Study Examines Medication Management for Veterans with Schizophrenia
Appropriate medication management for schizophrenia reduces relapse and hospitalization, and improves functioning and quality of life. Although first- and second-generation antipsychotic medications for this serious mental illness have similar average efficacy (except for clozapine), they have very different side effect profiles. Clinical trials of second-generation agents have shown that some side effects are less common than with first-generation agents (e.g., tardive dyskinesia (TD), depression), while weight gain is more common. This study examined medication management for a random sample of Veterans who received drug therapy for schizophrenia at any one of three VA mental health clinics in Southern California between 2002 and 2003. Investigators interviewed 398 Veterans, assessing medication prescribing, symptoms, and side effects at baseline and one year later. Participants were classified as receiving overall inappropriate medication management if they met criteria for poor symptom management or poor side effect management in any of the following four domains: psychotic symptoms, TD, elevated weight, and depression. The number of patients with schizophrenia in each psychiatrist’s practice also was examined.
Findings show that at baseline, 73% of Veterans were prescribed a second-generation antipsychotic medication, 17% were prescribed a first-generation medication, and 10% were simultaneously prescribed medications from both classes. Overall, 67% of Veterans had inappropriate management in one or more domains at baseline: 32% had inappropriate management of psychotic symptoms, 45% had inappropriate management of weight, and 8% had inappropriate management of TD. Further, 11% had depression that was moderately severe or worse. At one year, the appropriateness of management for psychotic and depressive symptoms had not changed. The appropriateness of management of TD also did not change over time, but the management of elevated weight improved modestly. There were no significant differences between the three clinics in the prevalence of symptoms or side effects, or in the appropriateness of medication management. However, psychiatrists with more than 12 patients were significantly more likely to improve their patients’ care over time.
Young A, Niv N, Cohen A, Kessler C, and McNagny K. The appropriateness of routine medication treatment for schizophrenia. Schizophrenia Bulletin July 2010;36(4):732-739.
This study was partly funded by HSR&D (CPI 99-383, MNT 03-213). Drs. Young, Niv, and Cohen are part of the VA Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC) in Los Angeles, CA.