Antipsychotic polypharmacy in czech republic and in ukraine

Abstract

In prescription surveys, use of antipsychotic polypharmacy is common, despite scant supporting evidence. This study investigated the use of monotherapy and different types of polypharmacotherapy among inpatients with acute episodes of schizophrenia in the Czech Republic and in the Ukraine. Two hundred participants were enrolled from two sites: Lnare Psychiatric Clinic, Czech Republic (n = 100) and Psychiatric Hospital №1 in Simferopol, Crimea, Ukraine (n = 100). Each inpatient was evaluated twice with the Positive and Negative Symptom Scale (PANSS) at admission (acute stage) and at discharge (a stabilization stage) from hospital. This study revealed that antipsychotic polypharmacy was prescribed considerably more frequently in the Czech sample (43%) than in the Ukrainian group (29%). The use of combinations of first generation antipsychotics (FGAs) and second generation antipsychotics (SGAs) during hospitalization was six times more prevalent in the Czech Republic (31%) than in the Ukraine (5%; p < 0.001); 24% of the Ukranian inpatients received a combination of two or more FGAs, in comparison to 12% of the Czech inpatients (p < 0.05) at admission, and the rates decreased to 4% and 9%, respectively, at discharge (p < 0.05). Augmentation with off-label prescribed antidepressants and mood stabilizers was far more prevalent in the Ukraine (65 and 54%, at admission and discharge, respectively) than in the Czech sample (40 and 29%, at admission and discharge, respectively). Antipsychotic monotherapy for acute psychosis in the Czech Republic (20%; mainly SGAs) was almost three times more common than in the Ukraine (8%; mainly FGAs; t = 4.63, p < 0.001);. When the mental health condition stabilized, antipsychotic monotherapy was increased: from 20 to 33% in the Czech Republic and from 8 to 18% in the Ukraine. International multicenter studies are warranted to investigate the reasons for and the impact of the predominant use of polypharmacy.