Original Research

Correlates of high-dose antipsychotic prescription amongst outpatients with Schizophrenia in a Nigerian Hospital

Ihechiluru G. Anozie, Bawo O. James, Joyce O. Omoaregba, Sunday O. Oriji, Paul O. Erohubie, Anthony C. Enebe
South African Journal of Psychiatry | Vol 28 | a1791 | DOI: https://doi.org/10.4102/sajpsychiatry.v28i0.1791 | © 2022 Ihechiluru G. Anozie, Bawo O. James, Joyce O. Omoaregba, Sunday O. Oriji, Paul O. Erohubie, Anthony C. Enebe | This work is licensed under CC Attribution 4.0
Submitted: 22 August 2021 | Published: 29 April 2022

About the author(s)

Ihechiluru G. Anozie, Department of Clinical Sciences, Federal Neuropsychiatric Hospital, Benin City, Nigeria
Bawo O. James, Department of Clinical Sciences, Federal Neuropsychiatric Hospital, Benin City, Nigeria
Joyce O. Omoaregba, Department of Clinical Sciences, Federal Neuropsychiatric Hospital, Benin City, Nigeria
Sunday O. Oriji, Department of Clinical Sciences, Federal Neuropsychiatric Hospital, Benin City, Nigeria; and, Department of Mental Health, Nnamdi Azikiwe University, Awka, Nigeria
Paul O. Erohubie, Department of Clinical Sciences, Federal Neuropsychiatric Hospital, Benin City, Nigeria; and, Department of Mental Health, Irrua Specialist Teaching Hospital, Irrua, Nigeria
Anthony C. Enebe, Department of Clinical Sciences, Federal Neuropsychiatric Hospital, Benin City, Nigeria; and, Department of Mental Health Services, Federal Medical Centre Asaba, Asaba, Nigeria


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Abstract

Background: Treatment guidelines recommend the use of antipsychotic monotherapy at effective doses for the treatment of schizophrenia, although about a third of the sufferers still receive high-dose antipsychotic treatment. Current evidence suggests that high-dose antipsychotic prescription (HDAP) not only fails to improve outcomes but also increases side effects.

Aim: Our study aimed to determine the prevalence of HDAP and its association with illness severity, medication adherence behaviour and side effects amongst outpatients with schizophrenia.

Setting: The Federal Neuro-Psychiatric Hospital, Benin-City, Nigeria.

Methods: A cross-sectional study of 320 attendees with schizophrenia at the outpatient department was undertaken. We administered a sociodemographic and antipsychotic medication questionnaire, Mini-International Neuropsychiatric Interview, Positive and Negative Syndrome Scale, Liverpool University Neuroleptic Side Effects Rating Scales and Medication Adherence Rating Scales. High-dose antipsychotic prescription was determined by the ratio of prescribed daily dose to defined daily dose greater than 1.5.

Results: The prevalence of HDAP was 38.4%. Greater severity of illness, experiencing more side effects and poor medication adherence were significantly associated with HDAP. The major predictors of HDAP were antipsychotic polypharmacy and concurrent anticholinergic use.

Conclusion: We conclude that although the use of HDAP amongst patients with schizophrenia remains common, its persistent use should be discouraged.


Keywords

high dose; antipsychotics; prescription; schizophrenia; Nigeria

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