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Procyshyn RM, Kennedy NB, Tse G, et al. Antipsychotic polypharmacy: a survey of discharge prescriptions from a tertiary care psychiatric institution

Division of Medical Services, 422 Henry Esson Young Building, Riverview Hospital, 500 Lougheed Highway, Port Coquitlam, BC V3C 4J2.
Canadian journal of psychiatry. Revue canadienne de psychiatrie (Impact Factor: 2.41). 06/2001; 46(4):334-9.
Source: PubMed

ABSTRACT To perform a retrospective survey of discharge medications at a tertiary care psychiatric facility and to assess the incidence of antipsychotic polypharmacy.
This is a retrospective survey that used the Department of Pharmacy's computer database to obtain relevant discharge information on all nongeriatric patients with schizophrenia discharged from Riverview Hospital between November 1, 1996 and October 31, 1998. From a total of 492 eligible patients, 229 met the inclusion criteria and formed the database for the survey.
The main finding of the survey was that 27.5% of our discharged patients diagnosed with schizophrenia left our facility on an antipsychotic polypharmacy regimen. Compared with patients discharged on a single antipsychotic, the pooled data revealed a significantly greater use of anticholinergic agents in those patients prescribed an antipsychotic polypharmacy regimen. Further, of the atypical agents, only risperidone showed a statistically significant reduction in dosage when coprescribed with a second antipsychotic.
Although antipsychotic polypharmacy persists today, as it has over the past 30 years, evidence-based data to support this controversial treatment strategy is lacking. As a result clinicians are relying on their clinical experience, and perhaps intuition, to design antipsychotic polypharmacy treatment protocols. Efforts should be made to replace subjective clinical impression with a more rational approach to antipsychotic polypharmacy--one that is based on pharmacodynamic and pharmacokinetic understanding of drug action.

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    • "This PD imposes great cost burden on the individual and society. The prevalence of antipsychotic polypharmacy has been reported to be between 13 and 70%.[49101112] Despite advantages or disadvantages of antipsychotic polypharmacy, it increases treatment costs at a time of increasing budget constraints.[4121314151617] "
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    ABSTRACT: Antipsychotic monotherapy or polypharmacy (concurrent use of two or more antipsychotics) are used for treating patients with psychiatric disorders (PDs). Usually, antipsychotic monotherapy has a lower cost than polypharmacy. This study aimed to predict the cost of antipsychotic medications (AM) of psychiatric patients in Iran. For this purpose, 790 patients with PDs who were discharged between June and September 2010 were selected from Razi Psychiatric Hospital, Tehran, Iran. For cost prediction of AM of PD, neural network (NN) and multiple linear regression (MLR) models were used. Analysis of data was performed with R 2.15.1 software. Mean ± standard deviation (SD) of the duration of hospitalization (days) in patients who were on monotherapy and polypharmacy was 31.19 ± 15.55 and 36.69 ± 15.93, respectively (P < 0.001). Mean and median costs of medication for monotherapy (n = 507) were $8.25 and $6.23 and for polypharmacy (n =192) were $13.30 and $9.48, respectively (P = 0.001). The important variables for cost prediction of AM were duration of hospitalization, type of treatment, and type of psychiatric ward in the MLR model, and duration of hospitalization, type of diagnosed disorder, type of treatment, age, Chlorpromazine dosage, and duration of disorder in the NN model. Our findings showed that the artificial NN (ANN) model can be used as a flexible model for cost prediction of AM.
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    • "A study in South Africa reported a prevalence of 28.6% of antipsychotic polypharmacy while a study in Nigeria reported a prevalence of 92% of antipsychotic combination [15,16]. Studies in USA and Canada reported prevalence of antipsychotic combination similar to that in South Africa (27.5% and 25.7% respectively) [17,18]. Reports in Asia also showed low (< 31%) prevalence of antipsychotic combination [19,20]. "
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    BMC Psychiatry 07/2013; 13(1):179. DOI:10.1186/1471-244X-13-179 · 2.24 Impact Factor
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    • "Moreover, the fact that cross-sectional studies and those with shorter follow-up tended to have higher APP rates, suggests that at least some of the APP was either part of cross-titration or transient. The higher use of anticholinergics, found in multiple studies of APP (Chakos et al., 2006; Florez Menendez et al., 2004; Ganguly et al., 2004; Hong and Bishop, 2010; Kreyenbuhl et al., 2007b; Procyshyn et al., 2001; Sim et al., 2004), indicates that clinicians run the risk of inducing clinically relevant EPS in patients treated with APP. The association of peripherally measured anticholinergic medication load with impaired learning during cognitive remediation (Vinogradov et al., 2009) calls into question the benefits of treating patients with APP above the EPS threshold, followed by anticholinergic use. "
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    Schizophrenia Research 04/2012; 138(1):18-28. DOI:10.1016/j.schres.2012.03.018 · 4.43 Impact Factor
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