The first three years of pharmacotherapy in patients with psychotic disorders: a comparison between the early intervention programme and standard care service in Hong Kong

Abstract

This naturalistic study reviews the use of antipsychotics in patients with psychotic disorders in the first three years of psychiatric treatment. This historical-controlled study included 700 patients first presented to the local early intervention programme (EI) from 2001 to 2003, and 700 patients first presented to standard care service (SC) from 1998 to 2001. The data were systematically extracted from medical records according to operationalized definitions. In the EI group, 22.2% of cases were prescribed atypical antipsychotics as the initial pharmacotherapy, which increased to 59.4% and 58.7% in the first and second switches of antipsychotics respectively. Respective statistics in the SC group (6.3%, 19.5% and 23.4%, all p-value <.001) were significantly lower than the EI group. In EI, the three most frequently prescribed antipsychotics in initial treatment were conventionals: haloperidol (28.6%), trifluoperazine (23.7%) and sulpiride (14.5%). First switch of antipsychotics was mainly risperidone (22.0%), olanzapine (19.3%) and sulpiride (11.1%). Second switch of antipsychotics was mainly to olanzapine (19.9%), risperidone (13.6%) and sulpiride (10.7%). In SC, the three most frequently prescribed antipsychotics in the initial treatment were haloperidol (32.1%), trifluoperazine (26.6%) and chlorpromazine (12.7%). First switch of antipsychotics were mainly conventional antipsychotics, which were trifluoperazine (15.3%), sulpiride (15.0%) and chlorpromazine (11.1%). The second switch of antipsychotics was similar to the first switch: sulpiride (16.9%), chlorpromazine (14.9%) and trifluoperazine (12.9%). In the first three years of psychiatric treatment, the findings revealed that early intervention programme in Hong Kong had a different practice in prescribing antipsychotics. Atypical antipsychotics were more widespread in use in the EI group while conventional antipsychotics remained to be the major pharmacotherapy in the SC group.