Comparing the use and discontinuation of antipsychotics in clinical practice: an observational study.

Background: There are few independent studies comparing atypical or second-generation antipsychotics (SGAs).

Objective: To compare the patterns of use and discontinuation of commonly used SGAs.

Method: Retrospective review of 11,250 case records (2002-2005) of all mental health care contacts in a discrete geographical setting in Scotland. Patterns of use, mean dose, psychotropic co-prescription, duration of treatment, discontinuation rates, and admission rates were examined for amisulpride, clozapine, olanzapine, quetiapine, and risperidone.

Results: Clozapine had a significantly lower discontinuation rate in individuals with schizophrenia, compared to the other 4 SGAs. Off-license prescribing and polypharmacy were common.

Conclusion: SGAs are variously used for schizophrenia and mood disorder and have heterogeneous outcomes, with clozapine being most effective in this study. Independent observational studies such as this complement randomized controlled trials.