A Network Analysis of Psychiatric Symptoms in Patients With Schizophrenia Treated With Antipsychotic Polypharmacy Using Propensity Score Matching: Findings From the Research on Asian Psychotropic Prescription Patterns (REAP) Study

Wen Li¹, Qinge Zhang², Gabor S Ungvari^{3

4}, Seon-Cheol Park⁵, Lian-Yu Chen⁶, Kok Yoon Chee⁷, Roy Abraham Kallivayalil⁸, Kang Sim⁹, Yan-Ling He¹⁰, Norman Sartorius¹¹, Naotaka Shinfuku¹², Shih-Ku Lin¹³, Ajit Avasthi¹⁴, Sandeep Grover¹⁴, Takahiro A Kato¹⁵, Chee H Ng¹⁶, Yu-Tao Xiang^{17

18}

Affiliations

¹ Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Ministry of Justice, China, Shanghai, China.
² Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.
³ Section of Psychiatry, University of Notre Dame Australia, Fremantle, Australia.
⁴ Division of Psychiatry, School of Medicine, University of Western Australia, Perth, Australia.
⁵ Department of Psychiatry, Hanyang University College of Medicine, Seoul, Korea.
⁶ National Health Insurance Administration, Ministry and Health and Welfare, Taiwan & Graduate Institute of Clinical Medicine, National Chung Hsing University, Taichung, Taiwan.
⁷ Department of Psychiatry and Mental Health, Tunku Abdul Rahman Institute of Neurosciences, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia.
⁸ Department of Psychiatry, Pushpagiri Institute of Medical Sciences, Thiruvalla, India.
⁹ West Region, Institute of Mental Health, Singapore.
¹⁰ Department of Psychiatric Epidemiology, Shanghai Mental Health Center, Shanghai, China.
¹¹ Association for the Improvement of Mental Health Programs, Geneva, Switzerland.
¹² International Center for Medical Research, Kobe University School of Medicine, Kobe, Japan.
¹³ Department of Psychiatry, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan.
¹⁴ Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
¹⁵ Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
¹⁶ Department of Psychiatry, the Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, Australia.
¹⁷ Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macau SAR, China.
¹⁸ Centre for Cognitive and Brain Sciences, University of Macau, Macau SAR, China.

PMID: 40820587
DOI: 10.1111/appy.70005

A Network Analysis of Psychiatric Symptoms in Patients With Schizophrenia Treated With Antipsychotic Polypharmacy Using Propensity Score Matching: Findings From the Research on Asian Psychotropic Prescription Patterns (REAP) Study

Wen Li et al. Asia Pac Psychiatry. 2025 Sep.

. 2025 Sep;17(3):e70005.

doi: 10.1111/appy.70005.

Authors

Affiliations

¹ Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Ministry of Justice, China, Shanghai, China.
² Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.
³ Section of Psychiatry, University of Notre Dame Australia, Fremantle, Australia.
⁴ Division of Psychiatry, School of Medicine, University of Western Australia, Perth, Australia.
⁵ Department of Psychiatry, Hanyang University College of Medicine, Seoul, Korea.
⁶ National Health Insurance Administration, Ministry and Health and Welfare, Taiwan & Graduate Institute of Clinical Medicine, National Chung Hsing University, Taichung, Taiwan.
⁷ Department of Psychiatry and Mental Health, Tunku Abdul Rahman Institute of Neurosciences, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia.
⁸ Department of Psychiatry, Pushpagiri Institute of Medical Sciences, Thiruvalla, India.
⁹ West Region, Institute of Mental Health, Singapore.
¹⁰ Department of Psychiatric Epidemiology, Shanghai Mental Health Center, Shanghai, China.
¹¹ Association for the Improvement of Mental Health Programs, Geneva, Switzerland.
¹² International Center for Medical Research, Kobe University School of Medicine, Kobe, Japan.
¹³ Department of Psychiatry, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan.
¹⁴ Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
¹⁵ Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
¹⁶ Department of Psychiatry, the Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, Australia.
¹⁷ Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macau SAR, China.
¹⁸ Centre for Cognitive and Brain Sciences, University of Macau, Macau SAR, China.

PMID: 40820587
DOI: 10.1111/appy.70005

Abstract

Objectives: Antipsychotic polypharmacy (APP) is prevalent among patients with schizophrenia across countries in Asia. This study aimed to explore the relationships between psychiatric symptoms and APP using network analysis.

Methods: Data on nine major psychiatric symptoms and the number of prescribed antipsychotics were extracted from the fourth survey of the Research on Asian Psychotropic Prescription Patterns (REAP-AP). A network model of the nine psychiatric symptoms was constructed for patients treated with APP and antipsychotic monotherapy (APM) respectively. The interconnections between psychiatric symptoms and APP use were further analyzed using network analysis.

Results: A total of 1528 patients with schizophrenia treated with APP were matched with 1528 patients treated with APM in Asia. The top three central psychiatric symptoms in the networks of psychiatric symptoms were consistent, but in different orders for APP-treated patients (verbal aggression, hallucinations, and social/occupational dysfunction) and APM-treated patients (social/occupational dysfunction, verbal aggression, and hallucinations). Network analysis of APP and psychiatric symptoms revealed that disorganized/catatonic behavior was strongly linked with APP, followed by delusions, hallucinations, and verbal aggression.

Conclusion: Psychiatric symptoms closely associated with APP included verbal aggression, grossly disorganized/catatonic behavior, delusions, and hallucinations. For patients with schizophrenia who are primarily exhibiting such symptoms, alternative appropriate treatment strategies should be considered.

Keywords: antipsychotic polypharmacy; network analysis; psychiatric symptoms; schizophrenia.

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References

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A Network Analysis of Psychiatric Symptoms in Patients With Schizophrenia Treated With Antipsychotic Polypharmacy Using Propensity Score Matching: Findings From the Research on Asian Psychotropic Prescription Patterns (REAP) Study

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A Network Analysis of Psychiatric Symptoms in Patients With Schizophrenia Treated With Antipsychotic Polypharmacy Using Propensity Score Matching: Findings From the Research on Asian Psychotropic Prescription Patterns (REAP) Study

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