Am J Psychiatry 1995; 152:1038-1044
Copyright © 1995 by American Psychiatric Association
Hospital use of antipsychotic agents in 1989 and 1993: stable dosing with decreased length of stay
RJ Baldessarini, JC Kando and F Centorrino
Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
OBJECTIVE: This study evaluated recent and current use of antipsychotics by
psychiatric inpatients. METHOD: Computer-based hospital pharmacy records
identified prescriptions for antipsychotics in 1993. Medical records were
reviewed to verify prescription and clinical data, and these were compared
with similar data from 1989. RESULTS: In 1993, antipsychotics were
prescribed for 299 (42%) of 709 hospitalized patients. Treatment usually
started within 24 hours of admissions averaging 18 days. High-potency
agents were used 2.4 times more frequently than low-potency drugs; 13%
received clozapine. The mean chlorpromazine-equivalent daily dose,
corrected for as-needed supplements, was 305 mg; peak doses were 32%
higher. Doses of the most potent agents (fluphenazine and haloperidol) were
only 22%-33% above the overall mean. Rarely were two neuroleptics given
simultaneously, but cotreatment with an anticonvulsant (84% of patients,
92% of whom received valproate), a potent benzodiazepine (81%), lithium
(70%), one CNS depressant (84%), or more (45%) was common. Doses averaged
20% higher for men, 42% lower at age > 50 years versus 20-30 years, and
53% greater for schizophrenia or schizoaffective disorder versus other
conditions. Comparison with 1989 admissions (N = 50) averaging 73 days
indicated few differences in use of neuroleptics or benzodiazepines but
less frequent use of anticonvulsants and lithium. CONCLUSIONS: High-
potency antipsychotic agents and clozapine were used most often in 1993;
doses of high-potency agents were only slightly higher than doses of
low-potency agents, but combinations with mood stabilizers were more common
in 1993, when length of stay was one-fourth that in 1989.
