The use of antipsychotics in the real-world clinical practice in Russia (based on the results of the EPIDEMICUS program)

The optimization of antipsychotic therapy is an urgent issue not only in psychiatry, but in healthcare as a whole. Objective: to analyze the results of the non-interventional EPIDEMICUS epidemiological study of the real-world practice of the use of quetiapine (Seroquel®) during combined treatment and therapy switching in patients with various mental disturbances. Material and methods. Based on a special questionnaire, an analysis of the prescription of quetiapine and other antipsychotics by psychiatrists in 21 cities of Russia was carried out. The treatment data of 1264 patients aged 43.9±5.2 years were analyzed; the average duration of mental illness at the beginning of the study was 10.5 years. Results. In most cases, physicians preferred to switch to the quetiapine monotherapy, but in 10% of cases an antipsychotic was also added. According to the doctors, patients with schizophrenia most frequently required a therapy switch (46.3%). In bipolar affective disorder (BAD), one in three patients (30.8%) required therapy switch. For other mental disorders, doctors more frequently added quetiapine to the therapy (23.2%; p<0.001) or switched the previous therapy (12.1%). The significantly more frequent reasons given by doctors for switching from oneneuroleptic to another were the need to intensify antipsychotic effect (p<0.001) , to increase sedation (p<0.001) and to improve tolerability (p<0.001) . There is no recommended "overlap period" when switching from one medication to another. Changes in the therapy with mood stabilizers and anxiolytics were performed to enhance antipsychotic and sedative effects (p<0.001) and, as a tendency to improve tolerability. The concomitant administration of two or more antipsychotics could be due to both medical error and an attempt to overcome drug resistance. Conclusion. In the real-world clinical practice of domestic psychiatrists, at least one third of patients taking antipsychotics for various conditions (schizophrenia, bipolar disorder, etc.) require a switch or additional therapy. The reasons for therapy switching can be diagnostic errors, the choice of medication as well as insufficient efficacy or poor tolerability of the antipsychotics. Quetiapine (Seroquel®) is recognized in real-world clinical practice by psychiatrists as a highly effective and well-tolerated antipsychotic with a broad spectrum of activity that goes beyond the official indications.