Polypharmacy with second-generation antipsychotics: a review of evidence.
ABSTRACT The objective of this study was to review the prevalence of polypharmacy with second-generation antipsychotics (SGAs) in clinical practice, pharmacological reasons for such practice, and the evidence for and against such polypharmacy.
Clinical trial reports, case reports, and reviews were identified by a PubMed literature search from 1966 through October 2006, with retrieved publications queried for additional references. We excluded reports on augmentation with non-antipsychotic medications and polypharmacy involving combinations of SGAs and first-generation (conventional) antipsychotics (FGAs) or combinations of two FGAs. We identified 75 reports concerning SGA polypharmacy, from which we extracted data on study design, sample size, medications, rating scales, outcome, and conclusions. Data from randomized controlled trials and larger case series are presented in detail and case reports are briefly discussed.
Polypharmacy with SGAs is not uncommon, with prevalence varying widely (3.9% to 50%) depending on setting and patient population, despite limited support from blinded, randomized, controlled trials or case reports that employed an A-B-A (monotherapy-combination therapy-monotherapy) design and adequate dosing and duration of treatment. Rather than prohibiting or discouraging co-prescription of SGAs, needs of patients and clinicians should be addressed through evidence-based algorithms. Based on unmet clinical needs and modest evidence from case reports, combinations of two SGAs may merit future investigation in efficacy trials involving patients with schizophrenia who have treatment-resistant illness (including partial response) or who are responsive to treatment but develop intolerable adverse effects. Other areas that may merit future research are efficacy of SGA polypharmacy for schizophrenia accompanied by comorbid conditions (eg, anxiety, suicidal or self-injurious behavior, aggression) and for reducing length of stay in acute care settings.
SourceAvailable from: Hasan Karadag
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ABSTRACT: To quantify the number of medications used for treating psychiatric and addictive disorders in a cohort of dual diagnosis with substance dependence outpatients and report the most frequent pharmacological groups used. A descriptive, cross-sectional study was conducted. Demographic data, Axis I comorbidity diagnosis with substance dependence, and the medications prescribed were recorded. Diagnosis was assessed by the Structured Clinical Interview for DSM-IV (SCID). One hundred seven patients (mean age 37.7 years; SD = 10.2 years) were evaluated (76.6% men). On average, patients took 4.0 (SD = 1.8) medications. The pharmacological groups prescribed were antipsychotics (69.2%) followed by antidepressants (65.4%), antiepileptics (58.9%), anxiolytics (37.4%), alcohol-aversive drugs (15.9%), methadone (15.9%), lithium (3.7%), and naltrexone (2.8%). Older patients (>45 years old) were found to have a higher number of prescribed medications. Patients diagnosed with a dual psychotic disorder were prescribed a larger number of pharmacological agents (mean = 4.4; SD = 2.1) than patients with a mood disorder (mean = 3.7; SD = 1.3) or an anxiety disorder (mean = 2.9; SD = 1.2), K = 10.5, P = 0.005. Because polypharmacy is frequent in patients with mental illness and a co-occurring substance use disorder, specialized approaches need to be developed.Journal of Addiction Medicine 02/2014; DOI:10.1097/ADM.0000000000000024 · 1.71 Impact Factor
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ABSTRACT: The goals and strategies of treatment in schizophrenia may vary according to the phase and severity of the illness. Antipsychotics remain the cornerstone in the acute phase treatment, in the long-term maintenance therapy and in the prevention of relapse of schizophrenia. This paper is intended to review the current practice in the management of the acute treatment of schizophrenia based on the recently published guidelines from the World Federation of Societies of Biological Psychiatry (WFSBP). Both first generation antipsychotics (FGAs) and second generation antipsychotics (SGAs) are effective in the acute treatment of schizophrenia and in relapse prevention. Clinicians must keep in mind that most patients are likely to require long-term, if not life-long, treatment which determines treatment strategy with an optimal balance between efficacy, side effects and compliance. In this regards, SGAs do have some advantages, but the risk of metabolic syndrome must be taken into account and carefully checked at regular intervals during the follow-up.Psychiatria Danubina 03/2014; 26(1):2-11. · 0.65 Impact Factor