Relapse According to Antipsychotic Treatment in Schizophrenic Patients

Aurelie Millier; Emmanuelle Sarlon; Jean-Michel Azorin; Laurent Boyer; Samuel Aballea; Pascal Auquier; Mondher Toumi

BMC Psychiatry. 2011;11

Abstract and Introduction

Abstract

Objective: To compare the rate of relapse as a function of antipsychotic treatment (monotherapy vs. polypharmacy) in schizophrenic patients over a 2-year period.
Methods: Using data from a multicenter cohort study conducted in France, we performed a propensity-adjusted analysis to examine the association between the rate of relapse over a 2-year period and antipsychotic treatment (monotherapy vs. polypharmacy).
Results: Our sample consisted in 183 patients; 50 patients (27.3%) had at least one period of relapse and 133 had no relapse (72.7%). Thirty-eight (37.7) percent of the patients received polypharmacy. The most severely ill patients were given polypharmacy: the age at onset of illness was lower in the polypharmacy group (p = 0.03). Patients that received polypharmacy also presented a higher general psychopathology PANSS subscore (p = 0.04) but no statistically significant difference was found in the PANSS total score or the PANSS positive or negative subscales. These patients were more likely to be given prescriptions for sedative drugs (p < 0.01) and antidepressant medications (p = 0.03). Relapse was found in 23.7% of patients given monotherapy and 33.3% given polypharmacy (p = 0.16). After stratification according to quintiles of the propensity score, which eliminated all significant differences for baseline characteristics, antipsychotic polypharmacy was not statistically associated with an increase of relapse: HR = 1.686 (0.812; 2.505).
Conclusion: After propensity score adjustment, antipsychotic polypharmacy is not statistically associated to an increase of relapse. Future randomised studies are needed to assess the impact of antipsychotic polypharmacy in schizophrenia.

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Table 1. Baseline characteristics for schizophrenic patients with monotherapy and polypharmacy (n = 183).
	Patients with monotherapy (n = 114)		Patients with polypharmacy (n = 69)		P value
	M	(SD)¹	M	(SD)
Socio-demographic characteristics
Gender (male), N (%)²	79	(69.3)	50	(73.5)	0.54
Age	37.9	(10.5)	40.6	(10.3)	0.08
Living conditions (Alone), N (%)	35	(30.7)	30	(43.5)	0.08
Clinical characteristics
Age at onset of illness	25.43	(8.20)	22.65	(7.28)	0.03
Total PANSS³ score	65.3	(18.0)	70.0	(22.2)	0.14
Positive PANSS score	14.0	(5.3)	13.7	(5.6)	0.74
Negative PANSS score	18.0	(6.9)	19.6	(8.2)	0.16
General Psychopathology PANSS score	33.3	(9.8)	36.7	(11.6)	0.04
GAF⁴ score	54.0	(14.0)	51.0	(16.3)	0.20
GARF⁵ score	55.7	(16.7)	54.3	(17.7)	0.59
SOFAS⁶ score	53.9	(13.4)	50.7	(15.7)	0.15
CDSS⁷ score	2.7	(3.3)	3.8	(4.1)	0.07
Medication
Drugs for side-effects^§, N (%)	40	(35.0)	42	(60.9)	<0.01
Sedative drugs^§§, N (%)	49	(43.0)	46	(66.7)	<0.01
Antidepressant, N (%)	18	(15.8)	20	(29.0)	0.03
AIMS⁸	2.7	(4.3)	3.1	(4.6)	0.53
BAS⁹	1.0	(1.9)	1.1	(2.1)	0.71
SAS¹⁰	2.9	(3.3)	3.8	(4.0)	0.13
ROMI¹¹
Compliance score	12.2	(2.8)	13.0	(2.7)	0.09
Non compliance score	14.2	(3.7)	14.0	(3.8)	0.74
Number of previous hospitalisations	5.5	(5.3)	7.5	(6.9)	0.05
Quality of life: SF-36
Physical Functioning	82.0	(20.5)	76.3	(22.9)	0.10
Role-Physical Limitations	74.2	(32.9)	65.9	(40.2)	0.15
Bodily Pain	72.7	(26.3)	71.9	(27.6)	0.85
General Health	58.2	(21.4)	58.3	(21.0)	0.98
Vitality	50.9	(19.1)	48.0	(17.9)	0.34
Mental Health	63.4	(20.4)	59.5	(17.3)	0.21
Role-Emotional Limitations	74.3	(36.4)	60.8	(40.2)	0.03
Social Functioning	68.9	(30.1)	67.1	(25.8)	0.70
Relapse, N (%)	27	(23.7)	23	(33.3)	0.16

¹ Mean (Standard Deviation)
² Effective (Percentage)
³ Positive and Negative Syndrome Scale; ⁴Global Assessment Functioning; ⁵Global Assessment of Relational Functioning; ⁶Social and Occupational Functioning Assessment Scale; ⁷Calgary Depression Scale for Schizophrenia; ⁸Abnormal Involuntary Movement Score; ⁹Barnes Akathisia score; ¹⁰Simpson-Angus score; ¹¹Rating of Medication Influences Scale.
§ Drugs for side effects: Biperiden hydrochloride, Tropatepine hydrochloride, and Trihexyphenidyl hydrochloride.
§§ Sedative drugs: Benzodiazepines, Antihistamines, and Hypnotics.
Values significant at the 5% level are marked in bold.

Table 2. Univariate and propensity score-stratified models: Hazard Ratio (HR) and its corresponding 95% confidence interval (CI) for risk factors associated with relapse (n = 183).
	Patients with relapse (n = 50)		Patients with no relapse (n = 133)			Propensity score-stratified model
	M	(SD)¹	>M	(SD)	P value	HR	(95% CI)
Socio-demographic characteristics
Gender (male), N (%)²	34	(68.0)	95	(72.0)	0.60	-	-
Age	36.3	(9.7)	39.9	(10.6)	0.04	-	-
Living conditions (Alone), N (%)	12	(24.0)	53	(39.9)	0.04	-	-
Clinical characteristics
Age at onset of illness	21.5	(5.6)	25.4	(8.4)	<0.01	-	-
Total PANSS³ score	66.4	(18.7)	67.4	(20.2)	0.76	-	-
Positive PANSS score	14.6	(5.4)	13.6	(5.5)	0.26	-	-
Negative PANSS score	17.7	(6.5)	19.0	(7.8)	0.31	-	-
General Psychopathology PANSS score	34.0	(10.9)	34.8	(10.5)	0.66	-	-
GAF⁴ score	51.9	(14.2)	53.3	(15.2)	0.58	-	-
GARF⁵ score	54.2	(15.9)	55.5	(17.5)	0.64	-	-
SOFAS⁶ score	52.0	(14.4)	52.9	(14.4)	0.72	-	-
CDSS⁷ score	3.9	(4.5)	2.8	(3.3)	0.11	-	-
Medication
Drugs for side-effects, N (%)	19	(38.0)	63	(47.4)	0.26	-	-
Sedatives drugs, N (%)	31	(62.0)	64	(48.1)	0.09	-	-
Antidepressants, N (%)	13	(26.0)	25	(18.8)	0.28	-	-
AIMS⁸	2.7	(4.3)	2.9	(4.4)	0.82	-	-
BAS⁹	1.1	(2.0)	1.0	(2.0)	0.74	-	-
SAS¹⁰	3.2	(3.1)	3.3	(3.8)	0.81	-	-
ROMI¹¹						-	-
Compliance score	12.9	(2.6)	12.4	(2.8)	0.20
Non compliance score	14.5	(3.8)	14.0	(3.7)	0.40
Number of previous hospitalisations	7.7	(7.2)	5.7	(5.5)	0.10
Quality of life:SF-36
Physical Functioning	83.3	(18.8)	78.8	(22.3)	0.23	-	-
Role-Physical Limitations	66.5	(39.1)	72.7	(34.6)	0.32	-	-
Bodily Pain	69.4	(27.6)	73.4	(26.4)	0.39	-	-
General Health	55.8	(22.5)	59.1	(20.8)	0.38	-	-
Vitality	51.5	(16.6)	49.3	(29.4)	0.50	-	-
Mental Health	61.9	(19.5)	62.1	(19.4)	0.96	-	-
Role-Emotional Limitations	63.2	(39.1)	71.5	(38.0)	0.22	-	-
Social Functioning	68.6	(27.7)	68.2	(29.0)	0.93	-	-
Polypharmacy	23	(46.0)	46	(34.6)	0.15	1.686	(0.812; 2.505)

¹ Mean (Standard Deviation)
² Effective (Percentage)
³ Positive and Negative Syndrome Scale; ⁴Global Assessment Functioning; ⁵Global Assessment of Relational Functioning; ⁶Social and Occupational Functioning Assessment Scale; ⁷Calgary Depression Scale for Schizophrenia; ⁸Abnormal Involuntary Movement Score; ⁹Barnes Akathisia score; ¹⁰Simpson-Angus score; ¹¹Rating of Medication Influences Scale.
Values significant at the 5% level are marked in bold.

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