Clinical and Social Determinants of Long-Term Use of Benzodiazepines and its Impact on Quality of Life of Chinese Schizophrenia Patients

 

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Abstract

Aims: To date there have been no studies investigating prescription patterns of benzodiazepine agents (BZDs) in Chinese outpatients with schizophrenia. This study examined the frequency and socio-demographic and clinical correlates of BZD prescription in Hong Kong (HK) and Beijing (BJ), China.

Methods: Five hundred and five clinically stable outpatients with schizophrenia were randomly selected and interviewed in HK and BJ using standardized assessment instruments. Basic socio-demographic and clinical data and psychotropic drug prescriptions were collected at the time of a diagnostic interview.

Results: One-hundred and fifty one (29.9%) patients were prescribed BZDs in the whole sample; 25.1% and 34.8% of the HK and BJ samples, respectively. Use of BZDs was associated with sex, employment status, history of suicide, less use of clozapine, more frequent use of typical antipsychotics (APs), higher doses of APs, severity of positive symptoms, extrapyramidal side effects (EPS) and insomnia. In multiple logistic regression analysis, severity of depressive symptoms, study site, sex, employment status, less use of clozapine and history of suicide remained significantly associated with BZDs.

Conclusion: Although the ethnic and clinical characteristics of the two samples were nearly identical, there was a wide variation in the frequency of BZD prescriptions between HK and BJ suggesting that socio-cultural and economic factors as well as traditions of psychiatric training and practice all played a role in determining the use of BZDs. Prescription of BZDs in either site was not in line with current recommendation.

References

• 1 APA .Diagnostic and Statistical Manual of Mental Disorders. 4th edn Washington, American Psychiatric Association 1994
• 2 Ashton H. The treatment of benzodiazepine dependence.  Addiction. 1994;  89 1535-1541
  CrossrefPubMedGoogle Scholar
• 3 Barnes TR. A rating scale for drug-induced akathisia.  Br J Psychiatry. 1989;  154 672-676
  CrossrefPubMedGoogle Scholar
• 4 Baum C, Kennedy DL, Forbes MB, Jones JK. Drug use in the United States in 1981.  JAMA. 1984;  251 1293-1297
  CrossrefPubMedGoogle Scholar
• 5 Bechdolf A, Klosterkotter J, Hambrecht M, Knost B, Kuntermann C, Schiller S. et al . Determinants of subjective quality of life in post acute patients with schizophrenia.  Eur Arch Psychiatry Clin Neurosci. 2003;  253 228-235
  CrossrefPubMedGoogle Scholar
• 6 Chen CN, Wong J, Lee N, Chan-Ho MW, Lau JT, Fung M. The Shatin community mental health survey in Hong Kong. II. Major finding.  Arch Gen Psychiatry. 1993;  50 125-133
  PubMedGoogle Scholar
• 7 Fang JQ, Hao YT, Li CX. Reliability and validity for Chinese version of WHO quality of life scale (In Chinese).  Chin Ment Health J. 1999;  13 203-205
  PubMedGoogle Scholar
• 8 Hamilton M. A rating scale for depression.  J Neurol Neurosurg Psychiatry. 1960;  23 56-62
  CrossrefPubMedGoogle Scholar
• 9 Haw C, Stubbs J. Benzodiazepines - a necessary evil? A survey of prescribing at a specialist UK psychiatric hospital.  J Psychopharmacol. 2006;  , Epub ahead of print
  PubMedGoogle Scholar
• 10 Huppert JD, Smith TE. Longitudinal analysis of subjective quality of life in schizophrenia: anxiety as the best symptom predictor.  J Nerv Ment Dis. 2001;  189 669-675
  CrossrefPubMedGoogle Scholar
• 11 Kane JM. Schizophrenia.  N Engl J Med. 1996;  334 34-41
  CrossrefPubMedGoogle Scholar
• 12 Lader M, Petursson H. Rational use of anxiolytic/sedative drugs.  Drugs. 1983;  25 514-528
  PubMedGoogle Scholar
• 13 Laux G, Konig W. Long-term use of benzodiazepines in psychiatric inpatients.  Acta Psychiatr Scand. 1987;  76 64-70
  PubMedGoogle Scholar
• 14 Li XF, Zhang X, Chen JS, Yuan YG, Yang JM. Prescription pattern of benzodiazepine in schizophrenia inpatients (In Chinese).  Si Chuan Mental Health Journal. 2000;  13 51
  PubMedGoogle Scholar
• 15 Lobana A, Mattoo SK, Basu D, Gupta N. Quality of life in schizophrenia in India: comparison of three approaches.  Acta Psychiatr Scand. 2001;  104 51-55
  CrossrefPubMedGoogle Scholar
• 16 Luo JY. Use of benzodiazepine in first-admitted schizophrenia patients (In Chinese).  Chinese J Behavioral Med Sci. 2002;  11 223
  PubMedGoogle Scholar
• 17 Mant A, Mattick RP, Burgh S de, Donnelly N, Hall W. Benzodiazepine prescribing in general practice: dispelling some myths.  Fam Pract. 1995;  12 37-43
  CrossrefPubMedGoogle Scholar
• 18 Olfson M, Pincus HA. Use of benzodiazepines in the community.  Arch Intern Med. 1994;  154 1235-1240
  CrossrefPubMedGoogle Scholar
• 19 Overall JE, Beller SA. The Brief Psychiatric Rating Scale (BPRS) in geropsychiatric research: I. Factor structure on an impatient unit.  J Gerontol. 1984;  39 187-193
  CrossrefPubMedGoogle Scholar
• 20 Paton C, Banham S. Benzodiazepines in schizophrenia. Is there a trend toward long-term prescribing?.  Psychiatr Bull. 2000;  24 113-115
  PubMedGoogle Scholar
• 21 Pearson V. Goods on which one loses: women and mental health in China.  Soc Sci Med. 1995;  41 1159-1173
  CrossrefPubMedGoogle Scholar
• 22 Putzhammer A, Perfahl M, Pfeiff L, Hajak G. Correlation of subjective well-being in schizophrenic patients with gait parameters, expert-rated motor disturbances, and psychopathological status.  Pharmacopsychiatry. 2005;  38 132-138
  Article in Thieme ConnectPubMedGoogle Scholar
• 23 Ran MS, Xiang MZ, Mao WJ, Hou ZJ, Tang MN, Chen EY. et al . Characteristics of suicide attempters and nonattempters with schizophrenia in a rural community.  Suicide Life Threat Behav. 2005;  35 694-701
  CrossrefPubMedGoogle Scholar
• 24 Remington G, Saha A, Chong SA, Shammi C. Augmentation strategies in clozapine-resistant schizophrenia.  CNS Drugs. 2005;  19 843-872
  CrossrefPubMedGoogle Scholar
• 25 Ritsner M, Kurs R, Ponizovsky A, Hadjez J. Perceived quality of life in schizophrenia: relationships to sleep quality.  Qual Life Res. 2004;  13 783-791
  CrossrefPubMedGoogle Scholar
• 26 Rudnick A. The impact of coping on the relation between symptoms and quality of life in schizophrenia.  Psychiatry. 2001;  64 304-308
  PubMedGoogle Scholar
• 27 Shen YC. Psychiatry. People's medical publishing house, Beijing 2002
• 28 Shin SK, Lukens EP. Effects of psychoeducation for Korean Americans with chronic mental illness.  Psychiatr Serv. 2002;  53 1125-1131
  CrossrefPubMedGoogle Scholar
• 29 Sim K, Su A, Chan YH, Shinfuku N, Kua EH, Tan CH. Clinical correlates of antipsychotic polytherapy in patients with schizophrenia in Singapore.  Psychiatry Clin Neurosci. 2004;  58 324-329
  CrossrefPubMedGoogle Scholar
• 30 Sim K, Su A, Fujii S, Yang SY, Chong MY, Ungvari GS. et al . Antipsychotic polypharmacy in patients with schizophrenia: a multicentre comparative study in East Asia.  Br J Clin Pharmacol. 2004;  58 178-183
  CrossrefPubMedGoogle Scholar
• 31 Sim K, Su A, Leong JY, Yip K, Chong MY, Fujii S. et al . High dose antipsychotic use in schizophrenia: findings of the REAP (research on east Asia psychotropic prescriptions) study.  Pharmacopsychiatry. 2004;  37 175-179
  Article in Thieme ConnectPubMedGoogle Scholar
• 32 Simpson GM, Angus JW. A rating scale for extrapyramidal side effects.  Acta Psychiatr Scand Suppl. 1970;  212 11-19
  PubMedGoogle Scholar
• 33 Swartz M, Landerman R, George LK, Melville ML, Blazer D, Smith K. Benzodiazepine anti-anxiety agents: prevalence and correlates of use in a southern community.  Am J Public Health. 1991;  81 592-596
  PubMedGoogle Scholar
• 34 Taylor D, Paton C, Kerwin R. The Maudsley Prescribing Guidelines. London, Martin Dunitz 2003
• 35 Taylor D, Paton C, Kerwin R. The Maudsley Prescribing Guidelines (2005-2006). Abingdon Taylor & Francis 2005
• 36 Ungvari GS, Chung YG, Chee YK, Fung-Shing N, Kwong TW, Chiu HF. The pharmacological treatment of schizophrenia in Chinese patients: a comparison of prescription patterns between 1996 and 1999.  Br J Clin Pharmacol. 2002;  54 437-444
  CrossrefPubMedGoogle Scholar
• 37 Waals FW van der, Mohrs J, Foets M. Sex differences among recipients of benzodiazepines in Dutch general practice.  BMJ. 1993;  307 363-366
  PubMedGoogle Scholar
• 38 Hulten R van, Teeuw KB, Bakker A, Leufkens HG. Initial 3-month usage characteristics predict long-term use of benzodiazepines: an 8-year follow-up.  Eur J Clin Pharmacol. 2003;  58 689-694
  PubMedGoogle Scholar
• 39 WHO . The World Health Organization Quality of Life assessment (WHOQOL): position paper from the World Health Organization.  Soc Sci Med. 1995;  41 1403-1409
  CrossrefPubMedGoogle Scholar
• 40 Wolf B, Grohmann R, Biber D, Brenner PM, Ruther E. Benzodiazepine abuse and dependence in psychiatric inpatients.  Pharmacopsychiatry. 1989;  22 54-60
  PubMedGoogle Scholar
• 41 Xiang YT, Weng YZ, Leung CM, Tang WK, Ungvari GS. Clinical and social determinants of antipsychotic polypharmacy for Chinese patients with schizophrenia.  Pharmacopsychiatry. 2007;  40 47-52
  Article in Thieme ConnectPubMedGoogle Scholar
• 42 Xiang YT, Weng YZ, Leung CM, Tang WK, Ungvari GS. Quality of life of Chinese schizophrenia outpatients in Hong Kong: relationship to sociodemographic factors and symptomatology.  Aust N Z J Psychiatry. 2007;  41 442-449
  CrossrefPubMedGoogle Scholar
• 43 Zhang SY, Yu HY, Wang GJ. Time-point investigation of diagnosis and its antipsychotics drug in mental inpatients.  Sichuan Mental Health. 2001;  14 72-74
  PubMedGoogle Scholar
• 44 Zhang W. Use of benzodiazepine and its correlates.  Chinese J Drug Abuse Prevention and Treatment. 2001;  5 36-37
  PubMedGoogle Scholar
• 45 Zhang WX, Shen YC, Li SR, Chen CW, Huang YQ, Wang JR. Epidemiological investigation on mental disorders in 7 areas of China (in Chinese).  Chinese Journal of Psychiatry. 1998;  31 69-71
  PubMedGoogle Scholar

Correspondence

Dr. Y.-T. Xiang

Department of Psychiatry

Shatin Hospital

Shatin

N.T

Hong Kong SAR

People's Republic of China

Phone: +852/2636 77 48

Fax: +852/2647/53 21

Email: xyutly@cuhk.edu.hk