A Network Analysis of Psychiatric Symptoms in Patients With Schizophrenia Treated With Antipsychotic Polypharmacy Using Propensity Score Matching: Findings From the Research on Asian Psychotropic Prescription Patterns (REAP) Study

Abstract

Objectives: Antipsychotic polypharmacy (APP) is prevalent among patients with schizophrenia across countries in Asia. This study aimed to explore the relationships between psychiatric symptoms and APP using network analysis. Methods: Data on nine major psychiatric symptoms and the number of prescribed antipsychotics were extracted from the fourth survey of the Research on Asian Psychotropic Prescription Patterns (REAP-AP). A network model of the nine psychiatric symptoms was constructed for patients treated with APP and antipsychotic monotherapy (APM) respectively. The interconnections between psychiatric symptoms and APP use were further analyzed using network analysis. Results: A total of 1528 patients with schizophrenia treated with APP were matched with 1528 patients treated with APM in Asia. The top three central psychiatric symptoms in the networks of psychiatric symptoms were consistent, but in different orders for APP-treated patients (verbal aggression, hallucinations, and social/occupational dysfunction) and APM-treated patients (social/occupational dysfunction, verbal aggression, and hallucinations). Network analysis of APP and psychiatric symptoms revealed that disorganized/catatonic behavior was strongly linked with APP, followed by delusions, hallucinations, and verbal aggression. Conclusion: Psychiatric symptoms closely associated with APP included verbal aggression, grossly disorganized/catatonic behavior, delusions, and hallucinations. For patients with schizophrenia who are primarily exhibiting such symptoms, alternative appropriate treatment strategies should be considered.