Switching antipsychotics in the treatment of schizophrenia : a two-year comparison of patient characteristics and psychiatric service use

The present investigation explored the determinants and effects of switching antipsychotic medications in a "real-world" clinical setting. Methods . A hospital chart review of randomly selected patient files was undertaken. Comparisons were made between patients who were maintained on the same antipsychotic versus those who were switched or initiated on polypharmacy for socio-demographic and clinical characteristics, and psychiatric services utilized during the two year study period. Results. Eleven per cent (n=23) of the included patients (N=201) experienced a switch, and 11 % (n=22) had another antipsychotic added to their treatment. A history of recent psychiatric hospitalizations and secondary diagnoses of personality disorders were more common among switched and add-on patients than maintenance group patients. During the study period, significantly more switched and add-on patients used outpatient, emergency and inpatient psychiatric services than maintained patients. Conclusions. Patients whose antipsychotic treatment was changed had likely been experiencing clinically significant problems for which a change was implemented. The high rate of study service use indicates that these problems were conserved despite changes in antipsychotic medications