Antipsychotic polypharmacy: A survey study of prescriber attitudes, knowledge and behavior
Section snippets
Setting and procedures
All inpatient and outpatient prescribers at the Zucker Hillside Hospital were contacted to participate in this study. This included psychiatrists, nurse practitioners, and third- and fourth-year psychiatry residents. Prescribers were interviewed between December 2006 and April 2007, using a newly developed, semi-structured questionnaire, the Prescriber's Reasons for Antipsychotic Combination Treatment Questionnaire (PRACT-Q, available upon request from the first author). Prescribers unable to
Prescriber demographics
Forty-four prescribers (22 attending and 22 resident/fellow level clinicians) of 59 eligible clinicians (74.6%) participated in this study. Prescriber characteristics are summarized in Table 1.
Antipsychotic polypharmacy prescribing
Among patients treated with antipsychotics, practitioners estimated that 17.0 ± 10.0% of patients were receiving antipsychotic polypharmacy (Table 1). Atypical antipsychotic combinations predominated 63.5 ± 35.0%. Although clinicians estimated to have self-initiated antipsychotic polypharmacy in only 23.3 ±
Discussion
This study found that most prescribers provided appropriate justifications for antipsychotic polypharmacy, and that 75% of their cases of polypharmacy had been inherited. Furthermore, clinicians were reluctant to reduce the number of antipsychotics in more than 40% of cases, although they reported this was successful in 28% of cases. Similarly, a prior co-treatment with antipsychotic polytherapy was reported being a strong predictor of future polypharmacy (Biancosino et al., 2005).
Although no
Role of funding source
Funding for this study was supported in part by The Zucker Hillside Hospital Mental Advanced Center for Intervention and Services Research for the Study of Schizophrenia (MH090590) from the National Institute of Mental Health, Bethesda, Md. The NIMH had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.
Contributors
Dr. Correll designed and managed the study, designed the prescriber questionnaire, and conducted literature searches and statistical analyses. Dr. Shaikh, Nachbar and Olshanskiy conducted the prescriber interviews and entered the data. Dr. Correll wrote the first draft of the manuscript and Dr. Gallego, Dr. Kishimoto and Dr. Kane helped reviewed the content of the manuscript. All authors contributed to and have approved the final manuscript.
Conflict of interest
Dr. Correll has been a consultant and/or advisor to or has received honoraria from: Actelion, AstraZeneca, Boehringer-Ingelheim, Bristol-Myers Squibb, Cephalon, Eli Lilly, GSK, Hoffmann-La Roche, IntraCellular Therapies, Lundbeck, Medicure, Merck, Ortho-McNeill/Janssen/J&J, Otsuka, Pfizer, Schering-Plough, and Sepracor/Sunovion, Takeda and Vanda. He has sat on the Data Safety Monitoring Board for Supernus and has received grant support from the Feinstein Institute for Medical Research, the
Acknowledgments
Supported in part by The Zucker Hillside Hospital Mental Advanced Center for Intervention and Services Research for the Study of Schizophrenia (MH090590) from the National Institute of Mental Health, Bethesda, Md.
References (36)
- et al.
Does antipsychotic polypharmacy increase the risk for metabolic syndrome?
Schizophr. Res.
(2007) - et al.
Exploring regional variation in antipsychotic coprescribing practice: a danish questionnaire survey
J. Clin. Psychiatry
(2010) - et al.
Does the Addition of a Second Antipsychotic Drug Improve Clozapine Treatment?
Schizophr. Bull.
(2009) - et al.
Determinants of antipsychotic polypharmacy in psychiatric inpatients: a prospective study
Int. Clin. Psychopharmacol.
(2005) - et al.
Multiple versus single antipsychotic agents for hospitalized psychiatric patients: case-control study of risks versus benefits
Am. J. Psychiatry
(2004) - et al.
Aripiprazole augmentation in clozapine-treated patients with refractory schizophrenia: an 8-week, randomized, double-blind, placebo-controlled trial
J. Clin. Psychiatry
(2008) Antipsychotic polypharmacy, part 1: Shotgun approach or targeted cotreatment?
J. Clin. Psychiatry
(2008)- et al.
Antipsychotic Combinations vs Monotherapy in Schizophrenia: A Meta-analysis of Randomized Controlled Trials
Schizophr. Bull.
(2009) - et al.
Antipsychotic monotherapy and polypharmacy in the naturalistic treatment of schizophrenia with atypical antipsychotics
BMC Psychiatry
(2005) - et al.
Effects of adjunctive treatment with aripiprazole on body weight and clinical efficacy in schizophrenia patients treated with clozapine: a randomized, double-blind, placebo-controlled trial
Int. J. Neuropsychopharmacol.
(2010)
Prevalence, trends, and factors associated with antipsychotic polypharmacy among Medicaid-eligible schizophrenia patients, 1998–2000
J. Clin. Psychiatry
Antipsychotic polypharmacy trends among Medicaid beneficiaries with schizophrenia in San Diego County, 1999–2004
Psychiatr. Serv.
Polypharmacy and excessive dosing: psychiatrists' perceptions of antipsychotic drug prescription
Br. J. Psychiatry
Antipsychotic medication coprescribing in a large state hospital system
Pharmacoepidemiol. Drug Saf.
Schizophrenia, neuroleptic medication and mortality
Br. J. Psychiatry
Past and present progress in the pharmacologic treatment of schizophrenia
J. Clin. Psychiatry
Treatment with antipsychotics and the risk of diabetes in clinical practice
Br. J. Psychiatry
Polypharmacy in patients with schizophrenia
J. Clin. Psychiatry
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