Polypharmacy in Patients With Schizophrenia
J Clin Psychiatry 2003;64:984-989
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Polypharmacy in patients with
schizophrenia is a common practice with little basis in
well-controlled studies. The objective of this report is to
describe the changes in prescription practices with psychotropic
medications for patients diagnosed with schizophrenia in 1995 and
Method: The medical records of patients who were
discharged from our facility in 1995 and 2000 with the diagnosis
of schizophrenia (DSM-IV criteria) were reviewed. The
psychotropic medications at discharge were compared. The
incidence of adverse drug reactions and indicators of patient
outcome were also compared.
Results: 459 records were reviewed for 1995 and
584 were reviewed for 2000. Patients discharged in 2000 were
significantly more likely to receive antidepressants, mood
stabilizers, anxiolytics, and multiple antipsychotics than
patients discharged in 1995 (p < .0001). Patients discharged
in 2000 were given significantly fewer anticholinergics (p <
.0001). There was a large increase in the use of divalproex. No
patients were discharged on treatment with more than 1
antipsychotic in 1995, whereas in 2000, 15.9% of patients were.
The most common antipsychotic combination was haloperidol and
olanzapine. Paralleling the increased use of polypharmacy, there
were significantly fewer adverse drug reactions in 2000 than in
1995 (p = .002). In addition, patients with schizophrenia who
were discharged in 2000 had significantly shorter lengths of stay
(p < .0001) and were significantly more likely to be
discharged to the community than to a state hospital (p = .0001).
Conclusion: This study found that acutely ill
hospitalized patients with schizophrenia are being treated with
more psychotropic medications, including more than 1
antipsychotic. These changes are coincidental with a decrease in
adverse drug reactions and an improvement in indicators of