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Pharmacopsychiatry 2012; 45(04): 133-137
DOI: 10.1055/s-0031-1297934
Original Paper
© Georg Thieme Verlag KG Stuttgart · New York

How Psychotropic Polypharmacy in Schizophrenia Begins: A Longitudinal Perspective

M. Shinfuku
1   Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
2   Department of Psychiatry, Asaka Hospital, Fukushima, Japan
,
H. Uchida
1   Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
3   Geriatric Mental Health Program, Centre for Addiction and Mental Health,Toronto, Canada
4   Department of Psychiatry, Asakadai Mental Clinic, Saitama, Japan
,
C. Tsutsumi
1   Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
5   Department of Psychiatry, Komagino Hospital,Tokyo, Japan
,
T. Suzuki
1   Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
,
K. Watanabe
1   Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
6   Department of Psychiatry, Ohizumi Hospital, Tokyo, Japan
,
Y. Kimura
4   Department of Psychiatry, Asakadai Mental Clinic, Saitama, Japan
6   Department of Psychiatry, Ohizumi Hospital, Tokyo, Japan
,
Y. Tsutsumi
7   Department of Psychiatry, Ongata Hospital, Tokyo, Japan
,
K. Ishii
6   Department of Psychiatry, Ohizumi Hospital, Tokyo, Japan
,
Y. Imasaka
6   Department of Psychiatry, Ohizumi Hospital, Tokyo, Japan
8   Department of Psychiatry, Ohizumi Mental Clinic, Tokyo, Japan
,
M. Mimura
1   Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
,
S. Kapur
9   Institute of Psychiatry, King’s College, London, United Kingdom
› Author Affiliations
Further Information

Publication History

received 23 July 2011
revised 06 September 2011

accepted 16 October 2011

Publication Date:
15 December 2011 (online)

Also available at
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Abstract

Introduction:

While patients with schizophrenia are often treated with psychotropic polyphar­macy, how and when polypharmacy begins is not well documented.

Methods:

A systematic chart review of 300 patients, 100 of whom were psychotropic-free prior to their first visit, was conducted to examine 2-year longitudinal prescription patterns of concomitant psychotropics, in addition to a primary antipsychotic.

Results:

Overall polypharmacy occurred in 79% patients, with 2-year rates of the use of hypnotics, benzodiazepine derivative anxiolytics, anticholinergic drugs, antidepressants, and mood stabilizers were 56.7, 49.7, 38.3, 21.3, and 14.0%, respectively. Once polypharmacy had started, it was continued until their final visit in >70% of the patients. In a subgroup of 100 psychotropic-free patients, mood stabilizers, antidepressants, anticholinergic antiparkinsonian drugs, anxiolytics, and hypnotics were initiated after 2.3, 2.3, 2.1, 1.6, and 1.5 antipsychotics had been prescribed, respectively (mean duration before the introduction of a concomitant drug in days: 17.7, 121.6, 86.4, 32.1, and, 57.7, respectively).

Conclusion:

Routine practice deviates significantly from algorithms – with polypharmacy often being initiated early, often a without trial of other options, and once started commonly stays.

Key words

concomitant drugs - polypharmacy - psychotropics - schizophrenia
 

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