Nationwide trends in antipsychotic and co-medication prescribing for schizophrenia: analysis of National Health Insurance data (2011-2023).

INTRODUCTION

Schizophrenia treatment has increasingly shifted toward the use of second-generation antipsychotics (SGAs), yet real-world prescribing often involves complex polypharmacy. Evidence from Asian countries, particularly regarding adjunctive psychotropic use at treatment initiation, remains insufficient. This study aimed to describe changes in antipsychotic prescribing patterns among newly diagnosed patients with schizophrenia in South Korea from 2012 to 2023 and to examine socioeconomic and clinical factors.

METHODS

We analyzed nationwide National Health Insurance (NHI) claims data covering 2012-2023. Adults aged 20-65 years with newly diagnosed schizophrenia (ICD-10 F20.0-F20.9) were included (n = 320,591). Annual prescription rates were examined for antipsychotics, benzodiazepines, anticonvulsants, and antidepressants. Logistic regression was conducted to identify sociodemographic and clinical correlates of drug use.

RESULTS

SGA use increased steadily from 84.0% in 2012 to 94.2% in 2023 (p for trend <0.0001), indicating a shift toward guideline-recommended treatment at initiation. In contrast, benzodiazepine use remained persistently high (72.5-73.7%) with no significant trend, while anticonvulsant use remained stable (∼21-23%). Antidepressant use increased from 32.4% to 45.1% (p for trend <0.0001). Medical Aid beneficiaries were less likely to receive SGAs (adjusted OR = 0.55, 95% CI 0.53-0.56).

CONCLUSION

Over the past decade, initial treatment of schizophrenia in Korea has increasingly shifted toward SGA-based therapy. However, persistent use of benzodiazepines and early socioeconomic disparities highlight ongoing challenges in achieving rational and equitable pharmacotherapy. These findings highlight the importance of continued monitoring and targeted policy efforts to improve the appropriateness and equity of psychotropic prescribing.