Nursing Research: Prescribing Trends in Schizophrenia (Research Paper Sample)

Prescribing Trends in Schizophrenia: Literature Review
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Prescribing Trends in Schizophrenia: Literature Review
This study will seek to investigate first episode schizophrenia. It will explore the trends in prescribing for schizophrenia as well as how “evidence-based medicine” has influenced decision-making for schizophrenia treatment. To achieve this, research evidence, clinical expertise/experience, patient values, and organizational issues affecting decision-making, in a prescription for schizophrenia, will be adequately addressed.
Review of Literature
Schizophrenia is a critical disease affecting the brain and requires special attention. The choice of treatment method that is antipsychotic treatment is a crucial issue challenging schizophrenia treatment (Edlinger et al., 2009). Edlinger et al. (2009) carried out a study to investigate various factors affecting decision-making in an antipsychotic prescription for treatment of schizophrenia. The study took place in Innsbruck where 108 patients (both in and outpatients) were the respondents. The main factors investigated in the survey include “sociodemographic and illness-related variables, pre-treatment, the reasons for the change of treatment (lack of efficacy, side effects, non-compliance), side effects of pre-treatment and body-mass-index (BMI)” (Edlinger et al., 2009, p. 246). From the study, it was evident that socio-demographic as well as other “illness-related variables had no influence on physicians’ decision-making on the choice of treatment for schizophrenia.
Another study done by Heres et al. (2011) tried to demonstrate the several factors that affect decision-making in an antipsychotic prescription for First-Episode Patients (FEP). The survey involved 198 participants, who were “psychiatrists attending the congress of the German Society of Psychiatry, Psychotherapy, and Nervous Diseases (DGPPN) held in November 2008” (Heres et al., 2011, p. 297). The results indicated that the participants reported 3 out of the 12 factors used in the study. These factors were “rejection of the offer by FEP,” lack of prior exposure to relapse and inadequacy of the of the Second Generation Antipsychotics (SGA) depot drugs (Heres et al., 2011, Pp. 298-299). The survey provides the factors mentioned above as the original statements influencing psychiatrists’ choice of treatment to administer to First-Episode Patients. Implications from the study are that, instead of making assumptions of patients’ likes and dislikes, psychiatrists should prefer depot treatment as the standard and routine choice for all patients including FEP.
Additionally, to comprehend the several trends in schizophrenia and this has affected the choice of a prescription; numerous scientific studies have been carried out on the subject matter.
Quality Prescribing for Schizophrenia
Patel et al. (2014) did a study to elaborate on the audit done by the National Audit of Schizophrenia (NAS) in England and Wales. This audit examined the clinical guidelines in place for schizophrenia in the in England and Wales. The audit was done 5055 schizophrenia patients where most of them attested to pharmacological treatment that was by the stipulated national guidelines. However, despite these positive remarks, it was found that at least “15.9% of the total sample (95%CI: 14.9–16.9) were prescribed two or more antipsychotics concurrently and10.1%ofpatients (95%CI: 9.3–10.9) were prescribed medication in excess of recommended limits” (Patel et al. 2014, p. 499). Similarly, the results of the audit proved that 23.7% of the patients under study received clozapine. These findings gave a chance for UK to be compared with other countries like the equivalent US guidelines on clinical/pharmacological treatment (Patel et al., 2014). They also gave the implication that professionalism needs to be enhanced among mental health practitioners. A study done by Ho et al. (2011), demonstrates why it is significant to uphold professionalism in the mental health field. The study proved that prolonged use of antipsychotics significantly influences the brain volumes. The long-term use of antipsychotics was “associated with a greater decrease in brain tissue volumes” (Ho et al., 2011, p. 134). These results could contain substantial implications concerning the clinical decision-making on prescribing for schizophrenia.
The use of antipsychotics treatment has both positive and negative results. In their study, Edlinger et al. (2009) demonstrated “persistent positive and negative symptoms” evident in “First-Episode Patients” (p. 246). Similarly, Patel et al. (2014) explain the emphasis placed on adequate trials of both antipsychotics and clozapine in schizophrenia treatment, by both UK and US guidelines. It is, therefore, paramount for more studies to be done exploring the quality of prescribing for antipsychotics as well as clozapine in the quest to manage schizophrenia in the UK.
Clinical Expertise/Experience and Guidelines
Several studies have been done to relate “clinical expertise/experience” with respect to decision-making on prescribing for schizophrenia. A study by Ito, Koyama and Higuchi (2005), provides evidence that due to their experience, psychiatrists have a perception towards the use of drugs for the treatment of schizophrenia. The study included “139 patients with schizophrenia, in 19 acute psychiatric units in Japanese hospitals, who were due to be discharged between October and December 2003” (Ito, Koyama & Higuchi, 2005, p. 243). The results of this study were that only 27% of the participants were on preferred or standard dosage; 73% were not on a typical dosage. Among the 27%, 78% were on atypical antipsychotics while for the 73%, 94% of them were using “more than one drug” and at least 33% of them were on an “excessive dosage” prescription (Ito, Koyama & Higuchi, 2005, p. 244). From the results, it was evident that “psychiatrists’ perceptions of the use of algorithms and nurses’ requests for more drugs, as well as the clinical variables of the patients” are the main contributors to excessive antipsychotic dosage (Ito, Koyama & Higuchi, 2005, p. 245). It is clear that despite the elaborate guidelines provided by clinical experts in the mental health field, the practitioners ignore them and apply their experience perceptions to give non-standard treatment to patients; using their judgment and expertise to make a decision on treatment choice.
A book by Taylor, Paton and Kerwin (2005) elaborates the guidelines providing essential advice to the clinician, in prescribing treatments for schizophrenia, in the UK and other countries. The book gives an excellent explanation of the national guidelines in the UK, which are also applicable in other nations. These guidelines play a crucial role in clinical decision-making. A study by Warnez and Severini (2014) investigates the efficiency/effectiveness of clozapine in refractory schizophrenia treatment. The study used “publications in the last 10-year period (2004 and 2014)” which were obtained from “PubMed, Psychinfo, EMBASE and Cochrane databases” (Warnez and Severini, 2014 p. 2). The findings from this study indicate underutilization of clozapine, despite the primary emphasis of its use by the clinical guidelines. This creates the implication that more research needs to be done to provide adequate and reliable evidence for the effectiveness of clozapine, which will erase the fears by psychiatrists that the treatment may cause severe side effects.
Trends in Prescribing for Schizophrenia
Over the years, there has been a dramatic increase in the use of antipsychotic drugs especially in developed states such as UK and US. A study carried out by Pincus et al. (1998) was geared at investigating how the increased recommendations for psychotropic medication have influenced the prescribing patterns. The study utilized available data to investigate the changes between the year 1985 and 1995. To achieve this, Pincus et al. (1998) used information from “National Ambulatory Medical Care Surveys conducted in 1985, 1993 and 1994” (p. 526). These surveys took place in the United States. From the surveys, it was noted that there was a significant increase in the number of patients, going for psychotic medication, by 12.91 million, which was “from 32.73 million to 45.54 million” (Pincus et al., 1998, p. 528). In 1985, females comprised 67.1% of the total visits for treatment while in 1994; the percentage of females going for the medication was 64.1%. The number of those with 18 years and below increased from 1.10 million to 3.78 million. These results were evident due to the following recommendation for various medications to manage schizophrenia.
A study by Siris et al. (2001) demonstrated the standard clinical practices as well as prescribing trends in schizophrenia. The research took place in the US, Canada, Europe, and Australia were around 80, 000 participants were involved. The researchers issued questionnaires with 48 items that were fixed and open questions. There were 37,513 participants chosen in the USA, 43,454 in Canada, and others in Europe and Australia who received the questionnaires. From the USA, 1,128 members responded; of whom were all psychiatrists. “Responses to questionnaires regarding treatment approaches and care scenarios demonstrated that the level of adjunctive prescribing of antidepressants in the USA is often higher than other regions,” (Siris et al. 2001, p. 185).
Clark et al. (2002) carried out a study to investigate the implications of the trends in antipsychotic combination therapy. The study focused on &...