Abstract
Atypical antipsychotics (AAP) are the prevailing form of schizophrenia treatment today due to their low side effects and superior efficacy. Nevertheless, some issues still need to be addressed. First, there are still a large number of patients with treatment-resistant schizophrenia (TRS), which has led to a growing trend to resort to AAP polypharmacy with few side effects. Most clinical treatment guidelines recommend clozapine monotherapy in TRS, but around one third of schizophrenic patients fail to respond to clozapine. For these patients, with clozapine-resistant schizophrenia AAP polypharmacy is a common strategy with a continually growing evidence base. Second, AAP generally have great risks for developing metabolic syndrome, such as weight gain, abnormality in glucose, and lipid metabolism. These metabolic side effects have become huge stumbling blocks in today’s schizophrenia treatment that aims to improve patients’ quality of life as well as symptoms. The exact reasons why this particular syndrome occurs in patients treated with AAP is as yet unclear though factors such as interaction of AAP with neurotransmitter receptors, genetic pholymorphisms, type of AAPs, length of AAP use, and life style of schizophrenic patients that may contribute to its development. The present article aimed to review the evidence underlying these key issues and provide the most reasonable interpretations to expand the overall scope of antipsychotics usage.
Highlights
The advent of atypical antipsychotics (AAP) has enabled clinicians to treat schizophrenia with an increased efficacy and fewer side effects when compared to typical antipsychotics (TAP) [1]
Despite the passive attitudes maintained in clinical treatment guidelines, antipsychotics polypharmacy is used quite frequently in the clinical setting
Clinicians choose polypharmacy to control the symptoms of treatment-resistant schizophrenic patients or the side effects that occur as a result of using antipsychotic monotherapy
Summary
The advent of atypical antipsychotics (AAP) has enabled clinicians to treat schizophrenia with an increased efficacy and fewer side effects when compared to typical antipsychotics (TAP) [1]. There are still patients with treatment-resistant schizophrenia (TRS), which has led to a growing trend to resort to AAP polypharmacy, with few side effects [2,3]. This has created a gap between the treatment guidelines and actual clinical practice, as most clinical treatment guidelines recommend monotherapy in patients with TRS. Because the newer AAPs have the notable features in their diverse pharmacologic action and lower adverse event profiles, many clinicians have an interest in using the AAP combination therapy. Up to the present date, we are in lack of the evidence of the rationale and background of this practice
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