Are patients with schizophrenia under-treated with second-generation antipsychotics? A pilot study of the prescription practices of German psychiatrists

Introduction: Patients' and relatives' associations, psychiatrists, and pharmaceutical companies are complaining about a deficiency in the care of psychiatric patients with innovative medications in Germany. They estimate that only about 10-30% of all patients with schizophrenia receive second-generation antipsychotics, a figure that lies significantly below the international average. Methods: In order to determine the frequency of use of second-generation antipsychotics in the actual care of schizophrenic patients, we conducted the following investigations: Discharge papers of schizophrenic inpatients from a university hospital and from a district hospital were studied with regard to the antipsychotic discharge medication. Practicing psychiatrists were contacted and asked whether during the first 3 months after discharge they had continued the antipsychotic discharge medication that was proposed by the hospital. Results: The investigation of a total of 200 discharge papers and the subsequent questioning of the psychiatrists who carried out the follow-up treatment showed that 166 patients (83%) received a second-generation antipsychotic upon discharge. Only 5% of these patients were switched to conventional antipsychotics in the outpatient treatment. Thus, contrary to our expectations, there was no noteworthy change from second-generation to classical antipsychotics. Discussion: Therefore, in the sample analyzed the second-gene ration antipsychotics were far more frequently prescribed than would have been expected according to general estimates, and it was not possible to verify the often-heard complaints of an under-treatment with second generations in this study. Our findings suggest, however, that only 60% of the patients still receive their discharge medication 3 months after discharge from the hospital. This raises the important question as to how continuity of the antipsychotic treatment could be better ensured.