Antipsychotic Polypharmacy

Abstract

The administration of more than one drug for a single medical condition is considered to be polypharmacy. There are many possible reasons for polypharmacy: (1) psychosis is a chronic disease that cannot be cured; (2) expectations to improve patients' quality of life beyond what drugs can actually do is high; (3) the lack of side effects and interactions can cause physicians to be more daring in terms of potential complications; (4) information from the Internet may cause patients and their families to demand medications; (5) the diluted mental health system allows legal guardians and other mental health professionals to force physicians to provide multiple drugs; (6) many new drugs are available; and (7) physicians are forced to shorten hospitalization days. The 1997 American Psychiatric Association Practice Research Network found that 17% of 146 patients with schizophrenia were treated concurrently with more than one antipsychotic medication. Polypharmacy may increase the risk of adverse effects, drug interactions, noncompliance, and medication errors. It is not wise to use polypharmacy only to prevent side effects and drug and interactions. Our attempts to reduce polypharmacy may fail, as academicians also propagate polypharmacy, and all of the algorithms indicate polypharmacy as an option, putting physicians in a legal and ethical bind. Techniques such as experimental ward, peer review, computer information feedback, and comparing different techniques may temporarily reduce polypharmacy but long-term outcome is not affected. Scientific data on the efficacy of polypharmacy is needed in order to sort out good and bad polypharmacy.

Utilization of herbal and nutritional compounds among older adults with bipolar disorder and with major depression

“…The number of medications an individual is typically prescribed has been demonstrated to be increased with age (Kaufman et al, 2002;Cannon et al, 2006;Hayes, 2007) and among those with mental disorders (Ananth, 2004;Kreyenbuhl, 2007;Morrato, 2007). Older adults in this sample had, on average, between 2-3 medical conditions in addition to their mood disorders, with concomitant use of, on average, 5-6 medications for medical comorbidity and 2-3 medications for psychiatric illness.…”

The Janus face of polypharmacy – overuse versus underuse of medication

“…Some researchers have made a distinction between minor (2-4 drugs) and major (five or more drugs) polypharmacy (13). The number could reflect the total numbers of drugs used in the patient's medication regimen, or it could refer to the number of drugs for a particular condition (15) which is often the case in studies of psychiatric disorders (16,20). Further, in research studies, the number of drugs which are defined as polypharmacy varies from study to study: 2 or more drugs (13,16,21), 3 or more drugs (22), 5 or more drugs (13,14,23,24), 6 drugs (9,25,26), 10 or more drugs (4,27).…”

“…Studies have also been performed based on data from prescription or population databases (13,28,(40)(41)(42). Further, studies have explored polypharmacy in specific disease entities such as psychiatric diseases (16,20,35), rheumatic diseases (34), asthma (42), and heart failure (43). Due to different settings and definitions given in the various studies, the frequency of polypharmacy varies widely.…”

Changes in the Treatment of Acute Psychosis in a German Public Hospital from 1998 to 2004

“…Most published investigations are comparisons of long-term medication with AAP in comparison with conventional antipsychotics analyzing relapse-rates, compliance and side-effects [12][13][14][15][16]. Furthermore, switching strategies and polypharmacological practices in between second generation AAP are moving more in focus [17][18][19][20][21][22]. Current estimates of switching strategies in the US suggest, that up to one-third of outpatients will switch antipsychotic therapy within one year [23,24].…”

“…This result can be interpreted by the intention, to achieve a stabilization of affective symptoms and reduction of impulsive, aggressive and agitated behaviour [29]. Among national and international guidelines there is currently debate about this treatment option [17,30]. The rigorous reduction of the duration of hospitalization in 2004 corresponds to a general trend in our national public health system and should be understood as a result of better effectiveness of AAP.…”