Antipsychotic prescribing trends in schizophrenia between 2011 and 2021: real-world data from a US electronic health record database

Kira Griffiths, Antonio D Martínez-Gutiérrez, Miguel E Rentería, Rashmi Patel

Research output: Contribution to journalMeeting abstractpeer-review


Background: Schizophrenia is a severe and chronic psychiatric illness which is primarily treated with antipsychotic medication. Several antipsychotics are available, although the efficacy and tolerability of these compounds varies between individuals.[1,2] As such, international clinical guidelines do not specify treatment regimens and encourage tailored treatment on a patient-by-patient basis.[3] Electronic health records (EHRs) contain routinely collected information on medication prescriptions and therefore represent treatment regimens in real-world schizophrenia populations that capture real-world clinical decision making. This study describes antipsychotic prescribing trends over a 10-year period for patients with schizophrenia treated across US mental healthcare providers.

Methods: De-identified data were extracted from EHR systems across 26 US mental healthcare providers over a period of 10 years (2011–2021). The cohort included adult patients with an International Classification of Diseases revision 9 or 10 (ICD-9/10) diagnosis of schizophrenia who were treated across inpatient and outpatient settings. Inclusion in the cohort required patients to have at least one short-acting antipsychotic prescribed for a minimum duration of 14 days from the date of schizophrenia diagnosis (+/- 14days). Patient-level data on the antipsychotic prescribed at the first recorded diagnosis of schizophrenia within the EHR system was extracted using the Holmusk NeuroBlu platform.[4] The frequency of different antipsychotic prescriptions was recorded. A bump chart was used to illustrate changes in the hierarchy of antipsychotic prescribing patterns over the 10-year period.

Results: Short-acting antipsychotic prescription data were available for 3,642 patients (Table 1) (mean age = 38.3years ± 14.4; 65% male). Across time, the top five antipsychotics prescribed were risperidone (27.9%), olanzapine (14.5%), haloperidol (12.9%), quetiapine (12.9%), and aripiprazole (11.1%). Paliperidone, fluphenazine, clozapine and lurasidone were also amongst the most frequently prescribed antipsychotics, although the frequency of prescription was much lower for these medications (2.4–3.9%). Risperidone has consistently been the most frequently prescribed antipsychotic at first clinical contact recorded in the EHR system between 2011 and 2021. Haloperidol was the second most frequently prescribed antipsychotic between 2012 and 2014. The frequency of haloperidol prescriptions was exceeded by quetiapine, olanzapine and aripiprazole in the years that followed. The relative frequency of paliperidone prescription has increased over time (rank 8th in 2011 to 4th in 2020).

Conclusion: In line with clinical guidelines, second-generation antipsychotics are commonly prescribed for patients with schizophrenia treated across US mental healthcare providers, although haloperidol prescriptions were also high despite its association with an increased risk of extrapyramidal side effects.[5] The presence of clozapine prescriptions, which are not recommended as a first-line treatment, may reflect the first presentation of patients with treatment resistant schizophrenia who may have received other antipsychotic treatments in other clinical settings. A limitation is that this prescription data does not represent first-line prescribed antipsychotics at the individual patient level, as patients may previously been treated elsewhere. Overall, real-world data can generate insights on the degree to which clinical prescribing practises reflect clinical guidelines.
Original languageEnglish
Article number100636
Pages (from-to)269
Number of pages270
JournalNeuroscience Applied
Issue numberS2
Publication statusPublished - 24 Dec 2022


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