Antipsychotic Treatment Approaches in Schizophrenia Spectrum and Other Psychotic Disorders

Background: The objective of this study was to characterize real-world prescription patterns of antipsychotic drugs in patients with various psychiatric disorders with psychotic features. Method: We analyzed the discharge prescription plans of 59,962 cases with the main diagnoses schizophrenia, schizoaffective disorder, acute transient psychotic disorder, delusional disorder, psychotic bipolar disorder, psychotic depression, organic delusional disorder or substance-induced psychosis. We analyzed the overall use, pharmacological subgroups, the use of long-acting injectable (LAI) formulations, and the frequency of prescription of the singular antipsychotic drugs. Results: Significant differences in prescribing patterns were observed across diagnoses, though effect sizes were generally low. Overall, second-generation antipsychotics (SGA) were most frequently prescribed. Patients with schizophrenia and schizoaffective disorder (SAD) were the groups with the highest use of high-potency first-generation antipsychotics (FGA). LAIs and clozapine were most used in schizophrenia. Quetiapine was favoured in psychotic bipolar disorder and psychotic depression, while risperidone was common in delusional and organic delusional disorder. Conclusion: Patients with SAD could potentially benefit from higher rates of LAI and clozapine prescriptions. Also, current prescribing practices in patients with psychotic depression may not adequately consider the potential benefits of LAI antipsychotics. Regarding the previously mentioned prescription preferences, further research on the comparative effectiveness of different antipsychotics for these patient groups is warranted.