Discontinuity of Outpatient Antipsychotic Pharmacotherapy: Risperidone Maintenance after Hospitalization

Abstract

Objective:

To investigate continuity of outpatient antipsychotic pharmacotherapy with risperidone in patients discharged from state psychiatric hospitals.

Methods:

Of 1,201 patients discharged from Illinois state psychiatric hospitals while taking risperidone during the first year of the medication's commercial availability, 627 public aid–eligible patients were trackable on the basis of public aid billing data. Data on risperidone continuation and other medication use for these patients were collected for the two-year period following each patient's discharge.

Results:

Forty-four percent of the patients discontinued risperidone within two weeks of hospital discharge, with one-half receiving no medications and most of the remainder switching to other antipsychotics. More than 75% of the patients discontinued risperidone within one year of hospital discharge, and fewer than 1% received continuous risperidone pharmacotherapy for the two-year follow-up period.

Conclusions:

Although the study methods do not permit us to draw conclusions regarding specific reasons for risperidone discontinuation in this patient sample, 66% of whom had a diagnosis of schizophrenia or schizoaffective disorder and 86% of whom had psychotic diagnoses, the rapid drop-off and discontinuity in medication management following hospital discharge is almost certainly inconsistent with optimum clinical care for this group of patients. Discontinuities in maintenance pharmacotherapy may compromise medical effectiveness, even for newer antipsychotic medications such as risperidone.