Proportion of High-dose Antipsychotic Therapy and Prescription Pattern in Patients Diagnosed with Schizophrenia from a Tertiary Care Hospital in Nepal: An Observational Study

Introduction: High-dose antipsychotic therapy, defined as dosing exceeding 100% of the British National Formulary recommended maximum daily dose, is associated with increased risk of adverse effects and is generally discouraged by clinical guidelines. However, its use persists in clinical practice. This study aimed to determine the proportion of high-dose antipsychotic prescriptions and describe prescribing patterns among patients with schizophrenia in a tertiary care hospital in Nepal. Methods: A hospital-based observational cross-sectional study was conducted in the Department of Psychiatry, Nepal Medical College and Teaching Hospital, Kathmandu, from August 2024 to April 2025. All 245 patients diagnosed with schizophrenia were included by consecutive sampling. Diagnosis was based on standard clinical criteria (ICD-10/DSM-5 as applied in practice). Demographic and prescribing details were recorded at encounter. Total daily antipsychotic doses were calculated using British National Formulary factors, and prescriptions with a factor >1.0 were classified as high dose. Data were analyzed using frequencies and percentages. Results: Of 245 patients, 36 (14.7%) received high-dose antipsychotic therapy, whereas 209 (85.3%) received doses within British National Formulary limits. High dose prescription was found in 25 (10.2%) patients of 31-45-year age group, 19 (7.8%) male and 17(6.9%) female. Olanzapine was prescribed in 140 (57.1%) patients and was associated with high-dose therapy, either as monotherapy or in combination. Olanzapine with haloperidol was prescribed in 10 (27.77%) patients. Conclusion: Despite guideline recommendations against high-dose antipsychotic therapy, a notable proportion of patients with schizophrenia received high-dose antipsychotics, predominantly involving olanzapine-based regimens.