The Relationship of the Structure of Antipsychotic Prescriptions with Socio-Demographic and Clinical-Dynamic Indicators in Patients with Paranoid Schizophrenia

Background: it is well known that improving clinical guidelines should take into account the results of studies conducted in real-world clinical practice. Data of the prescription patterns and dosages of antipsychotic medications in patients with schizophrenia of varying disease duration are in the area of special interest.

The aim was to study the relationship between the prescription patterns of antipsychotics and the socio-demographic, clinical and dynamic characteristics, quality of life indicators, and social functioning of patients with paranoid schizophrenia.

Patients and Methods: the study included 208 inpatients with paranoid schizophrenia (total sample; mean age — 30.21 ± 6.84 years, males — 58.65% (n = 122)). The structure of antipsychotic prescriptions was analyzed based on medical records from 2018 to 2024. For all medications, the standard daily dose was determined using the Defined Daily Dose (WHO) methodology. Socio-demographic, clinical and dynamic characteristics were assessed, along with PANSS, BACS, PSP, and WHOQOL-BREF scale scores.

Results: a total of 16 antipsychotic drugs were identified in the prescription structure. Two patient groups were identified in the principal component space. Group 1 included patients with a significant (> 60%) predominance of risperidone and olanzapine prescriptions (n = 136). Group 2 made up patients with a comparable predominance of haloperidol and clozapine prescriptions (n = 72). Group 1 included 94 (69.1%) patients experiencing their first psychotic episode, whereas Group 2 included 50 (69.4%) chronic patients. Group 1 had significantly lower disease duration, number of hospitalizations (p < 0.001), number of disabilities (p = 0.003); significantly higher mean duration of outpatient treatment (p < 0.001), higher scores on the BACS subtests “verbal learning” (p = 0.009) and “working memory” (p = 0.049).

Conclusion: risperidone, olanzapine, and other second-generation antipsychotics are significantly more frequently prescribed in real-world clinical practice to patients with shorter disease duration and relatively preserved cognitive functions. In contrast, haloperidol and clozapine predominate in the prescriptions of chronic patients.

1. Klinicheskie rekomendacii “Shizofreniya”. Odobreno Nauchno-prakticheskim Sovetom Minzdrava RF. Dostup iz sajta Ministerstva zdravoohraneniya Rossijskoj Federacii. URL: https://cr.minzdrav.gov.ru/schema/451_3 (data of access: 27.03.2025) (In Russ.).

2. Prikaz Minzdrava Rossii ot 05.07.2022 N 471n “Ob utverzhdenii standarta medicinskoj pomoshchi vzroslym pri shizofrenii (diagnostika i lechenie)” (In Russ.).

3. Groenendaal E, Lynch S, Dornbush R, Klepacz L, Ferrando S. Clinical determinants, patterns and outcomes of antipsychotic medication prescribing in the treatment of schizophrenia and schizoaffective disorder: A naturalistic cohort study. J Psychiatr Res. 2023;158:273–280. doi: 10.1016/j.jpsychires.2022.12.044

4. Vinnikova IN, Kravchenko IV, Chizhikov II, Sidorov VG. Analysis of the effectiveness of psychopharmacotherapy in patients with paranoid schizophrenia with non-suicidal autoaggression and deficit personality changes. Doctor.Ru. 2024;23(7):56–62. (In Russ.). doi: 10.31550/1727-2378-2024-23-7-56-62

5. Monteleone P, Cascino G, Rossi A, Rocca P, Bertolino A, Aguglia E, Amore M, Andriola I, Bellomo A, Biondi M, Brasso C, Carpiniello B, Collantoni E, Dell'Osso L, di Giannantonio M, Fabrazzo M, Fagiolini A, Giordano GM, Marcatili M, Marchesi C, Monteleone AM, Pompili M, Roncone R, Siracusano A, Vita A, Zeppegno P, Galderisi S, Maj M; Italian Network for Research on Psychoses. Evolution of antipsychotic-induced extrapyramidal symptoms in patients with schizophrenia in the real-life: A 4-year follow-up naturalistic study. Schizophr Res. 2022;248:279–286. doi: 10.1016/j.schres.2022.08.015

6. Alhasani DM, Ibn Auf A, Alghamdi AA, Alzahrani AR. Metabolic Syndrome among Patients Taking Atypical Antipsychotics: A Comparative Cross-Sectional Study at Erada and Mental Health Complex in Taif, Saudi Arabia. Psychopharmacol Bull. 2024;54(4):35–44. PMID: 39263195; PMCID: PMC11385268

7. Schneider-Thoma J, Chalkou K, Dörries C, Bighelli I, Ceraso A, Huhn M, Siafis S, Davis JM, Cipriani A, Furukawa TA, Salanti G, Leucht S. Comparative efficacy and tolerability of 32 oral and long-acting injectable antipsychotics for the maintenance treatment of adults with schizophrenia: a systematic review and network meta-analysis. Lancet. 2022;399(10327):824–836. doi: 10.1016/S0140-6736(21)01997-8

8. Toto S, Grohmann R, Bleich S, Frieling H, Maier HB, Greil W, Cordes J, Schmidt-Kraepelin C, Kasper S, Stübner S, Degner D, Druschky K, Zindler T, Neyazi A. Psychopharmacological Treatment of Schizophrenia Over Time in 30 908 Inpatients: Data From the AMSP Study. Int J Neuropsychopharmacol. 2019;22(9):560– 573. doi: 10.1093/ijnp/pyz037

9. Sofronov AG, Dobrovolskaya AE, Gvozdetckii AN, Kushnerev IS. Antipsychotic Prescribing Practices for In-patients with Schizophrenia. Psychiatry (Moscow) (Psikhiatriya). 2024;22(4):61–73. (In Russ.). doi: 10.30629/2618-6667-2024-22-4-61-73

10. Guo X, Yu H, Wang H. Antipsychotic patterns in outpatients with schizophrenia in China: A cross sectional study. Medicine (Baltimore). 2021;100(32):e26912. doi: 10.1097/MD.0000000000026912

11. Alekhin IN, Dushina EV, Apkhanova NS, Gaidarov GM, Vorsina OP, Prokopyeva ML. Continuity in the staged management of patientswith mental illness between the district psychiatric service and inpatient psychiatric institutions. Bulletin of Semashko National Research Institute of Public Health. 2022;(3):35–39. (In Russ.). doi: 10.25742/NRIPH.2022.03.006

12. de Cruppé W, Assheuer M, Geraedts M, Beine K. Association between continuity of care and treatment outcomes in psychiatric patients in Germany: a prospective cohort study. BMC Psychiatry. 2023;23(1):52. doi: 10.1186/s12888-023-04545-x

13. Tumova MA, Stepanova AA, Zazulina YS, Guseinova ZT, Zaitseva MM, Dyment IV, Kotsyubinsky AP, Ivanov MV. An effect of antipsychotic and anticholinergic treatment on cognitive function in patients with schizophrenia. S.S. Korsakov Journal of Neurology and Psychiatry. 2023;123(7):80–85. (In Russ.). doi: 10.17116/jnevro202312307180

14. Lee SU, Soh M, Ryu V, Kim CE, Park S, Roh S, Oh IH, Lee HY, Choi S. Analysis of the Health Insurance Review and Assessment Service data from 2011 to 2015. Int J Ment Health Syst. 2018;12:9. doi: 10.1186/s13033-018-0187-1. Erratum in: Int J Ment Health Syst. 2018;12:32. doi: 10.1186/s13033-018-0193-3

15. Yasui-Furukori N, Kawamata Y, Sasaki T, Yokoyama S, Okayasu H, Shinozaki M, Takeuchi Y, Sato A, Ishikawa T, Komahashi-Sasaki H, Miyazaki K, Fukasawa T, Furukori H, Sugawara N, Shimoda K. Prescribing Trends for the Same Patients with Schizophrenia Over 20 Years. Neuropsychiatr Dis Treat. 2023;19:921–928. doi: 10.2147/NDT.S390482

16. Hashimoto N, Yasui-Furukori N, Hasegawa N, Ishikawa S, Hori H, Iida H, Ichihashi K, Miura K, Matsumoto J, Numata S, Kodaka F, Furihata R, Ohi K, Ogasawara K, Iga JI, Muraoka H, Komatsu H, Takeshima M, Atake K, Kido M, Nakamura T, Kishimoto T, Hishimoto A, Onitsuka T, Okada T, Ochi S, Nagasawa T, Makinodan M, Yamada H, Tsuboi T, Yamada H, Inada K, Watanabe K, Hashimoto R. Change of prescription for patients with schizophrenia or major depressive disorder during admission: real-world prescribing surveys from the effectiveness of guidelines for dissemination and education psychiatric treatment project. BMC Psychiatry. 2023;23(1):473. doi: 10.1186/s12888-023-04908-4

17. Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull. 1987;13(2):261–276. doi: 10.1093/schbul/13.2.261

18. Keefe RS, Goldberg TE, Harvey PD, Gold JM, Poe MP, Coughenour L. The Brief Assessment of Cognition in Schizophrenia: reliability, sensitivity, and comparison with a standard neurocognitive battery. Schizophr Res. 2004;68(2-3):283–297. doi: 10.1016/j.schres.2003.09.011

19. Sarkisyan GR, Gurovich IYa, Keefe RS. Normative data for the russian population and standardization of the brief assessment of cognition in schizophrenia (BACS) scale. Social and clinical psychiatry. 2010;20(3):13–19. (In Russ.).

20. Maslovskiy SYu, Kozlovskiy VL. Evaluating quality of life of patients with schizophrenia during maintenance therapy. V.M. Bekhterev review of psychiatry and medical psychology. 2009;(3):29–32. (In Russ.).

21. Morosini PL, Magliano L, Brambilla L, Ugolini S, Pioli R. Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social functioning. Acta Psychiatr Scand. 2000;101(4):323–329. PMID: 10782554.

22. Leucht S, Crippa A, Siafis S, Patel MX, Orsini N, Davis JM. Dose-Response Meta-Analysis of Antipsychotic Drugs for Acute Schizophrenia [published correction appears in Am J Psychiatry. 2020;177(3):272. doi: 10.1176/appi.ajp.2020.1773correction2.]. Am J Psychiatry. 2020;177(4):342–353. doi: 10.1176/appi.ajp.2019.19010034

23. Chiquet J, Mariadassou M, Robin S. The Poisson-Lognormal Model as a Versatile Framework for the Joint Analysis of Species Abundances. Front. Ecol. Evol. 2021;9:588292. doi: 10.3389/fevo.2021.588292

24. McDonald JH. Handbook of Biological Statistics, 3rd edition. Baltimore, Maryland: Sparky House Publishing, 2014:299.

25. Brunner E, Munzel U. The Nonparametric Behrens-Fisher Problem: Asymptotic Theory and a Small-Sample Approximation. Biom. J. 2000;42:17–25. doi: 10.1002/(SICI)1521-4036(200001)42:1<17::AIDBIMJ17>3.0.CO;2-U

26. Benjamin DJ, Berger JO, Johannesson M, Nosek BA, Wagenmakers EJ, Berk R. Bollen K.A, Brembs B, Brown L, Camerer C, Cesarini D, Chambers CD, Clyde M, Cook TD, Boeck PD, Dienes Z, Dreber A, Easwaran K, Efferson C, Fehr E, Fidler F, Field AP, Forster M, George EI, Gonzalez R, Goodman S, Green E, Green DP, Greenwald AG, Hadfield JD, Hedges LV, Held L, Ho TH, Hoijtink H, Hruschka DJ, Imai K, Imbens G, Ioannidis JPA, Jeon M, Jones JH, Kirchler M, Laibson D, List J, Little R, Lupia A, Machery E, Maxwell SE, McCarthy M, Moore DA, Morgan SL, Munafó M, Nakagawa S, Nyhan B, Parker TH, Pericchi L, Perugini M, Rouder J, Rousseau J, Savalei V, Schönbrodt FD, SellkeT, Sinclair B, Tingley D, Zandt TV, Vazire S, Watts DJ, Winship C, Wolpert RL, Xie Y, Young C, Zinman J, Johnso VE. Redefine statistical significance. Nature Human Behaviour. 2018;2(1):6–10. doi: 10.1038/s41562-017-0189-z

27. Grjibovski AM, Gvozdeckii AN. Interpretation of and alternatives to p-values in biomedical sciences. Human Ecology. 2022;29(3):209–218. (In Russ.). doi: 10.17816/humeco97249

28. Benjamini Y, Hochberg Y. Controlling the False Discovery Rate: A Practical and Powerful Approach to Multiple Testing. Journal of the Royal Statistical Society: Series B (Methodological). 1995;57(1):289–300. doi: 10.1111/j.2517-6161.1995.tb02031.x

29. Mruh О, Rymsha S, Mruh V. Evaluation of the efficacy of atypical antipsychotic drugs and psychotherapy in patients with paranoid schizophrenia based on the duration of remission. Georgian Med News. 2020;(302):86–92. PMID: 32672696.

30. Lin YH, Wu CS, Liu CC, Kuo PH, Chan HY, Chen WJ. Comparative Effectiveness of Antipsychotics in Preventing Readmission for First-Admission Schizophrenia Patients in National Cohorts From 2001 to 2017 in Taiwan. Schizophr Bull. 2022;48(4):785–794. doi: 10.1093/schbul/sbac046

31. Starzer M, Hansen HG, Hjorthøj C, Albert N, Nordentoft M, Madsen T. 20-year trajectories of positive and negative symptoms after the first psychotic episode in patients with schizophrenia spectrum disorder: results from the OPUS study. World Psychiatry. 2023;22(3):424–432. doi: 10.1002/wps.21121

32. Feber L, Peter NL, Chiocchia V, Schneider-Thoma J, Siafis S, Bighelli I, Hansen WP, Lin X, Prates-Baldez D, Salanti G, Keefe RSE, Engel RR, Leucht S. Antipsychotic Drugs and Cognitive Function: A Systematic Review and Network Meta-Analysis. JAMA Psychiatry. 2025;82(1):47–56. doi: 10.1001/jamapsychiatry.2024.2890. Erratum in: JAMA Psychiatry. 2024;81(12):1279. doi: 10.1001/jamapsychiatry.2024.4051

33. Vaskova LB, Tiapkina MV, Mikhaylenko EV. Comparative analysis of antipsychotic drug consumption for inpatient schizophrenia treatment: a retrospective study with 5-year follow-up. Farmakoekonomika. Modern Pharmacoeconomics and Pharmacoepidemiology. 2020;13(3):251–261. (In Russ.). doi: 10.17749/2070-4909/farmakoekonomika.2020.053

34. Carpiniello B, Pinna F, Manchia M, Tusconi M, Cavallaro R, Bosia M. Sustained symptomatic remission in schizophrenia: Course and predictors from a two-year prospective study. Schizophr Res. 2022;239:34–41. doi: 10.1016/j.schres.2021.11.023