pharmacoepidemiology and drug safety 2012; 21: 145–151

Published online 1 July 2011 in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/pds.2166

ORIGINAL REPORT

Prescription patterns of patients diagnosed with schizophrenia in

mental hospitals in Tashkent/Uzbekistan and in four German cities
Adrian P. Mundt1*, Marion C. Aichberger1, Sardor Fakhriddinov2, Maria Fayzirahmanova2, Renate Grohmann3,
Andreas Heinz1, Sebastian Ivens1, Shakhnoza Magzumova2, Norman Sartorius4 and Andreas Ströhle1
1
Department of Psychiatry and Psychotherapy, Charité Campus Mitte Universitätsmedizin Berlin, Germany
2
Department of Psychiatry and Medical Psychology, Tashkent Medical Academy, Tashkent City 100109, Uzbekistan
3
Department of Psychiatry and Psychotherapy, Ludwig‐Maximilian‐Universität, Munich, Germany
4
Association for the Improvement of Mental Health programmes, AMH, Geneva, Switzerland

ABSTRACT
Purpose Little is known about psychopharmacological prescription practice in low‐income countries. The present study aimed for an
analysis of pharmacological treatment strategies for inpatients with schizophrenia in Tashkent, the capital city of Uzbekistan, facing a low‐
income situation as compared with four German cities in a high‐income Western situation.
Methods We conducted a cross‐sectional quantitative survey of age, gender, diagnoses, and psychotropic medication of 845 urban
psychiatric inpatients of the Tashkent psychiatric hospital and of 922 urban psychiatric inpatients in four German cities on 1 day in October
2008. We compared the current treatment strategies for specific diagnostic categories between the two settings.
Results In Tashkent, patients diagnosed with schizophrenia were treated with clozapine (66%), haloperidol (62%), or both (44%). More
than one‐third of the patients treated for schizophrenia were prescribed amitriptyline. The usual treatment strategy for schizophrenia was the
combination of two or more antipsychotics (67%). In German cities, the preferred antipsychotics for the treatment of schizophrenia were
olanzapine (21%), clozapine (20%), quetiapine (17%), risperidone (17%), and haloperidol (14%); the most common treatment strategy for
patients with schizophrenia was the combination of antipsychotics and benzodiazepines; 44% of the patients were treated with two or more
antipsychotics at a time.
Conclusions In both settings, psychotropic combination treatments are common for the treatment of schizophrenia contrasting current
guideline recommendations. Its rationale and effectiveness needs to be tested in further studies. Copyright # 2011 John Wiley & Sons, Ltd.

key words — pharmacoepidemiology; schizophrenia; inpatients; Uzbekistan; German cities; prescription patterns

Received 20 November 2010; Revised 7 April 2011; Accepted 11 April 2011

BACKGROUND Central Asia, in particular. The Research on East

Psychopharmacological inpatient treatment
Pharmacological treatment of psychiatric inpatients is
subject to multiple influencing factors as expert
opinions, treatment guidelines, psychiatric traditions
and schools, financial resources, availablity of medi-
cation, and others. It changes over time and differs
between countries and cultures. Little is known about
prescription patterns in low‐income situations, in
general, and in post‐Soviet situations/regions, such as
*Correspondence to: A. Mundt, Department of Psychiatry and Psychother-
apy, Charité Universitätsmedizin Berlin, St. Hedwig Krankenhaus, Germany.
E‐mail: adrian.mundt@charite.de
Asian Prescription studies examined psychotropic
prescription patterns in six East Asian countries (five
high‐income situations and China) regarding dosage,
sex, and specific psychotropic subgroups.1–3 Cooper
et al. (2007) presented 20 case histories from Central
Asian Republics discussing pharmacological practice.4
Arzneimittelsicherheit in der Psychiatrie (AMSP)5 is
a continuous pharmacological surveillance program
that monitors prescription patterns and severe adverse
events6–8 in psychiatric inpatients of 57 participating
centers in five Central European countries. It has been
used to monitor trends in prescription practice over
time9 and to present prescription patterns for specific
diagnostic entities.10–12 Evaluation of current treat-
ment practice may contribute to an improvement of

Copyright # 2011 John Wiley & Sons, Ltd.

146 a. p. mundt ET AL.

safety and effectiveness. The prescription data from the
AMSP network are used to put prescription patterns
from Uzbekistan into an international perspective.
Treatment guidelines are by and largely written by
psychiatrists from Western Europe and the USA.13–15
Cultural factors may influence the symptom manifes-
tation and diagnoses.16 Most data on efficacy and
effectiveness of drug treatments are derived from trials
conducted in Western countries and not necessarily
applicable in vastly different settings.17 Evaluation
and interpretation of current treatment practices in
Western and developing countries may contribute to a
continuous effort to improve pharmacotherapy. We
studied psychiatric inpatient populations in Tashkent
and in four German cities regarding the types and
dosages of psychotropic substances that were used for
the treatment of patients diagnosed with schizophrenia
hoping that the results of this investigation will be
helpful for prescribers to improve their pharmacolog-
ical prescription practice and for researchers to test the
evidence base of what is current practice.
Socio‐economic background
Uzbekistan is a Central Asian republic of 26 million
people, considered a low‐income country with a
gross national income (GNI) of International $2430
per capita at purchasing power parity (PPP) (www.
worldbank.org, accessed August 2010) (Table 1). In
2006, the total estimated health care spending in
Uzbekistan amounted to International $177 per capita
at PPP. The total health care expenditure corresponds
to 4.7% of the gross domestic product (GDP) (www.
who.int/countries; accessed August 2010). In 1997,
47.0% of the total budget was spent on inpatient care,
down from 80% in 1991. In 1997, 10% of the total
health care budget was spent on pharmaceutical drugs.
There is a list of essential drugs issued by the ministry
of health. If patients have the possibility to pay for
other medication, doctors may use it. Less than 10% of
the essential drugs are of domestic production.
Inpatient treatment and medication are officially free
of charge. Under‐the‐table payments are common.18–20
Germany is a Central European republic of 82 million
people, considered a high‐income country with a
GNI of $34 740 per capita at PPP. Total health care
expenditure amounted to $3328 per capita at PPP
corresponding 10.4% of the GDP. Regarding indica-
tors of mental health service provision, the two settings
differ vastly (Table 1).
METHODS
We conducted a cross‐sectional survey of age, gender,
diagnoses given, and psychotropic medication applied
to urban psychiatric inpatient populations in Tashkent
and in four German cities on 1 day in October 2008.
We included 845 patients in the psychiatric hospital of
the Tashkent Medical Academy. We included 17 out
of 18 wards, excluding the forensic ward where we
did not have the permission to conduct the study. The
study was permitted by the Ministry of Health in
Uzbekistan. The hospital serves as a university and a
teaching institution. At the same time, it is the only
psychiatric hospital serving the entire population of
Tashkent, the capital city of Uzbekistan with a
population of 2.3 million people. In Tashkent, all
diagnoses were recorded as they were written in the
patients’ files in the Russian language. The diagnoses
were translated in the same phrasing into German.
Patients were sorted according to the main treatment
diagnosis. In the German cities, we included all
university and non‐academic psychiatric hospitals and
departments that are part of the AMSP (Drug Safety
in Psychiatry) drug surveillance program located in
the cities Berlin, Hamburg, Munich, and Düsseldorf.
We chose to compare urban inpatient populations in
Germany and in Uzbekistan because it is unclear
whether there are differences in the prescription

Table 1. Socio‐economic differences regarding mental health care between the German cities and Uzbekistan
Uzbekistan (year) Germany (year) Ratio Germany/Uzbekistan

Gross national income (at purchasing power parity) per capita in Int. $ 2430.00 (2007) 34 740.00 (2007) 14.30
Health care expenditure per capita in Int. $ (at purchasing power parity) 177.00 (2006) 3328.00 (2006) 18.80
Health care budget in % of gross domestic product 4.70 (2006) 10.40 (2006) 2.21
Life expectancy at birth 67.00 (2007) 80.00 (2007) 1.19
Physicians per 10 000 27.00 (2006) 34.0 (2006) 1.26
Hospital beds per 10 000 52.00 (2005) 83.00 (2005) 1.60
Psychiatric beds per 100 000 31.00 (2005) 75.00 (2005) 2.42
Psychiatrists per 100 000 3.30 (2005) 11.80 (2005) 3.58
Psychologists per 100 000 0.05 (2005) 51.50 (2005) 1030.00
Social workers per 100 000 0.10 (2005) 477.00 (2005) 4770.00

Sources: Worldbank (accessed Aug 2010) and WHO (www.who.int/countries, accessed Aug 2010).

Copyright # 2011 John Wiley & Sons, Ltd. Pharmacoepidemiology and Drug Safety, 2012; 21: 145–151
DOI: 10.1002/pds
 prescription pattern of schizophrenia patients
patterns of urban and rural situations. The data
collection for AMSP takes place every 6 months
cross‐sectionally on one single day in April and
October of each year.9 It was implemented to relate
prescription patterns to the occurrence of severe
adverse drug events in order to improve drug safety
for psychiatric inpatient settings. The same method of
data collection was used for the first time in October
2008 in Tashkent. In both settings, every inpatient was
sorted into one of the following diagnostic categories:
schizophrenia, unipolar depression, organic mental
disorder (subgroup: dementia), substance use disorder
(subgroup: alcohol use disorder), mental retardation,
bipolar disorder, personality disorder, schizoaffective
disorder, and others according to the main treatment
diagnosis. We assumed that co‐morbidity was largely
under‐recorded as in most naturalistic samples.
The use of psychotropic medication for inpatients
was analyzed by diagnostic categories as it had been
done before in German samples to evaluate current
prescription patterns for specific disease entities.11 The
urban Uzbek and German inpatient populations
differed considerably in their diagnostic distribution.
In Tashkent, schizophrenia (59.3%), organic mental
disorders (20.5%), mental retardation (6.9%), and
substance use disorders (6.4%) were the most important
diagnostic categories. In the four German cities,
psychiatric inpatients were treated for schizophrenia
(29.9%), unipolar non‐psychotic depression (29.5%),
organic mental disorders (10.4%), substance use
disorders (8.9%), schizoaffective disorders (5.6%),
personality disorders (5.2%), and bipolar disorders
(3.5%). Differences in the diagnostic strategies and
distributions between Tashkent and Berlin are
described and discussed elsewhere.21 We chose to
compare the prescription patterns of patients treated for
schizophrenia, the largest diagnostic category in both
settings. All calculations refer to inpatients diagnosed
with schizophrenia in both settings. We calculated the
percentage of patients treated with at least one sub-
stance out of the pharmacological substance groups
(antipsychotic, antidepressant, antiepileptic, or anti-
parkinsonian). The percentage of patients treated with
the same psychotropic substance was estimated using
8% of the patients treated with the same substance as a
cut‐off for clinical importance. We calculated the mean
dosages ± standard deviation of the mean for each
pharmacological substance. We quantified the degree
of psychotropic substance combinations (polyphar-
macy). The percentage of patients diagnosed with
schizophrenia treated with several (two or more, three
or more, four or more, and 5 or more) antipsychotics
and psychotropics at the same time was calculated for
Copyright # 2011 John Wiley & Sons, Ltd.
147
each sample. The percentages of patients treated with
antiparkinsonian medication and with substance com-
binations were compared between the German and
Uzbek samples using Pearson’s Chi‐squared test. There
was a discussion between experts from both settings on
the reason for pharmacological treatment strategies.
RESULTS
In Tashkent, antipsychotic medications were available
to all inpatients treated for schizophrenia. The mean age
of the patients present on the day of the survey was
43 ± 13 years, and 46% of the patients were female.
Nearly all (96%) of the patients were prescribed an
antipsychotic medication. The antipsychotic medica-
tions prescribed most frequently were clozapine in 66%
of the patients at a mean dosage of 69 ± 51 mg/day,
haloperidol (62%; mean dosage 7.8 ± 4.6 mg/day),
chlorpromazine (13%; 124 ± 64 mg/day), risperidone
(12%; 4.6 ± 1.3 mg/day), and trifluoperazine (10%;
33 ± 24 mg/day). Half (50%) of the patients received
the antiparkinsonian medication trihexyphenidyl to
prevent or treat adverse effects of antipsychotic medi-
cation. Furthermore, 38% of the patients received
any antidepressant. More than one‐third (35%) of the
inpatients treated for schizophrenia received the try-
cyclic antidepressant amitriptyline (51 ± 20 mg/day).
The antiepileptic carbamazepine (358 ± 161 mg/day)
was used in 17% of the inpatients (Figure 1). The most
common combination of antipsychotic medications
was haloperidol and clozapine prescribed to 44% of
the inpatient population treated for schizophrenia. This
combination can be seen as the usual inpatient
treatment of schizophrenia in Tashkent. Haloperidol
and amitriptyline (23%) and the triple combination
haloperidol, clozapine, and amitriptyline (13%) were
the second and the third most frequent treatment
combinations (Table 2).
In the German cities, 94% of the patients
hospitalized for schizophrenia received any kind of
antipsychotic. The mean age of patients present on the
day of the survey was 41 years, and 42% of the
patients were female. Olanzapine (21%; 19 ± 7 mg/day),
clozapine (20%; 392 ± 215 mg/day), quetiapine (17%;
563 ± 270 mg/day), risperidone (17%; 4.1 ± 1.6 mg/
day), and haloperidol (14%; 11.6 ± 6.5 mg/day) were
used most frequently (Figure 1). The antiparkinsonian
biperiden was used in 14% (4.1 ± 1.0 mg/day) of the
patients. Important group of medication used in the
treatment of acute schizophrenia were benzodiazepines
(37%) and hypnotics (9%): most commonly used
substances were lorazepam (24%; 1.9 ± 1.4 mg/day),
diazepam (13%; 14.4 ± 10.2 mg/day), and zopiclone
Pharmacoepidemiology and Drug Safety, 2012; 21: 145–151
DOI: 10.1002/pds
148 a. p. mundt ET AL.

Tashkent German cities

% of patients treated for schizophrenia

% of patients treated for schizophrenia

70 70
60 60
50 50
40 40
30 30
20 20
10 10
0 0
e

ne

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en

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id
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zi

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rid
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az

ap

ep
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id

id

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tia
ze

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ip

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pi
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op

az

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er

op

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pe
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la
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Figure 1. Substances used for the psychiatric inpatients treated for schizophrenia in the Tashkent psychiatric hospital and in four German cities. Same
patterns indicate same substance groups

Table 2. Pharmacological treatment combinations used for the treatment of inpatients diagnosed with schizophrenia in Tashkent (N = 503) and in German
cities (N = 269)
Pharmacological treatment of patients treated for schizophrenia Tashkent N (%) German cities N (%) Chi square (df = 1)

Psychotropics
≥2 psychotropics 445 (88) 202 (75) 8.542**
≥3 psychotropics 332 (66) 113 (42) 40.362**
≥4 psychotropics 157 (31) 51 (19) 12.757**
≥5 psychotropics 50 (10) 27 (10) 0.006
Antipsychotics
≥2 antipsychotics 337 (67) 118 (44) 37.796**
Haloperidol + clozapine 219 (44) 8 (3) 136.996**
≥3 antipsychotics 60 (12) 27 (10) 0.451
Combinations of substance groups
≥1 antipsychotic + ≥1 antidepressant 183 (36) 38 (14) 41.410**
Haloperidol and amitriptyline 114 (23) – –
≥2 antipsychotics + ≥1 antidepressant 115 (23) 13 (5) 40.548**
Haloperidol, clozapine, and amitriptyline 65 (13) – –
≥1 antipsychotic + ≥1 antiepileptic 82 (16) 35 (13) 1.232
≥2 antipsychotics + ≥1 antiepileptic 58 (12) 19 (7) 3737.000
Antiparkinsonian medication 252 (50) 40 (15) 91.006**

**p < 0.01.

(9%; 8.7 ± 2.7 mg/day). Moreover, 12% of the patients 12% of the inpatients in Tashkent and 10% of the
with schizophrenia were treated with at least one inpatients in the German cities. When three or more
antiepileptic. Valproic acid was the preferred substance antipsychotics were used in Tashkent, they usually
given to 8% (1467 ± 458 mg/day) of the patients. were clozapine, haloperidol, and another first‐
Furthermore, 17% of the patients were treated with generation antipsychotic. Most psychotropic sub-
any antidepressant. stance combinations (antipsychotic and another
In both settings, polypharmacy within substance antipsychotic, antipsychotic and antiepileptic, and
groups and across substance groups was common antipsychotic and antidepressant) are more common
for the treatment of schizophrenia. Three or more in Tashkent than in the German cities (Table 2).
psychotropic medications at a time were prescribed
to a majority (66%) of the patients in Tashkent and DISCUSSION
close to one‐half (42%) of the patients in the
German hospitals. Two or more antipsychotics were In Tashkent, the antipsychotics clozapine and
used to treat 67% of the patients in Tashkent and haloperidol have a predominant importance. Both
44% of the patients in the German hospitals. Three substances are usually prescribed in lower dosage
or more antipsychotics at a time were prescribed to than in the German hospitals and in combination with

Copyright # 2011 John Wiley & Sons, Ltd. Pharmacoepidemiology and Drug Safety, 2012; 21: 145–151
DOI: 10.1002/pds
 prescription pattern of schizophrenia patients
another antipsychotic medication. In Tashkent, clo-
zapine and amitriptyline were used as sedating and
sleep‐inducing medications given in low dose at
bedtime. The use of clozapine imposes a risk of fatal
agranulocytosis if not accompanied by regular
leukocyte counts.22 One possible explanation for the
common use of amitriptyline in patients diagnosed
with schizophrenia in Tashkent is a different diag-
nostic practice, which included affective psychosis in
the broader concept of schizophrenia.21 There is
inconclusive evidence for the use of amitriptyline
against depressive symptoms in patients with chronic
schizophrenia.23 The role of clozapine for the
treatment of schizophrenia is still under discussion
in Western settings. Recent findings from an 11‐year
follow‐up study in Finland indicate that the use
of clozapine is associated with the lowest mortality
in schizophrenia patients as compared with any
other substance and no treatment,24 recommending
reassessment of restrictions for its use as seen in
Western guidelines, but this refers to a context where
leukocyte counts are regularly available.
In Germany, atypicals are usually combined with
benzodiazepines. Olanzapine and quetiapine, the most
important antipsychotics in the German hospitals were
not yet available in Tashkent. Marketing may be one
factor influencing the treatment decision; sedating side
effects may be another. Evidence from the Clinical
Antipsychotic Trials of Intervention Effectiveness study
does not allow the conclusion that second‐generation
antipsychotics have a general advantage over first‐
generation antipsychotics regarding effectiveness.25
Nevertheless, they are generally the preferred first‐line
treatment option in Western settings. In the German
hospitals, non‐sedating atypicals such as ziprasidone,
amisulpride and aripiprazole play a minor role. A recent
study indicates olanzapine and risperidone to be
superior to quetiapine and other second‐generation
antipsychotics for the acute phase treatment.26
In both settings, the high rate of patients treated with
pharmacological combinations within and between
substance groups contrasts with current treatment
recommendations of guidelines.14,15,27 A few studies
revealing current pharmacological treatment strategies
for psychiatric inpatients all show a high degree of
polydrug use.12,28–30 Those findings give rise to
concern. They call for a more rationale evidence‐based
use of medications. Researchers should set up more
studies to investigate the psychotropic combinations
that are common in clinical practice.
Case 10 in the case book Images of Mental Illness
in Central Asia from Tashkent illustrates the initial
intravenous use of haloperidol and levomepromazine,
Copyright # 2011 John Wiley & Sons, Ltd.
149
two typical antypsychotics with differential receptor
profiles,4 a treatment strategy that was common also in
Japan.24,30 There are a number of positive double‐blind
trials from China starting treatment with antipsychotic
combinations including clozapine as one of the
medications.31 The combination of antipsychotics
and benzodiazepines is usually allowed in Western
treatment trials and the preferred treatment strategy in
Western settings. However, there is no conclusive
evidence for the use of benzodiazepine sedation,
neither in acute psychosis nor in maintenance treat-
ment.31 Low‐dose clozapine serves a similar add‐on
sedative purpose in Uzbekistan as benzodiazepines do
in Germany. There is little evidence for the combina-
tion of antipsychotics as augmentation strategy in
partial response.32 Nevertheless, combinations of
antipsychotics seem to be a common strategy in many
settings. Those descrepancies between guidelines and
treatment reality in schizophrenia were shown for
Norway33 and France.34 Among clinicians, resistance
to treatment with clozapine is considered a reason for
antipsychotic combination treatment with or without
clozapine.35,36 Trials are designed to improve the
evidence base for this strategy.37 The common use
of antipsychotic combinations for the long‐term out-
patient treatment of schizophrenia was recently shown
for a large sample in Germany.38
Recommendations. Antipsychotic polypharmacy
should be reduced in both settings. Although poly-
pharmacy is neither linked to abundant availability
of medication and resources nor to scarcity of re-
sources, further studies should target the better
understanding of its rationale and effectiveness. In
Tashkent, benzodiazepines or low‐potency to middle‐
potency first‐generation antipsychotics may be a safer
and cost‐effective alternative to low‐dose clozapine.
The common use of clozapine in the context of
irregular availability of leukocyte counts should be
re‐evaluated. The availability of risperidone should
consequently be pushed forward in Tashkent for all
patients. It may be a cost‐effective first‐line treatment
for schizophrenia.
The study has a descriptive character and the
following limitations. Diagnoses were generated in
different ways in Germany and in Uzbekistan. In
Germany, the use of the International Classification of
Diseases (10th revision; ICD‐10) is obligatory. In
Uzbekistan, the ICD‐10 is available, but it is not yet
implemented, which means that not all patients treated
for schizophrenia in Uzbekistan fulfill the ICD‐10
criteria. There was a broader concept of schizophrenia
including delusional disorders and affective psychoses
in Tashkent.21 To evaluate prescription patterns for the
Pharmacoepidemiology and Drug Safety, 2012; 21: 145–151
DOI: 10.1002/pds
150 a. p. mundt
diagnoses, the way they are generated in the naturalistic
setting may be more informative for treatment decisions
within the same setting. The study cannot show whether
a pharmacological treatment was directed against
possible co‐morbidity. The naturalistic design does
not allow systematic evaluation of co‐morbidity.
The census of psychiatric prescription practice for
the treatment of schizophrenia presents a useful way
to start discussion about pharmacological treatment
and its optimization.
ACKNOWLEDGEMENTS
We would like to acknowledge all the psychiatric
residents of the Tashkent psychiatric hospital who
contributed to the data collection and all the AMSP
drug monitors who collected the data in the German
cities. We would like to acknowledge Dr. Christian
Guksch, Center of International Migration, Charité
Center of the Tashkent Medical Academy, who pro-
vided most valuable logistical support and advice. We
would like to acknowledge Deutscher Akademischer
Austauschdienst DAAD for providing a travel grant to
Adrian Mundt.
CONFLICT OF INTEREST
The AMSP drug safety program is organized by non‐
profit associations in Germany, Austria, and Switzerland.
Almost all pharmaceutical companies involved in
CNS research contribute financial support to the three
associations.
Educational and research grants since 1993:
Austrian companies: Astra Zeneca Österreich GmbH,
Boehringer Ingelheim Austria, Bristol Myers Squibb
GmbH, CSC Pharmaceuticals GmbH, Eli Lilly GmbH,
Germania Pharma GmbH, GlaxoSmithKline Pharma
GmbH, Janssen‐Cilag Pharma GmbH, Lundbeck
GmbH, Novartis Pharma GmbH, Pfizer Med Inform,
and Wyeth Lederle Pharma GmbH.
German companies: Abbott GmbH & Co. KG, Astra-
Zeneca GmbH, Aventis Pharma Deutschland GmbH
GE‐O/R/N, Bayer Vital GmbH & Co. KG, Boehringer
Mannheim GmbH, Bristol‐Myers‐Squibb, Ciba Geigy
GmbH, Desitin Arzneimittel GmbH, Duphar Pharma
GmbH & Co. KG, Eisai GmbH, esparma GmbH
Arzneimittel, GlaxoSmithKline Pharma GmbH &
Co. KG, Hoffmann‐La Roche AG Medical Affairs,
Janssen‐Cilag GmbH, Janssen Research Foundation,
Knoll Deutschland GmbH, Lilly Deutschland GmbH
Niederlassung Bad Homburg, Lundbeck GmbH & Co.
KG, Novartis Pharma GmbH, Nordmark Arzneimittel
GmbH, Organon GmbH, Otsuka‐Pharma Frankfurt,
Copyright # 2011 John Wiley & Sons, Ltd.
ET AL.
Pfizer GmbH, Pharmacia & Upjohn GmbH, Promonta
Lundbeck Arzneimittel, Rhone‐Poulenc Rohrer, Sanofi‐
Synthelabo GmbH, Sanofi‐Aventis Deutschland, Schering
AG, SmithKline Beecham Pharma GmbH, Solvay
Arzneimittel GmbH, Synthelabo Arzneimittel GmbH,
Dr. Wilmar Schwabe GmbH & Co., Thiemann
Arzneimittel GmbH, Troponwerke GmbH & Co. KG,
Upjohn GmbH, Wander Pharma GmbH, and Wyeth‐
Pharma GmbH.
Switzerland companies: AHP (Schweiz) AG, AstraZeneca
AG, Bristol‐Myers Squibb AG, Desitin Pharma GmbH,
Eli Lilly (Suisse) S.A., Essex Chemie AG, GlaxoSmithKline
AG, Janssen‐Cilag AG, Lundbeck (Suisse) AG, Organon
AG, Pfizer AG, Pharmacia, Sanofi‐Aventis (Suisse) S.A.,
Sanofi‐Synthélabo SA, Servier SA, SmithKlineBeecham
AG, Solvay Pharma AG, Wyeth AHP (Suisse) AG, and
Wyeth Pharmaceuticals AG.
R. Grohmann is the project manager of AMSP.
Dr. Ströhle received research funding from Lundbeck
and speaker honoraria from AstraZeneca, Boehringer
Ingelheim, Bristol‐Myers Squibb, Eli Lilly & Co,
Lundbeck, Pfizer, Wyeth, and UCB. Educational grants
were given by the Stifterverband für die Deutsche
Wissenschaft, the Berlin Brandenburgische Akademie
der Wissenschaften, the Boehringer Ingelheim Fonds,
and the Eli Lilly International Foundation.
KEY POINTS
• The combination of medium‐dose haloperidol
and low‐dose clozapine is the most common
treatment strategy for schizophrenia in the
Tashkent Psychiatric hospital.
• Sedating atypical antipsychotics in combination
with benzodiazepines are the most common
strategy in German hospitals.
• Polypharmacy is more common in the lower‐
resourced setting as compared with the higher‐
resourced setting.
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