Antipsychotic Polypharmacy in Patients With Schizophrenia in a Brief Hospitalization Unit

Lerma-Carrillo, Iván; Brühlmann, Silvia de Pablo; Pozo, M. Leonor del; Pascual-Pinazo, Fernando; Molina, Juan D.; Baca‐García, Enrique

doi:10.1097/wnf.0b013e31815cba78

Cited by 23 publications

(14 citation statements)

References 74 publications

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“…Clinical practice guidelines strongly recommended antipsychotic monotherapy for the treatment of schizophrenia (Barnes 2011; Lerma-Carrillo et al 2008; National Institute for Health and Care Excellence (NICE) 2014). …”

Section: Introductionmentioning

confidence: 99%

Switching from oral atypical antipsychotic monotherapy to paliperidone palmitate once-monthly in non-acute patients with schizophrenia: A prospective, open-label, interventional study

et al. 2016

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RationaleLong-acting injectable antipsychotic therapies may offer benefits over oral antipsychotics in patients with schizophrenia.ObjectiveThis study aimed to explore the safety, tolerability, and treatment response of paliperidone palmitate once-monthly in non-acute but symptomatic adult patients switched from previously unsuccessful monotherapy with frequently used oral atypical antipsychotics.MethodsThis was a post hoc analysis of a prospective, interventional, single-arm, international, multicenter, open-label, 6-month study.ResultsThe patients (N = 472) were switched to paliperidone palmitate once-monthly (PP1M) from daily oral treatment with either aripiprazole (n = 46), olanzapine (n = 87), paliperidone extended-release (n = 104), quetiapine (n = 44), or risperidone (n = 191). In all groups, mean Positive and Negative Syndrome Scale total (p < 0.0001) and Clinical Global Impression-Severity scores improved significantly (p = 0.0004 to p < 0.0001). An improvement of ≥50 % in the Positive and Negative Syndrome Scale total score was observed in 21.7 % (aripiprazole), 29.9 % (olanzapine), 29.8 % (paliperidone extended-release), 27.3 % (quetiapine), and 37.2 % (risperidone) of patients. The patients showed significant improvements in the Personal and Social Performance score (aripiprazole p = 0.0409, all others p ≤ 0.0015); Mini International Classification of Functionality, Disability and Health Rating for Activity and Participation Disorders in Psychological Illnesses total scores (all p < 0.01); and Treatment Satisfaction Questionnaire for Medication Global Satisfaction score (olanzapine and risperidone p < 0.0001, quetiapine p = 0.0465, paliperidone extended-release p = 0.0571, aripiprazole p = NS). Paliperidone palmitate once-monthly was well tolerated, presenting no new safety signals.ConclusionsThese data illustrate that stable, non-acute but symptomatic patients on oral antipsychotic monotherapy may show clinically meaningful improvement of symptoms, functioning, and treatment satisfaction after direct transition to PP1M. The findings are limited by the naturalistic study design; thus, further studies are required to confirm the current findings.Electronic supplementary materialThe online version of this article (doi:10.1007/s00213-016-4445-0) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Switching from oral atypical antipsychotic monotherapy to paliperidone palmitate once-monthly in non-acute patients with schizophrenia: A prospective, open-label, interventional study

et al. 2016

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“…Similarly, European data on patients diagnosed with schizophrenia and being treated in acute psychiatric units reveal that antipsychotic polypharmacy is a common (if not the most common) strategy and that it is not reserved for the most treatment-resistant cases [20,21]. …”

Section: Introductionmentioning

confidence: 99%

Antipsychotic polypharmacy in a regional health service: a population-based study

et al. 2012

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BackgroundTo analyse the extent and profile of outpatient regular dispensation of antipsychotics, both in combination and monotherapy, in the Barcelona Health Region (Spain), focusing on the use of clozapine and long-acting injections (LAI).MethodsAntipsychotic drugs dispensed for people older than 18 and processed by the Catalan Health Service during 2007 were retrospectively reviewed. First and second generation antipsychotic drugs (FGA and SGA) from the Anatomical Therapeutic Chemical classification (ATC) code N05A (except lithium) were included. A patient selection algorithm was designed to identify prescriptions regularly dispensed. Variables included were age, gender, antipsychotic type, route of administration and number of packages dispensed.ResultsA total of 117,811 patients were given any antipsychotic, of whom 71,004 regularly received such drugs. Among the latter, 9,855 (13.9%) corresponded to an antipsychotic combination, 47,386 (66.7%) to monotherapy and 13,763 (19.4%) to unspecified combinations. Of the patients given antipsychotics in association, 58% were men. Olanzapine (37.1%) and oral risperidone (36.4%) were the most common dispensations. Analysis of the patients dispensed two antipsychotics (57.8%) revealed 198 different combinations, the most frequent being the association of FGA and SGA (62.0%). Clozapine was dispensed to 2.3% of patients. Of those who were receiving antipsychotics in combination, 6.6% were given clozapine, being clozapine plus amisulpride the most frequent association (22.8%). A total of 3.800 patients (5.4%) were given LAI antipsychotics, and 2.662 of these (70.1%) were in combination. Risperidone was the most widely used LAI.ConclusionsThe scant evidence available regarding the efficacy of combining different antipsychotics contrasts with the high number and variety of combinations prescribed to outpatients, as well as with the limited use of clozapine.

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“…In our study, dual-psychotic patients were prescribed 3.6 (SD = 1.1) medications. Furthermore, in a retrospective study, Lerma-Carrillo et al (2008) reviewed all the psychotropic drugs dispensed to 209 inpatients diagnosed with schizophrenia or schizoaffective disorder of a brief hospitalization psychiatric unit. In another study, Pandurangi and Dalkilic (2008) described in a meta-analysis that 5% to 39% of psychotic patients consumed 2 or more medications.…”

Section: Discussionmentioning

confidence: 99%

“…In 2007, Kreyenbuhl et al reported the amount of antipsychotic medications consumed by psychotic patients and they found that 12.8% of psychotic patients took 2 or more antipsychotics. They found that only 45.5% received monotherapy, and the most frequent number of antipsychotic medications prescribed was 2 (range: 1-9) (Lerma-Carrillo et al, 2008). Furthermore, in a retrospective study, Lerma-Carrillo et al (2008) reviewed all the psychotropic drugs dispensed to 209 inpatients diagnosed with schizophrenia or schizoaffective disorder of a brief hospitalization psychiatric unit.…”

Section: Discussionmentioning

confidence: 99%

Observational Study on Medications Prescribed to Dual-Diagnosis Outpatients

Grau-López

Roncero

Daigre

et al. 2014

Journal of Addiction Medicine

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Antipsychotic Polypharmacy in Patients With Schizophrenia in a Brief Hospitalization Unit

Cited by 23 publications

References 74 publications

Switching from oral atypical antipsychotic monotherapy to paliperidone palmitate once-monthly in non-acute patients with schizophrenia: A prospective, open-label, interventional study

Switching from oral atypical antipsychotic monotherapy to paliperidone palmitate once-monthly in non-acute patients with schizophrenia: A prospective, open-label, interventional study

Antipsychotic polypharmacy in a regional health service: a population-based study

Observational Study on Medications Prescribed to Dual-Diagnosis Outpatients

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