Psychotropic Prescribing in Young People with Schizophrenia: Trends, Sex Differences, and COVID-19 Effects
AI Summary
Universal treatment intensification across all medication subclasses in young people with schizophrenia, with annual increases of 0.05 to 3.71 percentage points.
Males exhibited steeper prescribing increases than females after adjustment, with most specific agents rising significantly more in males.
COVID-19 caused complex, sex-specific disruptions detectable by interrupted time series in five medication subclasses, effects masked by aggregate period comparisons.
BACKGROUND AND HYPOTHESIS: Schizophrenia treatment in young people involves complex pharmacological decisions, yet sex-specific prescribing patterns and pandemic impacts remain poorly understood. We hypothesized that prescribing trends would differ systematically by sex and show pandemic-related disruptions.
STUDY DESIGN: This population-based cohort study analyzed 8092 individuals aged 15-29 years with schizophrenia-spectrum disorders in Hong Kong (2011-2023) using electronic health records from the Hospital Authority system. We examined temporal trends in 11 medication subclasses using generalized least squares models with autoregressive correlation structures, sex differences using interaction terms, and COVID-19 impacts using interrupted time series (ITS) analysis with adjustment for age and comorbidity.
STUDY RESULTS: After covariate adjustment, all medication subclasses increased over time (0.05-3.71 percentage points annually), indicating universal treatment intensification. Males showed steeper increases than females in 5 subclasses after adjustment, with 18 of 21 specific agents increasing significantly more in males. Period-level pandemic comparisons showed minimal effects, but ITS analysis revealed substantial COVID disruptions in 5 medication subclasses namely oral first-generation antipsychotics, injectable second-generation antipsychotics, serotonin and norepinephrine reuptake inhibitor, Z-hypnotics, and benzodiazepines.
CONCLUSIONS: Young people with schizophrenia experienced universal treatment intensification with males receiving more intensive pharmacotherapy after controlling for confounders. The pandemic produced complex sex-specific disruptions masked by aggregate analyses. Whether these prescribing patterns represent appropriate individualization or systematic care variation remains unknown, highlighting the critical need for studies linking prescribing patterns to functional outcomes and quality of life.
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