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Background <p>Antipsychotic polypharmacy (APP) remains common in schizophrenia despite guideline recommendations favoring monotherapy. Real-world prescribing patterns involving clozapine and long-acting injectable (LAI) antipsychotics may offer insights into treatment complexity in tertiary psychiatric settings.</p> Methods <p>This retrospective cross-sectional study included 114 outpatients with schizophrenia or schizoaffective disorder attending a tertiary psychotic disorders unit in Türkiye between June and November 2021. Sociodemographic and clinical variables were obtained from routine records. Symptom severity and functioning were assessed using the Brief Psychiatric Rating Scale, Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale for Schizophrenia, and Global Assessment of Functioning. Patients were evaluated by APP status, clozapine use, and LAI use. Logistic regression analyses identified factors associated with APP and clozapine treatment.</p> Results <p>Overall, 65.7% received antipsychotic monotherapy, while 32.4% received two or more agents. Aripiprazole (30.7%), olanzapine (28.1%), and clozapine (25.4%) were most frequently prescribed, with aripiprazole the most common in APP regimens. LAIs were prescribed in 18.4% of patients. APP was associated with longer illness duration and lower employment rates. Clozapine use was independently associated with longer illness duration and higher PANSS negative symptom scores.</p> Conclusions <p>APP remains common in tertiary outpatient psychotic disorders care and may reflect treatment complexity beyond illness severity, underscoring individualized prescribing strategies. Clozapine use is associated with longer illness duration and greater negative symptom burden, although delays in initiation may persist. Prospective studies are needed to clarify optimal strategies and improve individualized care.</p>

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Real-world antipsychotic prescribing patterns in psychotic disorders: polypharmacy, clozapine, and long-acting injectable use in a tertiary outpatient cohort

  • 期刊论文

  • 发表日期：

    2026年7月4日

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  • Büşra Uçar Bostan,
  • Ali Tarık Altunç,
  • Ersel Bulu,
  • Öznur Demirel,
  • Elif Burcu Ersungur Çelik,
  • Mehmet Murat Kırpınar,
  • Ömer Faruk Demirel

摘要

Background

Antipsychotic polypharmacy (APP) remains common in schizophrenia despite guideline recommendations favoring monotherapy. Real-world prescribing patterns involving clozapine and long-acting injectable (LAI) antipsychotics may offer insights into treatment complexity in tertiary psychiatric settings.

Methods

This retrospective cross-sectional study included 114 outpatients with schizophrenia or schizoaffective disorder attending a tertiary psychotic disorders unit in Türkiye between June and November 2021. Sociodemographic and clinical variables were obtained from routine records. Symptom severity and functioning were assessed using the Brief Psychiatric Rating Scale, Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale for Schizophrenia, and Global Assessment of Functioning. Patients were evaluated by APP status, clozapine use, and LAI use. Logistic regression analyses identified factors associated with APP and clozapine treatment.

Results

Overall, 65.7% received antipsychotic monotherapy, while 32.4% received two or more agents. Aripiprazole (30.7%), olanzapine (28.1%), and clozapine (25.4%) were most frequently prescribed, with aripiprazole the most common in APP regimens. LAIs were prescribed in 18.4% of patients. APP was associated with longer illness duration and lower employment rates. Clozapine use was independently associated with longer illness duration and higher PANSS negative symptom scores.

Conclusions

APP remains common in tertiary outpatient psychotic disorders care and may reflect treatment complexity beyond illness severity, underscoring individualized prescribing strategies. Clozapine use is associated with longer illness duration and greater negative symptom burden, although delays in initiation may persist. Prospective studies are needed to clarify optimal strategies and improve individualized care.