As an indicator of psychosis symptoms, the rate of seclusion room use was recorded. Additionally, we evaluated the impact of pharmacist intervention on medicine costs. Continuous variables were analyzed by Wilcoxon signed-rank sum tests, and categorical data were analyzed using Fisher's exact tests. RESULTS: Compared with pre-intervention, the dose (982.6 mg pre vs. 857.6 mg post; p < 0.01) and the number of antipsychotics (2.0 pre vs. 2.0 post; p < 0.05) at 1 year were significantly lower post-intervention. The seclusion room use rate was not significantly different but tended to be lower post-intervention than pre-intervention (p < 0.1). The cost (in USD) for all medicines (10.33 pre vs. 8.76 post; p < 0.05), antipsychotics (8.04 pre vs. 6.48 post; p < 0.05), and psychotropics (9.24 pre vs. 7.68 post; p < 0.01) were significantly lower post-intervention than pre-intervention. CONCLUSION: Pharmacist intervention has the potential to optimize medication prescribing and reduce medication costs in patients with chronic schizophrenia. It might be suggested that clinical practitioners as well as medical hospital administrators consider the pharmacists' ability to rationalize medication therapy in schizophrenia.

The need for educating patients with schizophrenia about the adverse effects of medications.

OBJECTIVE: Medication non-adherence is observed in many patients with schizophrenia. We investigated the effects of educational intervention on patient awareness of the adverse effects of their medication for patients with schizophrenia. METHODS: Inpatients with schizophrenia (N=87) in two Japanese hospitals were allocated to two groups, one that was aware of the adverse effects of medications and one that was unaware, according to their responses to the question 'In the past month, have you experienced any adverse effects from your medications?' Then, they were questioned about adverse effects. RESULTS: Only 27.6% of patients recognized the adverse effects of their medications. After pharmacists educated them and showed them a list of adverse effects, the prevalence of recognition increased dramatically (≤96.6%). Most patients with schizophrenia clearly did not recognize the adverse effects of their medications. When patients experienced discomfort they tended to stop taking their medications. CONCLUSIONS: Adverse effects are a common risk factor for discontinuation of medication, so early detection and reporting of such effects may result in them being addressed sooner. Considering the risks of relapse caused by discontinuation of medication, healthcare professionals should actively educate patients with schizophrenia about dysphoria and manage adverse effects.

Effects of antipsychotic polypharmacy on side-effects and concurrent use of medications in schizophrenic outpatients.

AIMS: Medical therapy is the cornerstone of schizophrenia, but >50% of patients do not adhere to medication regimens. In previous reports, the reasons for non-adherence were assessed only by medical staff. We think that patients have specific reasons for non-adherence. We researched whether there was an association between patients' subjective opinions and the number of antipsychotics used. METHODS: A self-rating questionnaire survey was conducted on 252 outpatients with schizophrenia at five psychiatric hospitals in Japan. Based on patients' subjective opinions, we retrospectively analyzed the patients' medications: the number of antipsychotics, concurrently used agents, and dosages of antipsychotics. RESULTS: There was no significant difference regarding attitudes toward medication between monotherapy and polypharmacy. The most common reason for not taking medications was 'I sometimes forget' followed by 'side-effects'. Of the latter, weight gain was the most common, and dry mouth (P < 0.05) and sexual dysfunction (P < 0.01) were significantly higher in polypharmacy. The dosages of antipsychotics (P < 0.01), concurrent use of anti-Parkinsonian agents (P < 0.01), and the number of side-effects (P < 0.01) were also higher in polypharmacy. CONCLUSIONS: Patients had good attitudes toward medication but a higher prevalence of side-effects was seen in polypharmacy of antipsychotics. Hence, monotherapy may be a more appropriate prescription with respect to side-effects. By using monotherapy, patients may reduce feelings of discomfort due to side-effects.