Coprescription of mood stabilizers in schizophrenia, dosing, and clinical correlates: An international study

Wai Kwong Lim, Qian Hui Chew, Yan Ling He, Tian Mei Si, Fung Kum Helen Chiu, Yu Tao Xiang, Takahiro A. Kato, Shigenobu Kanba, Naotaka Shinfuku, Min Soo Lee, Seon Cheol Park, Yong Chon Park, Mian Yoon Chong, Shih Ku Lin, Shu Yu Yang, Adarsh Tripathi, Ajit Avasthi, Sandeep Grover, Roy Abraham Kallivayalil, Pichet UdomratnKok Yoon Chee, Andi J. Tanra, Md Golam Rabbani, Afzal Javed, Samudra Kathiarachchi, Dulshika Waas, Wing Aung Myint, Norman Sartorius, Van Cuong Tran, Kim Viet Nguyen, Chay Hoon Tan, Ross J. Baldessarini, Kang Sim

Research output: Contribution to journalArticle

Abstract

Objective: Studies examining coprescription and dosages of mood stabilizers (MSs) with antipsychotics for psychotic disorders are infrequent. Based on sparse extant data and clinical experience, we hypothesized that adjunctive MS use would be associated with certain demographic (e.g., younger age), clinical factors (e.g., longer illness duration), and characteristics of antipsychotic treatment (e.g., multiple or high antipsychotic doses). Methods: Within an Asian research consortium focusing on pharmaco-epidemiological factors in schizophrenia, we evaluated rates of MS coprescription, including high doses (>1000 mg/day lithium-equivalents) and clinical correlates. Results: Among 3557 subjects diagnosed with schizophrenia in 14 Asian countries, MSs were coprescribed with antipsychotics in 13.6% (n = 485) of the sample, with 10.9% (n = 53) on a high dose. Adjunctive MS treatment was associated (all p < 0.005) with demographic (female sex and younger age), setting (country and hospitalization), illness (longer duration, more hospitalizations, non-remission of illness, behavioral disorganization, aggression, affective symptoms, and social–occupational dysfunction), and treatment-related factors (higher antipsychotic dose, multiple antipsychotics, higher body mass index, and greater sedation). Patients given high doses of MSs had a less favorable illness course, more behavioral disorganization, poorer functioning, and higher antipsychotic doses. Conclusions: Schizophrenia patients receiving adjunctive MS treatment in Asian psychiatric centers are more severely ill and less responsive to simpler treatment regimens.

Original languageEnglish
JournalHuman Psychopharmacology
DOIs
Publication statusAccepted/In press - 2020

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology
  • Psychiatry and Mental health
  • Pharmacology (medical)

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