J Korean Neuropsychiatr Assoc.  2017 Nov;56(4):168-174. 10.4306/jknpa.2017.56.4.168.

Benzodiazepine Use among Patients with Schizophrenia in Korea: Analysis of Database of Health Insurance Review Agency

• Choi S
• Lee SU
• Hwang TY

• KMID: 2396663
• DOI: http://doi.org/10.4306/jknpa.2017.56.4.168

Abstract

OBJECTIVE
This study was designed to examine the pattern of benzodiazepine use in a representative sample of patients with schizophrenia in Korea. METHOD: Data generated by the Health Insurance Review Agency of Korea was used to examine the frequency of benzodiazepine use. Demographic and geographic factors, hospital types in which patients received prescriptions, health insurance coverage, and the number of concomitant antipsychotics associated with benzodiazepine use were explored by multivariate logistic regression analysis.
RESULTS
Among the 183427 patients with schizophrenia, the frequency of benzodiazepine use was 67.5% (n=122859). Use of benzodiazepines was highly associated with female patients treated in hospitals located in Gyeonggi, Gyeongsang, and Gangwon provinces, medicaid patients, patients treated in mental hospitals and private psychiatric clinics, and patients using concomitant antipsychotic agents.
CONCLUSION
The study demonstrated that benzodiazepine use was highly prevalent among patients with schizophrenia. Long-term use of benzodiazepine may be at higher risk of neurocognitive side effects and risk of mortality. Therefore, patients with schizophrenia taking benzodiazepine concomitantly should be closely monitored for benefits and risks of benzodiazepine use. For the medicaid patients, policy change is urgently needed in order for patients to receive equal quality of treatment with that of non-medicaid patents.

Keyword

Benzodiazepine; Schizophrenia; Multivariate logistic regression analysis

MeSH Terms

Antipsychotic Agents
Benzodiazepines*
Female
Gangwon-do
Geography
Gyeonggi-do
Hospitals, Psychiatric
Humans
Insurance, Health*
Korea*
Logistic Models
Medicaid
Methods
Mortality
Prescriptions
Risk Assessment
Schizophrenia*
Antipsychotic Agents
Benzodiazepines

Reference

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. Washington, DC: American Psychiatric Publishing;2013. p. 99–105.

2. Sadock BJ, Sadock VA, Ruiz P. Synopsis of psychiatry: behavioral sciences/clinical psychiatry. 11th ed. Philadelphia, PA: Wolters Kluwer;2014. p. 300–323.

3. Kwon JS, Ahn YM, Kim JH. Korean medication guideline for schizophrenia. Seoul: Korean Medication Algorithm Task Force for Schizophrenia;2006.

4. Haw C, Stubbs J. Benzodiazepines--a necessary evil? A survey of prescribing at a specialist UK psychiatric hospital. J Psychopharmacol. 2007; 21:645–649.

5. Wolkowitz OM, Pickar D. Benzodiazepines in the treatment of schizophrenia: a review and reappraisal. Am J Psychiatry. 1991; 148:714–726.

6. Chakos MH, Glick ID, Miller AL, Hamner MB, Miller DD, Patel JK, et al. Baseline use of concomitant psychotropic medications to treat schizophrenia in the CATIE trial. Psychiatr Serv. 2006; 57:1094–1101.

7. Novick D, Bousono M, Suarez D, Olivares JM, Montejo AL, Haro JM, et al. Use of concomitant medication with antipsychotic treatment in outpatients with schizophrenia: results from the European Schizophrenia Outpatients Health Outcomes (SOHO) study. Prog Neuropsychopharmacol Biol Psychiatry. 2005; 29:972–982.

8. Clark RE, Xie H, Brunette MF. Benzodiazepine prescription practices and substance abuse in persons with severe mental illness. J Clin Psychiatry. 2004; 65:151–155.

9. Wu CS, Lin YJ, Liu SK. Benzodiazepine use among patients with schizophrenia in Taiwan: a nationwide population-based survey. Psychiatr Serv. 2011; 62:908–914.

10. Hwang IH, Kim DH, Oh DY. Psychotropic prescription patterns for inpatients with schizophrenia: 10-year comparison in a university-affiliated hospital in South Korea. Korean J Biol Psychiatry. 2014; 21:49–56.

11. Dold M, Li C, Tardy M, Khorsand V, Gillies D, Leucht S. Benzodiazepines for schizophrenia. Cochrane Database Syst Rev. 2012; 11:CD006391.

12. Brunette MF, Noordsy DL, Xie H, Drake RE. Benzodiazepine use and abuse among patients with severe mental illness and co-occurring substance use disorders. Psychiatr Serv. 2003; 54:1395–1401.

13. Dixon L. Dual diagnosis of substance abuse in schizophrenia: prevalence and impact on outcomes. Schizophr Res. 1999; 35:Suppl. S93–S100.

14. Green MF. Cognitive impairment and functional outcome in schizophrenia and bipolar disorder. J Clin Psychiatry. 2006; 67:e12.

15. Liu SK, Chiu CH, Chang CJ, Hwang TJ, Hwu HG, Chen WJ. Deficits in sustained attention in schizophrenia and affective disorders: stable versus state-dependent markers. Am J Psychiatry. 2002; 159:975–982.

16. Baandrup L, Gasse C, Jensen VD, Glenthoj BY, Nordentoft M, Lublin H, et al. Antipsychotic polypharmacy and risk of death from natural causes in patients with schizophrenia: a population-based nested case-control study. J Clin Psychiatry. 2010; 71:103–108.

17. Tiihonen J, Suokas JT, Suvisaari JM, Haukka J, Korhonen P. Polypharmacy with antipsychotics, antidepressants, or benzodiazepines and mortality in schizophrenia. Arch Gen Psychiatry. 2012; 69:476–483.

18. Fontanella CA, Campo JV, Phillips GS, Hiance-Steelesmith DL, Sweeney HA, Tam K, et al. Benzodiazepine use and risk of mortality among patients with schizophrenia: a retrospective longitudinal study. J Clin Psychiatry. 2016; 77:661–667.

19. Tiihonen J, Mittendorfer-Rutz E, Torniainen M, Alexanderson K, Tanskanen A. Mortality and cumulative exposure to antipsychotics, antidepressants, and benzodiazepines in patients with schizophrenia: an observational follow-up study. Am J Psychiatry. 2016; 173:600–606.

20. Kim L, Sakong J, Kim Y, Kim S, Kim S, Tchoe B, et al. Developing the inpatient sample for the national health insurance claims data. Health Policy Manag. 2013; 23:152–161.

21. WHO Collaborating Centre for Drug Statistics Methodology. Guidelines for ATC classification and DDD assignment. Oslo: WHO Collaborating Centre for Drug Statistics Methodology;2009.

22. Baldwin DS, Anderson IM, Nutt DJ, Bandelow B, Bond A, Davidson JR, et al. Evidence-based guidelines for the pharmacological treatment of anxiety disorders: recommendations from the British Association for Psychopharmacology. J Psychopharmacol. 2005; 19:567–596.

23. Jeong SH, Ahn YM, Kim YS. RODOS Investigator Group in Korea. The variations in the treatment pattern of schizophrenic patients with risperidone and olanzapine. J Korean Neuropsychiatr Assoc. 2003; 42:79–88.

24. National Center for Mental Health. National mental health statisticspilot study. Seoul: National Center for Mental Health;2016.

25. National Human Rights Commission of Korea. National report for human rights protection and enhancement of people with mental disabilities. Seoul: National Human Rights Commission of Korea;2009.