A total of 892 patients were eligible for the study (M/F, 362/530); their clinical characteristics are shown in Table .
Features of patients eligible for the study
Mood disorders (especially major depressive disorder and bipolar disorder) and schizophrenia were the most frequently diagnosed conditions, accounting for 36% and 35%, respectively, for a combined total of 72% of all diagnoses (Table ).
Diagnosis reported in therapeutic programs and coded with the ICD-9 system
In all, 63% of patients (564/892) were prescribed antipsychotics; 42% of them (235/564) were men and 58% (329/564) women. Their age range was 15-98 years and most (40% of the total) were in the age range 41-60 years, although a few prescriptions were made to patients aged <20 years (0.5%) and in their 90s (1%). Mean age of the analyzed population was 55 years (SD % ± 17).
Type of prescribed drugs
In patients on antipsychotics, 520/564 (92%) took second-generation antipsychotics (SGAs) whereas the remaining 8% (44/564) took first-generation antipsychotics (FGAs). The distribution is shown in Table .
Patients treated with antipsychotics and treatment adherence
Mean doses were consistently lower than those indicated by the DDDs. Namely, drugs with prescribed doses slightly lower than the DDDs were: aripiprazole 13.2 mg (DDD, 15 mg); olanzapine 8.6 mg (DDD, 10 mg); risperidone 3.7 mg (DDD, 5 mg); and haloperidol 3.7 mg (DDD, 8 mg) (Table ). Drugs with prescribed doses much lower than the DDDs were: quetiapine 230.6 mg (DDD, 400 mg); clozapine 179.5 mg (DDD, 300 mg); clotiapine 38.6 mg (DDD, 80 mg); levomepromazine 25 mg (DDD, 300 mg); chlorpromazine 62.5 mg (DDD, 300 mg) (Table ).
Antipsychotic dosages in milligrams used in therapy
Moreover, the following drugs were prescribed at doses lower than those described in the SPCs: clozapine 179.5 mg (SPC, 200-450 mg); haloperidol 3.71 mg (SPC, 60 mg); clotiapine 38.6 mg (SPC, 100-120 mg); and levomepromazine 25 mg (SPC 75-300 mg) (Table ).
Variations in therapy
In all, 16% of the analyzed population (95/564 patients) changed their drug dosage during therapy: 44/564 patients (8%) reduced it while 51/564 patients (9%) increased it. More specifically, increases in prescribed doses of the following drugs were noted: quetiapine (24/51), olanzapine (17/51), aripiprazole (4/51), haloperidol (3/51) and risperidone (3/51). Antipsychotics that were dose-reduced were olanzapine (25/44), aripiprazole (7/44), quetiapine (6/44), risperidone (5/44), and haloperidol (1/44).
The originally prescribed drug was switched to other medication in 14% of patients (81/564). As such, the following antipsychotics were switched: olanzapine 0.8%; risperidone 4%; quetiapine 3%; aripiprazole 1%; clotiapine 0.4%; haloperidol 0.4%; and chlorpromazine 0.2%.
Concomitant medications used with antipsychotics
In all, 427/564 patients (76%) were treated with antipsychotics and other concomitant therapies. Concomitant therapies prescribed with antipsychotics included the following: antidepressants 40% (228/564); antiepileptics 16% (88/564); anticholinergic 9% (48/564); antiepileptic and antidepressant 7% (40/564); anticholinergic and antidepressant 2% (12/564); anticholinergic and antiepileptic 1% (8/564); and anticholinergic, antidepressant, and antiepileptic 0.5% (3/564).
Among patients taking an antipsychotic with an antidepressant, 83% were on SGAs. Moreover, SGAs were frequently given with anticholinergics (73%).
Adherence to therapy
Patient adherence to therapy is shown in Table ; this parameter was calculated ranging from a minimum of 60% for risperidone to a maximum of 69% for chlorpromazine. Mean adherence to treatments was 64% (SD% ± 28).
We used the statistical t-test to evaluate and compare the average value of first-generation antipsychotic adherence to that of the second generation. For FGAs, the adherence mean was 66.97 (SD% ± 2.35), while for SGAs it was 59.89 (SD% ± 5.37). This statistical testing (95% confidence interval) resulted in a significant p-value equal to.038, showing a difference of treatment adherence among patients receiving the two categories of antipsychotics, slightly higher for patients using FGAs compared with patients treated with SGAs.
Among patients treated with psychopharmaceuticals, 40% (361/892) took antidepressants, among whom 63% (228/361) were women and 37% (133/361) men. Their mean age was 55 years (SD% ± 9). The most frequently observed age group was 41-60 years (43%). However, a small number of prescriptions to patients aged 21-30 years (5%) and 81-90 years (4%) were also made.
Type of prescribed drugs
Prescribed antidepressants are shown in Table . The most prescribed antidepressant was venlafaxine (24%) whereas the most prescribed drug category was selective serotonin reuptake inhibitors (SSRIs) at 55%.
Patients treated with antidepressants and treatment adherence
Minimum, mean, and maximum dosages of antidepressants and their comparison versus the DDDs and the SPCs are displayed in Table . The following antidepressants were given at higher doses versus the DDD: citalopram 44.3 mg (DDD, 20 mg); mirtazapine 44.2 mg (DDD, 30 mg); paroxetine 29.5 mg (DDD, 20 mg); sertraline 73.8 mg (DDD, 50 mg); venlafaxine 129.2 mg (DDD, 100 mg).
Antidepressants dosages in milligrams used in therapy
Variations in therapy
In all, 52 of 361 patients (14%) modified the dose of their therapy: 56% (29/52) of patients reduced it, while the remaining 44% (23/52) increased it.
The following drugs were dose-decreased during the observation period: 19/361 (5%) cases for venlafaxine; 3/361 (0.8%) each for citalopram and paroxetine; 2/361 (0.6%) for amitriptyline; and 1/361 (0.3%) each for sertraline and clomipramine.
On the other hand, patients who increased their drug doses were: 10/361 (3%) for citalopram; 4/361 (1%) for venlafaxine; 3/361 (0.8%) for paroxetine; 2/361 (0.6%) for sertraline; 1/361 (0.3%) each for mirtazapine, fluoxetine, trazodone, and clomipramine.
In all, 6% of patients (22/361) switched their originally prescribed medication to other drugs. More specifically, the following medications were switched to other drugs during the observation period: citalopram 23%; mirtazapine 18%, sertraline and venlafaxine both 14%; trazodone, reboxetine, and fluoxetine all 9%; and paroxetine 5%.
Concomitant therapies with antidepressants
Only 26% of patients took antidepressants as monotherapy. Drugs taken in addition to antidepressants were: another antidepressant 6% (22/361); antipsychotic 51% (184/361); antipsychotic and antiepileptic 9% (32/361); anticholinergic 0.5% (2/361); antiepileptic 4% (13/361); two antipsychotics 3% (11/361); antipsychotic and anticholinergic 0.3% (1/361); and antipsychotic, anticholinergic, and antiepileptic 0.3% (1/361).
Mean adherence to therapy
Mean adherence to therapy was: 81% for reboxetine; 77% for citalopram; 76% for trazodone; 59% for mirtazapine; 58% for paroxetine; 63% for sertraline; 62% for venlafaxine; and 52% for fluoxetine. Mean overall adherence to treatments was 64% (SD % ± 34).