Ochi Shinichiro, Kodaka Fumitoshi, Hasegawa Naomi, Tsuboi Takashi, Ohi Kazutaka, Igarashi Shun, Fukumoto Kentaro, Iga Jun-Ichi, Muraoka Hiroyuki, Iida Hitoshi, Tagata Hiromi, Kashiwagi Hiroko, Numata Shusuke, Yamagata Hirotaka, Takeshima Masahiro, Ichihashi Kayo, Hashimoto Naoki, Nagasawa Tatsuya, Nakamura Toshinori, Matsumoto Junya, Yamada Hisashi, Hori Hikaru, Ueno Shu-Ichi, Inada Ken, Hashimoto Ryota, Yasui-Furukori Norio
Department of Neuropsychiatry, Molecules and Function, Ehime University Graduate School of Medicine, Ehime, Japan.
Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan.
Int J Neuropsychopharmacol. 2025 Apr 11;28(4). doi: 10.1093/ijnp/pyaf011.
The rate of antipsychotic polypharmacy is high. One risk factor for antipsychotic polypharmacy may be the severity of schizophrenia, including treatment-resistant schizophrenia (TRS). We hypothesized that the institutions that are able to prescribe clozapine present differences in pharmacological treatment even before TRS is diagnosed.
A total of 8155 patients with schizophrenia were divided into the clozapine-available institution (CAI) group and the clozapine-unavailable institution (CUI) group. The psychotropic prescription rates at discharge were compared between the two groups. Furthermore, to investigate whether the diagnosis of TRS subgroups influenced treatment efficacy, we compared CAIs and CUIs with descriptions of subgroups with TRS (DSTRS) and those without descriptions of subgroups with TRS (NDSTRS).
Compared to the CUI group, the rates of both antipsychotic monotherapy (58.3% vs. 50.7%; P = 2.4 × 10-7) and antipsychotic monotherapy without the concomitant use of other psychotropics (20.4% vs. 15.6%; P = 3.8 × 10-5) were significantly higher in the CAI group. The rate of antipsychotic monotherapy in the CAI with DSTRS group (63.3%) was significantly higher than that in the CAI with NDSTRS group (54.5%; P = 1.4 × 10-12), the CUI with DSTRS group (49.6%; P = 4.9 × 10-9), and the CUI with NDSTRS group (50.9%; P = 2.0 × 10-8). The rate of antipsychotic monotherapy without the concomitant use of other psychotropics in the CAI with DSTRS group (22.6%) was also significantly higher than that in the CAI with NDSTRS group (18.7%; P = 4.7 × 10-4), the CUI with DSTRS group (15.9%; P = 5.5 × 10-4), and the CUI with NDSTRS group (15.2%; P = 8.0 × 10-5). There was no significant difference in these rates between the other groups.
Both the availability of clozapine prescriptions and the precise diagnosis of TRS subgroups at discharge can promote the development of an organizational culture that facilitates the treatment of patients with schizophrenia.
抗精神病药物联合使用的比例很高。抗精神病药物联合使用的一个风险因素可能是精神分裂症的严重程度，包括难治性精神分裂症（TRS）。我们假设，即使在诊断出TRS之前，能够开具氯氮平的机构在药物治疗方面也存在差异。
总共8155例精神分裂症患者被分为可获得氯氮平的机构（CAI）组和无法获得氯氮平的机构（CUI）组。比较了两组出院时的精神药物处方率。此外，为了研究TRS亚组的诊断是否会影响治疗效果，我们比较了有TRS亚组描述（DSTRS）的CAI和CUI与没有TRS亚组描述（NDSTRS）的CAI和CUI。
与CUI组相比，CAI组的抗精神病药物单一疗法（58.3%对50.7%；P = 2.4×10-7）和不联合使用其他精神药物的抗精神病药物单一疗法（20.4%对15.6%；P = 3.8×10-5）的比例均显著更高。有DSTRS的CAI组的抗精神病药物单一疗法比例（63.3%）显著高于有NDSTRS的CAI组（54.5%；P = 1.4×10-12）、有DSTRS的CUI组（49.6%；P = 4.9×10-9）和有NDSTRS的CUI组（50.9%；P = 2.0×10-8）。有DSTRS的CAI组不联合使用其他精神药物的抗精神病药物单一疗法比例（22.6%）也显著高于有NDSTRS的CAI组（18.7%；P = 4.7×10-4）、有DSTRS的CUI组（15.9%；P = 5.5×10-4）和有NDSTRS的CUI组（15.2%；P = 8.0×10-5）。其他组之间这些比例没有显著差异。
氯氮平处方的可获得性以及出院时TRS亚组的精确诊断均可以促进有利于精神分裂症患者治疗的组织文化的发展。
