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Pharmacological treatment for schizoaffective disorder

A comparison with schizophrenia and bipolar disorder

Pharmakologische Behandlung schizoaffektiver Störungen

Ein Vergleich mit schizophrenen und bipolaren Störungen

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Abstract

Background

Bipolar disorder and schizophrenia are severe mental illnesses, each with a prevalence of approximately 1–2% in the general population. There is considerable controversy about differentiating schizophrenia from schizoaffective or bipolar disorder owing to many similarities in psychopathology, progression, and biological factors. The aim of this study was to identify similarities and differences in the pharmacological treatment of these disorders by comparing the prescription patterns.

Method

In this retrospective, explorative study we analyzed the prescribed medication of 300 patients with bipolar, schizophrenic, or schizoaffective disorders from data obtained from ten German adult psychiatric clinics of the LWL (“Landschaftsverband Westfalen-Lippe”) psychiatric network.

Results

Only 21.8% of patients analyzed were consistently compliant in taking their medication before hospitalization. Polypharmacy was applied in 75.6% of cases, whereby 2.27 psychopharmacological agents were prescribed at discharge. Briefly, we observed greater similarity between prescription patterns associated with bipolar and schizoaffective disorders than with schizophrenia prescription patterns.

Conclusion

Polypharmacy tends to be more the rule than the exception, especially when patients present with affective psychotic features. Bipolar and schizoaffective disorders cannot be differentiated according to their prescription patterns.

Zusammenfassung

Hintergrund

Bipolare und schizophrene Störungen sind sehr schwere und bei einer Prävalenz von 1–2 % in der Allgemeinbevölkerung auch häufige psychische Erkrankungen. Aufgrund zahlreicher Gemeinsamkeiten zwischen Schizophrenien, schizoaffektiven und bipolaren Störungen hinsichtlich der Psychopathologie, dem Verlauf sowie der biologischen Grundlage wird eine klare Trennung dieser Entitäten kontrovers diskutiert. Der im Rahmen dieser Studie durchgeführte Vergleich der Verordnungsgewohnheiten in verschiedenen Kliniken hatte das Ziel, Hinweise auf eine differenzielle Pharmakotherapie dieser Störungen aufzudecken.

Methodik

In dieser retrospektiven, explorativen Studie wurde das medikamentöse Verordnungsverhalten bei bipolaren, schizophrenen bzw. schizoaffektiven Störungen bei insgesamt 300 Patienten aus 10 Kliniken des LWL-Psychiatrieverbunds untersucht.

Ergebnisse

Nur 21,8 % der insgesamt in die Studie eingeschlossenen Patienten zeigten eine befriedigende Compliance in der Medikamenteneinnahme vor dem stationären Aufenthalt. Polypharmazie lag bei 75,6 % der Patienten vor, im Mittel bestand eine Verordnung für 2,27 psychotrope Medikamente bei Entlassung. Zusammenfassend ähnelt das Verschreibungsverhalten bei bipolaren Störungen eher demjenigen bei schizoaffektiven Störungen als dem bei Schizophrenie.

Schlussfolgerung

Polypharmazie ist eher die Regel als die Ausnahme, besonders beim Vorliegen affektiver und psychotischer Merkmale. Im klinischen Verordnungsverhalten sind bipolare Störungen und schizoaffektive Störungen kaum zu unterscheiden.

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Acknowledgements

We wish to thank Dr. Stefan Bender, Dr. Christos Chrysanthou, Prof. Dr. Georg Juckel, Prof. Dr. Klaus-Thomas Kronmüller, Dr. Josef Leßmann, PD Dr. Gerhard Reymann, Dr. Luc Turmes, Prof. Dr. Ulrich Trenckmann, PD Dr. Bernward Vieten from the LWL-PsychiatrieVerbund (LWL psychiatric network) for access to patients’ data, Carole Cürten for her kind support regarding the English translation of this paper, and Dr. Bianca Ueberberg for her thorough revision of the text

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Authors and Affiliations

  1. LWL-Klinik Dortmund, Marsbruchstr. 179, 44287, Dortmund, Germany

    H.-J. Assion & H. Reinbold

  2. Tagesklinik des gpz Detmold, Hindenburgstr. 1, 32791, Lage, Germany

    A. Schweppe

  3. Psychiatry, Psychosomatic Medicine and Psychotherapy, Klinik an der Lindenhöhe, Bertha-von-Suttner-Str. 1, 77654, Offenburg, Germany

    U. Frommberger

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  1. H.-J. Assion
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Correspondence to H.-J. Assion.

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Conflict of interest

H.-J. Assion, A. Schweppe, H. Reinbold, and U. Frommberger declare that they have no competing interests.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Assion, HJ., Schweppe, A., Reinbold, H. et al. Pharmacological treatment for schizoaffective disorder. Nervenarzt 90 (Suppl 1), 1–8 (2019). https://doi.org/10.1007/s00115-018-0507-3

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