Efficacy and Clinical Determinants of Antipsychotic Polypharmacy in Psychotic Patients Experiencing an Acute Relapse and Admitted to Hospital Stay: Results from a Cross-Sectional and a Subsequent Longitudinal Pilot Study

Abstract

Background. Antipsychotic polypharmacy is used in several psychiatric disorders, despite poor evidence existing to support this practice. Aim. We evaluated whether psychotic patients in acute relapse exposed to antipsychotic polypharmacy (AP + AP) showed different demographic, clinical, or psychopathological features compared to those exposed to one antipsychotic (AP) and whether AP + AP patients showed significantly higher improvement compared to AP patients after a 4-week treatment. Methods. Inpatients were subdivided into AP + AP and AP ones. In the cross-sectional step, patients were compared according to demographics, clinical variables, and scores on rating scales. In the longitudinal step, patients remained for 4 weeks under admission medications and were compared for clinical improvement. Results. AP + AP patients were more frequently diagnosed with schizophrenia and mental retardation as a comorbid illness. AP + AP patients were more frequently under first-generation antipsychotics and had worse clinical presentation. After 4 weeks of treatment, both AP + AP and AP patients improved compared to the baseline. However, AP patients scored significantly less than AP + AP patients at the Clinical Global Impression Scale at the 4-week time point but not at the baseline, indicating a treatment-specific improvement. Conclusions. Antipsychotic polypharmacy may be offered to specific types of psychotic patients. However, efficacy of this strategy is limited at best.

Prevalence of and factors associated with antipsychotic polypharmacy in patients with serious mental illness: Findings from a cross-sectional study in an upper-middle-income country

“…Likewise, the associations of APP with male sex and greater number of hospital admissions could also be linked to greater illness severity, complexity, chronicity, and refractoriness in these patients, 25 as could the association with intellectual disability, given similar findings in previous studies and the suggestion that individuals suffering from intellectual disability may be poorly responsive to antipsychotic treatments. 33 While higher rates of APP in patients with diagnoses of schizophrenia and schizoaffective disorder were anticipated, it was of interest that APP was also observed in a fair number of patients with bipolar disorder and several patients with substance-induced disorders. Coprescription of sodium valproate showed a significant positive association with APP, occurring significantly more often in APP patients with diagnoses of schizophrenia and schizoaffective disorders.…”

“…Research on this association is lacking, with only a few previous studies examining APP in patients with comorbid substance use. 11,33,34 These studies have produced mixed results, showing both higher and lower APP prevalence in such patients. Reasons for conflicting findings remain unclear, but could result from differences in disclosure or methods of assessing substance use.…”

Unresolved Issues for Utilization of Atypical Antipsychotics in Schizophrenia: Antipsychotic Polypharmacy and Metabolic Syndrome

“…The fact that a high prevalence of polypharmacy is associated with patient young age, mania, and severe aggression, and that polypharmacy is more commonly used for inpatients or detained patients than for outpatients implies that polypharmacy is used to control acute violent behaviors or nervousness [ 9 ]. Among psychiatric inpatients, patients treated with antipsychotic polypharmacy were more frequently diagnosed with schizophrenia and mental retardation as a comorbid illness [ 10 ].…”

Treating the violent patient with psychosis or impulsivity utilizing antipsychotic polypharmacy and high-dose monotherapy

“…Also, although many studies have failed to show a benefit of antipsychotic polypharmacy over standard-dose monotherapy, more recent investigations do show some evidence for the benefit of combining antipsychotics 48 67 , 68 Notably, in line with our previous assertion that time may itself be like a drug, there is some evidence to suggest that treatment with antipsychotic polypharmacy must be continued for at least 10 weeks before a significant therapeutic effect is seen 35 67 Together, these data support the notion that a subpopulation of patients, likely including those who are treatment-resistant or violent, may require treatment measures such as antipsychotic polypharmacy 18 .…”