Use Of Antipsychotic Polypharmacy Research Articles

Antipsychotic Polypharmacy among Psychiatric Patients in Hospital Kajang, Malaysia

Background: Using antipsychotic polypharmacy is a routine practice despite the instructions and guidelines of avoiding such combinations till several successful trials upon antipsychotic combinations usage. This practice exposes severe side effects over the patient and also poses burden by unnecessary expenses. On the other hand, antipsychotic polypharmacy also has some benefits and most medical practitioners prescribe antipsychotic combinations in order to treat difficult and acute psychosis. Now-a-days, use of antipsychotic polypharmacy is common among psychiatric patients. There is gap due to low empirical evidences in support of its benefits, safety, risks, efficacy and proper way of practicing till now. There is no data available published at local level in Malaysia in spite of recurrent and more prevalent usage of antipsychotic polypharmacy. To determine the proportion and pattern of antipsychotic polypharmacy prescriptions and their possible risks among patients, this study was conducted. Methodology: This cross-sectional study was conducted over the patients prescribed with antipsychotic polypharmacy at Kajang Hospital, Malaysia from June until August 2017. Retrospective data was collected for patients who were admitted in the past 1 year (January 2016 to December 2016). The risk and usage of polypharmacy were assessed on the basis of clinical outcomes and range of prescription as medication non-adherence, adverse drug effects, drug-drug interaction, inappropriate prescriptions, hospitalization, functional decline and mortality resulted either by antipsychotic polypharmacy or due to monotherapy effects. Results: A total of 100 patients were included in this study. Overall there were 120 cases detected in this research. Sixty-two cases out of the total 120 were prescribed antipsychotic monotherapy, while 58 cases prescribed with antipsychotic polypharmacy medications. The use of polypharmacy as antipsychotic medications accounted for almost half of total cases with 48%. It was also found from this study that duration of illness had statistically significant association with antipsychotic polypharmacy (P<0.05). Polypharmacy in antipsychotic treatment caused adverse effects like hyperprolactinemia and EPS. Some other adverse effects were associated with monotherapy and polytherapy medications such as weight gain, hyperlipidemia, and metabolic syndrome but these were not statistically significant. Conclusion: The antipsychotic polypharmacy was high in proportion. Prescription of antipsychotic polypharmacy was concerned with severe side effects. While prescribing antipsychotics for diabetics and obese patients, caution must be taken. To enhance the prevention and management of these medications, there must be more information about risk and usage of antipsychotic polypharmacy.

Evolution of metabolic risk factors over a two-year period in a cohort of first episodes of psychosis

Patients with a first episode of psychosis (FEP) display a broad range of metabolic risk factors related to the development of diverse medical comorbidities. Initial stages of these disorders are essential in understanding the increased vulnerability of developing cardiometabolic disturbances, associated with a reduced life expectancy. This study aimed to evaluate the metabolic profile of a cohort of patients with a FEP and its evolution during a two year follow-up, as well as the factors that influence the changes in their metabolic status.16 participating centers from the PEPs Project recruited 335 subjects with a FEP and 253 matched healthy controls, aged 9–35years. We investigated a set of anthropometric measures, vital signs and laboratory data obtained from each participant over two years in a prospective, naturalistic study.From the beginning of the study the FEP group showed differences in the metabolic profile compared to the control group, together with a progressive worsening in the major part of the analyzed variables during the follow-up period, with higher rates of obesity and metabolic syndrome. Certain risk factors were related to determinate clinical variables such as male gender, the presence of affective symptoms or an early onset or to treatment variables such as the use of antipsychotic polypharmacy, antidepressants or mood stabilizers.Our results highlight the extremely high risk of patients at early phases of schizophrenia and other psychotic disorders of developing cardiovascular comorbidity and the fast worsening of the metabolic profile during the first two years.

Correlates and predictors of antipsychotic drug polypharmacy in real-life settings: Results from a nationwide cohort study

Reasons for using antipsychotic polypharmacy (APP) in routine clinical practice, despite a potentially unfavorable risk-benefit ratio, are poorly understood. This research aimed to determine (1) if severe courses of schizophrenia were associated with APP and (2) if a schizophrenia-related acute event would predict a switch to APP in the short term. Observational prospective data (at baseline and 6months) were drawn from a French nationwide cohort (“Cohorte Générale Schizophrénie”), which included 1859 inpatients and outpatients with schizophrenia. APP was defined as the prescription of ≥2 antipsychotic drugs (there being different active substances). Early-onset schizophrenia, legal guardianship, higher lifetime maximal severity of illness and comorbid antisocial personality were used as proxies for severe courses of schizophrenia. Schizophrenia-related acute events included hospitalization and recent suicide attempts. Logistic regression models were used to determine (1) whether the use of APP at baseline (vs. monotherapy) was associated with a severe course of schizophrenia or not, independent of acute events, and (2) if a switch to APP at 6months (vs. remaining on monotherapy) was associated with acute events, independent of severe courses of schizophrenia. Increased odds of APP use at baseline were independently associated with legal guardianship (OR=1.6; 95%CI=1.3, 2.0) and higher lifetime maximum severity of illness (OR=1.3; 95%CI=1.2, 1.5). A switch to APP at 6months was predicted by a hospitalization occurring since baseline (OR=6.1; 95%CI=3.9, 9.4). In routine clinical practice, APP is more likely prescribed to patients with severe courses of illness, possibly indicating the difficulty to manage these patients.

Attitudes towards and rationale for antipsychotic polypharmacy among psychiatrists in Nigeria: Characteristics associated with high reported antipsychotic polypharmacy

Antipsychotic polypharmacy (APP) is commonplace despite lacking evidence of its effectiveness. We aimed to identify psychiatrists’ rationale for and attitudes towards APP and to determine if attitudes influence antipsychotic polypharmacy prescription rates in a survey of a nationally representative sample of Nigerian psychiatrists (of which a majority were senior trainees: 74.2%). Prescriber characteristics, practices and attitudes were compared in ‘high’ (>30%) vs. ‘low’ (≤30%) antipsychotic polypharmacy prescribers and results were adjusted for multiple comparisons. Altogether, prescribers reported utilizing antipsychotic polypharmacy in 36.2% of their patients. Compared to ‘low’ antipsychotic polypharmacy prescribers, ‘high’ prescribers were significantly more likely using first-generation antipsychotics (FGA) combination, to have attempted a switch to monotherapy in less patients, or been successful in doing so. ‘High’ and ‘low’ antipsychotic polypharmacy prescribers were equally moderately concerned about the effects of antipsychotic polypharmacy and also did not differ regarding reasons not justifying antipsychotic polypharmacy. In a multivariable, backward elimination logistic regression model, ‘low’ antipsychotic polypharmacy was associated with having successfully switched patients to monotherapy, whereas the ‘high’ antipsychotic polypharmacy was associated with preferring FGA+FGA combinations and aiming for a reduction of non-antipsychotic medications. Antipsychotic polypharmacy is common among psychiatrists in Nigeria, with ‘high’ and ‘low’ antipsychotic polypharmacy prescribers sharing similar concerns/attitudes, but differing regarding their primary aim for antipsychotic polypharmacy and in their specific antipsychotic polypharmacy use characteristics.

Prevalence and correlates of antipsychotic polypharmacy among outpatients with schizophrenia attending a tertiary psychiatric facility in Nigeria.

The study aimed to determine the prevalence, pattern and correlates of antipsychotic polypharmacy (APP) among outpatients with schizophrenia attending a tertiary psychiatric facility in Nigeria. A cross-sectional study of 250 patients with schizophrenia attending the outpatient clinic of a regional tertiary psychiatric facility in Nigeria was undertaken. They were administered a sociodemographic questionnaire, the Positive and Negative Syndrome Scale (PANSS), the Global Assessment of Functioning (GAF) scale and the Liverpool University Side Effects Rating Scale (LUNSERS). Of the 250 subjects interviewed, 176 (70.4%) were on APP. APP was significantly associated with higher prescribed chlorpromazine equivalent doses of antipsychotics (p < 0.001), increased frequency of dosing (p < 0.001), negative symptoms (p < 0.01), poorer functioning (p = 0.04) and greater side-effect burden (p = 0.04). The APP rate reported from this study is high. Clinicians should be mindful of its impact on dosage and side-effect profiles as APP use is associated with negative symptoms and poor psychosocial functioning.

Antipsychotic polypharmacy and augmentation strategies prior to clozapine initiation: a historical cohort study of 310 adults with treatment-resistant schizophrenic disorders.

Antipsychotic polypharmacy (APP) is commonly used in schizophrenia despite a lack of robust evidence for efficacy, as well as evidence of increased rates of adverse drug reactions and mortality. We sought to examine APP and the use of other adjunctive medications in patients with treatment-resistant schizophrenic disorders (ICD-10 diagnoses F20-F29) immediately prior to clozapine initiation, and to investigate clinical and sociodemographic factors associated with APP use in this setting. Analysis of case notes from 310 patients receiving their first course of clozapine at the South London and Maudsley NHS Trust (SLaM) was undertaken using the Clinical Record Interactive Search (CRIS) case register. Medication taken immediately prior to clozapine initiation was recorded, and global clinical severity was assessed at time points throughout the year prior to medication assessment using the Clinical Global Impression - Severity scale (CGI-S). Logistic regression was used to investigate factors associated with APP. The point prevalence of APP prior to clozapine initiation was 13.6% (n=42), with 32.6% of subjects prescribed adjuvant psychotropic medications. APP was associated with increasing number of adjuvant medications (odds ratio (OR) 1.97, 95% confidence interval (CI) 1.27-3.06), concurrent depot antipsychotic prescription (OR 2.64, CI 1.24-5.62), concurrent antidepressant prescription (OR 4.40, CI 1.82-10.63) and a CGI-S over the previous year within the two middle quartiles (Quartile 2 vs 1 OR 6.19, CI 1.81-21.10; Quartile 3 vs 1 OR 4.45, CI 1.29-15.37; Quartile 4 vs 1 OR 1.88, CI 0.45-7.13). APP and augmentation of antipsychotics with antidepressants, mood stabilizers and benzodiazepines are being employed in treatment-resistant schizophrenia prior to clozapine. The conservative APP rate observed may have been influenced by an initiative within SLaM that reduced APP rates during the study window. Efforts to reduce the use of poorly evidenced prescribing should focus on adjuvant medications as well as APP.

Psychopharmacological treatment for schizophrenia: less is more.

BackgroundAntipsychotic polypharmacy in the treatment of schizophrenia is more common in China and other Asian countries than in Western countries. The reasons for this are unclear, but it may be related to an unsubstantiated belief among clinicians that multiple medications are more likely to achieve the desired clinical outcome. Antipsychotic medications are the mainstay of treatment for individuals with schizophrenia, but the use of antipsychotic polypharmacy and of high dosages of antipsychotic medication are associated with substantially increased risks without conferring improved clinical outcomes. It is generally accepted that high dosages of antipsychotic medications and the simultaneous use of multiple antipsychotics are associated with an increased prevalence, duration, and severity of adverse drug effects. More recent evidence also suggests that antipsychotic polypharmacy and the associated high overall dosage of antipsychotic medication lead to excessive striatal D2 receptor occupation (resulting in tolerance and drug withdrawal problems) and exacerbation of the impaired synaptic plasticity seen in schizophrenia (magnifying the cognitive impairment associated with the condition). Clinicians need to apply the ‘less is more’ principle in the psychopharmacological treatment of schizophrenia.

Predictors of antipsychotic polypharmacy in an acute-care teaching hospital

Introduction: Antipsychotic polypharmacy increases the risk of adverse reactions, interactions, and cost. Data for the use of antipsychotic polypharmacy are limited. The Joint Commission’s Hospital Based Inpatient Psychiatric Services (HBIPS) recently established a set of quality measures evaluating inpatient psychiatric care, including the rate of antipsychotic polypharmacy at discharge.Methods: A retrospective medical record review was approved by the Institutional Review Board. Admission records were used to identify patients 18 years or older who were discharged from an inpatient psychiatric unit from January 1, 2012 to June 30, 2012. Exclusion criteria included patients not discharged on antipsychotics, pregnancy, length of stay not more than three days, elopement or failing to return from leave, or those who expired. Patients were divided into two groups: those discharged on antipsychotic monotherapy or antipsychotic polypharmacy. The objective of this study was to determine the association between patient-specific factors and the presence of antipsychotic polypharmacy at discharge. A secondary objective was determining if appropriate justification for antipsychotic polypharmacy at discharge was documented.Results: Of 901 inpatient psychiatric admissions, 442 patients were included. There were 362 patients discharged on antipsychotic monotherapy and 80 patients discharged on antipsychotic polypharmacy. Five characteristics were significantly associated with antipsychotic polypharmacy at discharge: Medicare insurance (OR 2.156, 95% CI 1.279-3.636), psychotic disorders (OR 3.665, 95% CI 1.999-6.789), greater than one antipsychotic on admission (OR 27.179, 95% CI 13.895-53.668), quetiapine at discharge (OR 2.3, 95% CI 1.355-3.901), and paliperidone at discharge (OR 2.415, 95% CI 1.38-4.219). Of the 80 patients discharged on antipsychotic polypharmacy, 83.7% did not have appropriate justification for the polypharmacy documented.Conclusions: The patient-specific factors of Medicare, psychotic disorders, greater than one antipsychotic on admission, and quetiapine and paliperidone were significantly associated with antipsychotic polypharmacy at discharge. For patients discharged on multiple antipsychotics, supporting documentation was infrequent.

Prevalence and nature of antipsychotic polypharmacy among inpatients with schizophrenia spectrum disorders at an Australian mental health service.

Though antipsychotic polypharmacy (APP) is widely utilised in many clinical settings for the treatment of people with schizophrenia, the extent of this practice varies considerably between different regions, countries and clinical settings. Studies from Australasia exploring the prevalence and factors associated with APP are sparse and have yielded inconsistent results. We conducted a systematic retrospective audit of the medical records of all admissions in 2010 in the adult wards of a metropolitan public mental health service in Western Australia, having a diagnosis of schizophrenia or schizoaffective disorder. We analysed the rates of APP use, and its association with selected demographic and clinical variables. The prevalence of APP among our sample of 229 patients was high, at 43.2%. APP was associated with a longer hospital stay (p=0.033) and voluntary admission (p=0.027); but APP was not significantly related to: age, gender, diagnosis and treatment by different psychiatrists. Substantial difference exists between everyday clinical practice and recommendations of practice guidelines of schizophrenia, regarding the use of APP. Prospective studies from different settings exploring the relevant clinical, patient, prescriber and system-related issues are warranted, to comprehend the rationale behind high utilisation of APP in clinical practice.

Treating the violent patient with psychosis or impulsivity utilizing antipsychotic polypharmacy and high-dose monotherapy.

Insufficient treatment of psychosis often manifests as violent and aggressive behaviors that are dangerous to the patient and others, and that warrant treatment strategies which are not considered first-line, evidence-based practices. Such treatment strategies include both antipsychotic polypharmacy (simultaneous use of 2 antipsychotics) and high-dose antipsychotic monotherapy. Here we discuss the hypothesized neurobiological substrates of various types of violence and aggression, as well as providing arguments for the use of antipsychotic polypharmacy and high-dose monotherapy to target dysfunctional neurocircuitry in the subpopulation of patients that is treatment-resistant, violent, and aggressive. In this review, we focus primarily on the data supporting the use of second-generation, atypical antipsychotics both at high doses and in combination with other antipsychotics.

Factors Associated With Antipsychotic Polypharmacy and High-Dose Antipsychotics Among Individuals Receiving Compulsory Treatment in the Community

Community treatment orders (CTOs) are a form of compulsory treatment of individuals with a mental illness in the community. The objectives of this study were to determine the demographic, clinical, and treatment plan factors associated with antipsychotic polypharmacy and high-dose antipsychotics among individuals issued with a CTO. This was a secondary analysis of all 377 individuals who were prescribed an antipsychotic, extracted from a retrospective study of 378 individuals issued with a CTO by the New South Wales Mental Health Review Tribunal in Australia in 2009. Deidentified information relating to individuals' treatment plans, demographic, and clinical details were systematically extracted. Of the 377 individuals, 121 (32%) were prescribed antipsychotic polypharmacy and 101 (27%) high-dose antipsychotics. Unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) for factors associated with antipsychotic polypharmacy and high-dose antipsychotics were computed using binary logistic regression. There was a strong association between the use of antipsychotic polypharmacy and high-dose antipsychotics (P < 0.001). Only treatment plan factors were associated with antipsychotic polypharmacy and high-dose antipsychotics in adjusted models. Although first-generation long-acting injectable antipsychotics and clozapine were associated with antipsychotic polypharmacy (adjusted OR, 9.12; 95% CI, 4.21-19.74; adjusted OR, 7.97; 95% CI, 2.93-21.72), oral second-generation antipsychotics and risperidone long-acting injection were associated with high-dose antipsychotics (adjusted OR, 5.67; 95% CI, 2.89-11.12; adjusted OR, 8.14; 95% CI, 3.22-20.53). Therefore, the use of antipsychotic polypharmacy and high-dose antipsychotics among individuals issued with CTOs is associated only with the drugs prescribed in their treatment plans and not their individual demographic and clinical characteristics.

Low Prevalence of Metabolic Syndrome in a Group of Patients with Chronic Psychotic Disorders Taking Antipsychotic Polypharmacy in Residential Treatment While Adhering to a Mediterranean Diet

The aim of this abbreviated report is to describe the prevalence of the Metabolic Syndrome (MS) in a sample group of patients with psychosis in residential treatment in Spain, who have been treated with antipsychotic polypharmacy for 5 years or more. We designed a cross sectional study to describe the prevalence of MS in a population sample of 21 of such patients. Using the criteria recommended by the Third Report of the National Cholesterol Education program Expert panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (NCP-ATP III), In this group 19, 04% of these patients met such criteria. The prevalence is much smaller than those reported in other countries, especially the U.S. This is even more remarkable, given the use of antipsychotic polypharmacy in this sample group of patients, which is an additional risk factor for the development of M.S. Residential treatment (a controlled living environment), Short Communication Forcen et al; JSRR, Article no. JSRR.2014.12.01

Clinical Correlates and Description Profiles of Antipsychotic Polypharmacy for Patients with Schizophrenia

ObjectivesZZDespite increasing use of antipsychotic polypharmacy (APP), few studies have in- vestigated APP for Korean patients with schizophrenia. The aim of this study was to identify the sociodemographic and clinical correlates and recent prescription profiles of APP in schizophrenia patients. MethodsZZA total of 297 schizophrenia patients were recruited and interviewed using standard- ized assessment instruments in Seoul National Hospital. Differences in demographic and clinical characteristics between APP and antipsychotic monopharmacy (APM) groups were analyzed. The prescriptions of psychotropic drugs were collected by a review of medical records. ResultsZZIn comparison with the APM group, the APP group showed association with earlier onset, lower employment rate, and higher scores for Clinical Global Impression-Severity and Brief Psychiatric Rating Scale (BPRS) (p<0.001). In particular, the BPRS positive (p<0.001) and affective symptom scores (p<0.001) of the APP group were higher those of the APM group. The most frequent combination pattern of APP was second generation antipsychotics (SGA)+SGA, followed by SGA+first generation antipsychotics (FGA), and SGA+SGA+FGA. For antipsychotics, it was risperidone+quetiapine, followed by clozapine+risperidone, risperidone+sulpiride, and risperidone+haloperidol. ConclusionZZThe current study suggests that the usage of APP for schizophrenia could be re- lated to symptom severity affected by positive and affective symptoms. The prescription profile reflects that the proportion of atypical antipsychotics on APP has increased. J Kor ean Neuropsychiatr Assoc 2014;53(6):370-378

Emerging guidelines for the use of antipsychotic polypharmacy

s s i s a n o t o v i f h f m o m w W m b s r e a Although combining medications for the treatment of schizophrenia is the rule rather than the exception, the literature and treatment guidelines consistently direct clinicians away from this practice, emphasizing that antipsychotic polypharmacy/combination treatments are associated with higher medication costs, more side effects, and no clearly documented improvement in efficacy and in fact, worse outcomes.1--17 However, the tide may be beginning to turn in favor of antipsychotic polypharmacy for selected patients. Who are these patients and what are the emerging guidelines for using antipsychotic polypharmacy?

Antipsychotic polypharmacy: A Japanese survey of prescribers' attitudes and rationales

While combining antipsychotics is common in schizophrenia treatment, the literature on the reasons for antipsychotic polypharmacy (APP) is limited. We aimed to identify prescriber attitudes and rationales for APP in Japan where high APP utilization is reported. Two-hundred and seventeen psychiatrists participated in the survey, which assessed APP attitudes and behaviors. Prescribing APP to 47.7±24.7% (mean±S.D.) of their patients, psychiatrists reported that they were “moderately” concerned about APP. The most APP-justifiable factors were (1=“not at all” to 5=“extreme”) cross titration (4.50±0.67), randomized controlled evidence (3.67±0.83), and treatment of comorbid conditions (3.31±0.83). Conversely, APP-discouraging factors were chronic side effects (4.14±0.64), difficulty determining cause and effect (4.07±0.74), and acute side effects (3.99±0.81). Comparing high to low APP prescribers (>50% vs. ≤50% of patients), no differences emerged regarding APP justification and concerns. In multivariate analyses, high APP use was associated with practice at a psychiatric hospital (OR: 2.70, 95% CI: 1.29–5.67, p=0.009), concern about potential drug–drug interactions (OR: 1.56, 95% CI: 1.04–2.35, p=0.031), and less reliance on case reports of APP showing efficacy (OR: 0.64, 95% CI: 0.44–0.92, p=0.017) (r2=0.111, p=0.001). High and low APP prescribers shared a comparable degree of justifications and concerns. Future research should examine the impact of cultural determinants on APP.

Common Use of Antipsychotic Polypharmacy in Older Asian Patients With Schizophrenia (2001–2009)

The aim of this study was to survey the use of antipsychotic polypharmacy (APP) in older Asian patients with schizophrenia and examine its demographic and clinical correlates. Information on hospitalized patients with schizophrenia aged 55 or older was extracted from the database of the Research on Asian Psychotropic Prescription Patterns study. Data on 1439 patients in 6 Asian countries and territories including China, Hong Kong, Japan, Korea, Singapore, and Taiwan were analyzed. Sociodemographic and clinical characteristics and antipsychotic prescriptions were recorded using a standardized protocol and data collection procedure. The frequency of APP prescription was 51.6% in the pooled sample with wide intercountry variations. Multiple logistic regression analysis of the whole sample showed that patients on APP had higher antipsychotic doses and also were more likely to receive first-generation antipsychotics. Use of APP was common in older Asian patients with schizophrenia. Given the limited evidence supporting its efficacy, the potentially severe side effects and high costs, APP should be used with caution in this population. The reasons for and outcomes of the use of APP in this patient population merit further exploration.

Adherence to treatment guidelines in clinical practice: study of antipsychotic treatment prior to clozapine initiation

Clozapine is the only antipsychotic drug licensed for treatment-resistant schizophrenia but its use is often delayed. Since previous studies, national guidelines on the use of clozapine and other antipsychotics have been disseminated to clinicians. To determine the theoretical delay to clozapine initiation and to quantify the prior use of antipsychotic polypharmacy and high-dose antipsychotic treatment. Clinico-demographic data were extracted from the treatment records of all patients commencing clozapine in our centre between 2006 and 2010. Complete records were available for 149 patients. The mean theoretical delay in initiating clozapine was 47.7 months (s.d. = 49.7). Before commencing clozapine, antipsychotic polypharmacy and high-dose treatment was evident in 36.2 and 34.2% of patients respectively. Theoretical delay was related to illness duration (β = 0.7, P<0.001) but did not differ by gender or ethnicity. Substantial delays to clozapine initiation remain and antipsychotic polypharmacy and high doses are commonly used prior to clozapine, despite treatment guidelines.

Systematic practice-based interventions may help reduce the widespread use of antipsychotic polypharmacy

Systematic practice-based interventions may help reduce the widespread use of antipsychotic polypharmacy

Predictors of antipsychotic monotherapy with olanzapine during a 1-year naturalistic study of schizophrenia patients in Japan.

PurposeAlthough expert guidelines for the treatment of schizophrenia recommend antipsychotic monotherapy, the use of antipsychotic polypharmacy is common. This study identified characteristics that differentiate patients with schizophrenia who are treated with olanzapine monotherapy versus polypharmacy in usual care in Japan.Patients and methodsIn a large (N = 1850) prospective, observational study, Japanese patients with schizophrenia who initiated treatment with olanzapine were followed for 1 year. Consistent with past research, antipsychotic polypharmacy was defined as the concurrent use of olanzapine and another antipsychotic for at least 60 days. Switching was defined as discontinuing a prior antipsychotic therapy rather than augmenting the medication regimen. Predictors of antipsychotic monotherapy were based on information available at the time of olanzapine initiation. Baseline characteristics were compared using t-tests and χ2 tests. Stepwise logistic regression was used to identify independent predictors of monotherapy.ResultsPatients treated with olanzapine monotherapy (43.2%) differed from those treated with antipsychotic polypharmacy (56.8%) on demographics, treatment history, baseline symptom levels, functional levels, and treatment-emergent adverse events. Stepwise logistic regression identified multiple variables that significantly predicted monotherapy: older age, shorter duration of schizophrenia, outpatient status, comorbid medical conditions, lower body mass index, no prior anticholinergic use, no prior mood stabilizer use, and switching from a previous antipsychotic (typical or atypical).ConclusionConsistent with prior research in Japan, antipsychotic polypharmacy appears to be common in the treatment of schizophrenia. Patients treated with monotherapy could be differentiated from those treated with antipsychotic polypharmacy based on a specific set of demographic and baseline clinical characteristics.

PRACTICES OF ANTIPSYCHOTIC POLYPHARMACY IN SCHIZOPHRENIA: A REVIEW

With an increase in the new generation of antipsychotic drugs and resulting antipsychotic polypharmacy, treatment of schizophrenic patients has again come into the daily agenda. In spite of the annual increase of these new drugs in recent years no expected benefit in the treatment of patients has been observed. A lack of alternative treatments of schizophrenia and the increase of polypharmaceutical approaches to treatment have led to clinicians feeling helpless; especially as schizophrenia is known to be treatment resistant over time and is often subject to poor prognosis. According to the treatment algorhythm the application of antipsychotic polypharmacy can be the choice of treatment for treatment-resistant patients but only following a program of sufficient monotherapy. For a short period, antipsychotic polypharmacy can ease the transition from the use of one antipsychotic to that of another. However it is thought that this approach is often over used in clinical experiments and observations. The frequency of the antipsychotic polypharmacy use in schizophrenia has been discussed in this review. Key words: atypical antipsychotics, combination treatment, polypharmacy, schizophrenia