Antipsychotic Prescribing Patterns Upon Entering First Episode Psychosis Care: Investigating Concordance to NAVIGATE Guidelines
Sarosh Khan DO (1,2,3) Julie Ngo BA (2) Anne Thompson, MPH (1,2,3) Amelia Blanton BA (1,3) Brittany Gouse MD, MPH (1,2,3) Hannah Brown MD (1,2,3)
1. WRAP Research Program, Department of Psychiatry, Boston Medical Center
2. Boston University Chobanian & Avedisian School of Medicine
3. Department of Psychiatry, Boston University School of Medicine
Background: Antipsychotic medications are an integral part of recovery in early intervention (EI) for psychosis and vary greatly by formulation and side effect profile. EI programs emphasize the need for shared decision making between patients and providers to ensure initial antipsychotic choice considers patient preference, side effect profile, relevant medical history, risk factors, and long-term treatment planning. Since many patients are started on antipsychotics in acute care settings, further research is needed to evaluate if prescribing patterns follow practice guidelines.
Method: We conducted a retrospective chart review of initial intake appointments at our specialty psychosis program, the Wellness and Recovery After Psychosis (WRAP) program at Boston Medical Center between January 2020 to August 2022. We used descriptive statistics to report cohort characteristics and clinical factors. The primary outcome was antipsychotic prescribed upon entering the program.
Results: We analyzed 197 initial intake appointments with ICD-10 codes for schizophrenia spectrum psychotic disorders (Mean age: 39 years, SD: 4.2 years, 62% Black or African American, Insurance type: 80% Medicare or Medicaid). 81% of patients reported one or more psychiatric hospitalizations prior to intake appointment. 85% of patients were prescribed an antipsychotic medication prior to intake appointment. The three most common antipsychotic medications were: 1. Olanzapine (N = 40, 20%), 2. Risperidone (N = 34, 17%), 3. Aripiprazole (N = 22, 11%). Thirty-six (18%) patients presented to their intake appointments while taking a long acting injectable (LAI) antipsychotic. The most common LAIs were Paliperidone (N= 17, 9%) and Aripiprazole (N= 10, 5%). A minority of patients were prescribed clozapine (N =5, 2%).
Conclusion: Consistent with prior research, our findings show olanzapine was the most commonly prescribed antipsychotic among individuals entering WRAP. Given olanzapine’s significant cardiometabolic risk, in future work we will explore sociodemographic and clinical factors associated with olanzapine prescription upon entering EI care.