. 2022 Dec 26;21(1):52.

doi: 10.1186/s12991-022-00429-8.

The characteristics of discharge prescriptions including pro re nata psychotropic medications for patients with schizophrenia and major depressive disorder from the survey of the "Effectiveness of guidelines for dissemination and education in psychiatric treatment (EGUIDE)" project

Yoshitaka Kyou¹, Norio Yasui-Furukori², Naomi Hasegawa³, Kenta Ide^{3

4}, Kayo Ichihashi⁵, Naoki Hashimoto⁶, Hikaru Hori⁷, Yoshihito Shimizu⁸, Yayoi Imamura⁹, Hiroyuki Muraoka¹, Hitoshi Iida⁷, Kazutaka Ohi¹⁰, Yuka Yasuda^{3

11}, Kazuyoshi Ogasawara¹², Shusuke Numata¹³, Jun-Ichi Iga¹⁴, Takashi Tsuboi⁹, Shinichiro Ochi¹⁵, Fumitoshi Kodaka¹⁶, Ryuji Furihata¹⁷, Toshiaki Onitsuka¹⁸, Manabu Makinodan¹⁹, Hiroshi Komatsu²⁰, Masahiro Takeshima²¹, Chika Kubota²², Akitoyo Hishimoto²³, Kiyokazu Atake²⁴, Hirotaka Yamagata²⁵, Mikio Kido^{26

27}, Tatsuya Nagasawa²⁸, Masahide Usami²⁹, Taishiro Kishimoto³⁰, Saya Kikuchi²⁰, Junya Matsumoto³, Kenichiro Miura³, Hisashi Yamada^{3

31}, Koichiro Watanabe⁹, Ken Inada¹, Ryota Hahimoto³

Affiliations

¹ Department of Psychiatry, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0374, Japan.
² Department of Psychiatry, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Shimotsuga, Mibu, Tochigi, 321-0293, Japan. furukori@dokkyomed.ac.jp.
³ Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, Tokyo, 187-8553, Japan.
⁴ Department of Hospital Pharmacy, Hospital of University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-Ku, Kitakyushu-Shi, Fukuoka, 807-8555, Japan.
⁵ Department of Neuropsychiatry, University of Tokyo Hospital, 7-3-1 Hongo, Tokyo, 113-8655, Japan.
⁶ Department of Psychiatry, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-Ku, Sapporo, 060-8638, Japan.
⁷ Department of Psychiatry, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jyonan-Ku, Fukuoka City, Fukuoka, 814-0180, Japan.
⁸ Department of Pharmacy, Kanazawa Medical University Hospital, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, 920-0293, Japan.
⁹ Department of Neuropsychiatry, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-Shi, Tokyo, 181-8611, Japan.
¹⁰ Department of Psychiatry, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan.
¹¹ Life Grow Brilliant Mental Clinic, Medical Corporation Foster, 1-3-11 Oyodominami, Kitaku, Osaka, 531-0075, Japan.
¹² Center for Postgraduate Clinical Training and Career Development, Nagoya University Hospital, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan.
¹³ Department of Psychiatry, Graduate School of Biomedical Science, Tokushima University, 3-8-15 Kuramoto-Cho, Tokushima, 770-8503, Japan.
¹⁴ Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan.
¹⁵ Department of Neuropsychiatry, Molecules and Function, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan.
¹⁶ Department of Psychiatry, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minatoku, Japan.
¹⁷ Agency for Health, Safety and Environment, Kyoto University, Yoshida Honmachi, Sakyo-Ku, Kyoto, 606-8501, Japan.
¹⁸ Department of Neuroimaging Psychiatry, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashiku, Fukuoka, 812-8582, Japan.
¹⁹ Department of Psychiatry, Nara Medical University School of Medicine, 840 Shijocho Kashihara, Nara, 634-8522, Japan.
²⁰ Department of Psychiatry, Tohoku University Hospital, 1-1 Seiryo-Machi, Aobaku, Sendai, 980-8573, Japan.
²¹ Department of Neuropsychiatry, Akita University Graduate School of Medicine, 1-1-1, Hondo, Akita City, Akita, 010-8543, Japan.
²² Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1- Ogawahigashi, Kodaira, Tokyo, 187-8553, Japan.
²³ Department of Psychiatry, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama, 236-0004, Japan.
²⁴ Health Administration Center (Kyusyu Region), Nippon Telegraph and Telephone West Corporation, 13-8 DOIMACHI Bld.2F, Kamikawabatamachi, Hakata-Ku, Fukuoka, 812-0026, Japan.
²⁵ Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan.
²⁶ Kido Clinic, 244 Hounoki, Imizu, Toyama, 934-0053, Japan.
²⁷ Department of Neuropsychiatry, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
²⁸ Department of NeuroPsychiatry, Kanazawa Medical University, 1-1 Daigaku, Uchinada-Machi, Ishikawa, 920-0293, Japan.
²⁹ Department of Child and Adolescent Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1 Kohnodai, Ichikawa, Chiba, 272-8516, Japan.
³⁰ Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan.
³¹ Department of Neuropsychiatry, Hyogo Medical University, 1-1, Mukogawa-Cho, Nishinomiya, Hyogo, 663-8501, Japan.

PMID: 36567327
PMCID: PMC9791735
DOI: 10.1186/s12991-022-00429-8

The characteristics of discharge prescriptions including pro re nata psychotropic medications for patients with schizophrenia and major depressive disorder from the survey of the "Effectiveness of guidelines for dissemination and education in psychiatric treatment (EGUIDE)" project

Yoshitaka Kyou et al. Ann Gen Psychiatry. 2022.

. 2022 Dec 26;21(1):52.

doi: 10.1186/s12991-022-00429-8.

Authors

Affiliations

¹ Department of Psychiatry, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0374, Japan.
² Department of Psychiatry, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Shimotsuga, Mibu, Tochigi, 321-0293, Japan. furukori@dokkyomed.ac.jp.
³ Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, Tokyo, 187-8553, Japan.
⁴ Department of Hospital Pharmacy, Hospital of University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-Ku, Kitakyushu-Shi, Fukuoka, 807-8555, Japan.
⁵ Department of Neuropsychiatry, University of Tokyo Hospital, 7-3-1 Hongo, Tokyo, 113-8655, Japan.
⁶ Department of Psychiatry, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-Ku, Sapporo, 060-8638, Japan.
⁷ Department of Psychiatry, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jyonan-Ku, Fukuoka City, Fukuoka, 814-0180, Japan.
⁸ Department of Pharmacy, Kanazawa Medical University Hospital, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, 920-0293, Japan.
⁹ Department of Neuropsychiatry, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-Shi, Tokyo, 181-8611, Japan.
¹⁰ Department of Psychiatry, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan.
¹¹ Life Grow Brilliant Mental Clinic, Medical Corporation Foster, 1-3-11 Oyodominami, Kitaku, Osaka, 531-0075, Japan.
¹² Center for Postgraduate Clinical Training and Career Development, Nagoya University Hospital, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan.
¹³ Department of Psychiatry, Graduate School of Biomedical Science, Tokushima University, 3-8-15 Kuramoto-Cho, Tokushima, 770-8503, Japan.
¹⁴ Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan.
¹⁵ Department of Neuropsychiatry, Molecules and Function, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan.
¹⁶ Department of Psychiatry, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minatoku, Japan.
¹⁷ Agency for Health, Safety and Environment, Kyoto University, Yoshida Honmachi, Sakyo-Ku, Kyoto, 606-8501, Japan.
¹⁸ Department of Neuroimaging Psychiatry, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashiku, Fukuoka, 812-8582, Japan.
¹⁹ Department of Psychiatry, Nara Medical University School of Medicine, 840 Shijocho Kashihara, Nara, 634-8522, Japan.
²⁰ Department of Psychiatry, Tohoku University Hospital, 1-1 Seiryo-Machi, Aobaku, Sendai, 980-8573, Japan.
²¹ Department of Neuropsychiatry, Akita University Graduate School of Medicine, 1-1-1, Hondo, Akita City, Akita, 010-8543, Japan.
²² Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1- Ogawahigashi, Kodaira, Tokyo, 187-8553, Japan.
²³ Department of Psychiatry, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama, 236-0004, Japan.
²⁴ Health Administration Center (Kyusyu Region), Nippon Telegraph and Telephone West Corporation, 13-8 DOIMACHI Bld.2F, Kamikawabatamachi, Hakata-Ku, Fukuoka, 812-0026, Japan.
²⁵ Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan.
²⁶ Kido Clinic, 244 Hounoki, Imizu, Toyama, 934-0053, Japan.
²⁷ Department of Neuropsychiatry, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
²⁸ Department of NeuroPsychiatry, Kanazawa Medical University, 1-1 Daigaku, Uchinada-Machi, Ishikawa, 920-0293, Japan.
²⁹ Department of Child and Adolescent Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1 Kohnodai, Ichikawa, Chiba, 272-8516, Japan.
³⁰ Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan.
³¹ Department of Neuropsychiatry, Hyogo Medical University, 1-1, Mukogawa-Cho, Nishinomiya, Hyogo, 663-8501, Japan.

PMID: 36567327
PMCID: PMC9791735
DOI: 10.1186/s12991-022-00429-8

Abstract

Background: Several guidelines recommend monotherapy in pharmacotherapy for schizophrenia and major depressive disorder. The content of regular prescriptions has been reported in several studies, but not enough research has been conducted on the content of pharmacotherapy, including pro re nata (PRN) medications. The purpose of this study was to evaluate the content of pharmacotherapy, including PRN medications, and to clarify the relationship with regular prescriptions.

Methods: We used data from the "Effectiveness of Guidelines for Dissemination And Education in psychiatric treatment" (EGUIDE) project to investigate the presence or absence of PRN psychotropic medications at discharge for each drug category. We compared the PRN psychotropic prescription ratio at discharge by diagnosis for each drug category. The antipsychotic monotherapy ratio and no prescription ratio of other psychotropics for schizophrenia at discharge and the antidepressant monotherapy ratio and no prescription ratio of other psychotropics for major depressive disorder at discharge were calculated for each regular prescription, including PRN psychotropic medications, as quality indicators (QIs). Spearman's rank correlation test was performed for QI values of regular prescriptions and the QI ratio between regular prescriptions and prescriptions including PRN medications for each diagnosis.

Results: The PRN psychotropic prescription ratio at discharge was 28.7% for schizophrenia and 30.4% for major depressive disorder, with no significant differences by diagnosis. The prescription ratios of PRN antipsychotic medications and PRN antiparkinsonian medications were significantly higher for schizophrenia. The prescription ratios of PRN anxiolytic and hypnotic and PRN antidepressant medications were significantly higher for patients with major depressive disorder. For both schizophrenia and major depressive disorder, the QI was lower for discharge prescriptions, including PRN medications, than for regular prescriptions. QI values for regular prescriptions and the QI ratio were positively correlated.

Conclusions: Considering PRN psychotropic medications, the monotherapy ratio and no prescription ratio of other psychotropics at discharge decreased in pharmacotherapy for schizophrenia and major depressive disorder. A higher ratio of monotherapy and no prescription of other psychotropics on regular prescriptions may result in less concomitant use of PRN psychotropic medications. Further studies are needed to optimize PRN psychotropic prescriptions.

Keywords: Depression; EGUIDE; Pro re nata; Psychotropic; Schizophrenia.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

**Fig. 1**
Relations between quality indicator (QI) for regular prescriptions and QI ratio in schizophrenia in Figure A (left-hand) and in major depressive disorder in Figure B (right-hand)

See this image and copyright information in PMC

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The characteristics of discharge prescriptions including pro re nata psychotropic medications for patients with schizophrenia and major depressive disorder from the survey of the "Effectiveness of guidelines for dissemination and education in psychiatric treatment (EGUIDE)" project

Affiliations

The characteristics of discharge prescriptions including pro re nata psychotropic medications for patients with schizophrenia and major depressive disorder from the survey of the "Effectiveness of guidelines for dissemination and education in psychiatric treatment (EGUIDE)" project

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

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Abstract

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