Clearly, quality and continuity of care are enhanced with a trusting relationship with patients. Physicians need to speak up to bosses when our hiring organizations do not allow us enough patient time. We have empirical evidence that an entry in the electronic health record EHR does not ensure good clinical care. In fact, there is mounting evidence that too much physician time is spent inputting the EHR, actually, and this detracts from quality clinical care. Moreover, we seldom know if the patient can afford our prescribed medications.
Is she willing or able to return for a timely follow-up visit? Are there transportation issues to address?
Ten Drug Combinations That Show the Risks of Psychiatric Polypharmacy
Provision for home visits, etc.? These are essential details of person-centered care. When I was running the Community Mental Health Council, I worked with a psychiatrist who was fond of prescribing quetiapine, aripiprazole, ziprasidone, benzotropine, fluoxetine, mirtazapine, and citalopram, alprozalam, and sometimes a hypnotic as a sedative. I felt uncomfortable dictating to him how to prescribe meds so as to avoid polypharmacy; although a couple of times I was thinking about reporting his polypharmacy practices to the state licensing board, but he seemed to stay just inside the boundaries of reasonable care.
My experience is that many newly trained psychiatrists do not understand that prescribing meds to prevent the side effects of akathasia, dystonia, or akinesia probably can be stopped after a patient is on antipsychotics for a month or 2 or that anticholinergic meds halve the blood level of most antipsychotics, and I have inherited patients from other psychiatrists who have had these patients on anticholinergic medications for decades.
Skip to main content. Here are some of their responses: Empowering the patient Psychiatric polypharmacy described in the cited review article was very common in both the outpatient clinics and hospitals in which I worked. Lee H. Carl C.
Polypharmacy in Psychiatry
All this reflects the treatment strategies involved in the different university and non-university psychiatric hospitals, and means it can probably not be explained by clinical practice alone, but might have several reasons in the sense discussed above. In Austria the number of psychotropic medications per patient tends to be somewhat higher 5.
In an additional analysis it was demonstrated that, in particular, the increase above three medications is associated with a higher frequency of severe side effects and even death Grohmann oral communication. There are too many differences in terms of the availability of specific compounds in some countries and the way data were collected or analysed. This seems to go far beyond evidence-based indications for comedication and polypharmacy Frye et al. A few studies touched on the problems of pharmacokinetic interaction and increased number of side effects Daniel et al.
Comedication and even polypharmacy are meaningful and rational under certain conditions Preskorn and Lacey, Interestingly, in a recent survey it was found that high antipsychotic polypharmacy prescribers had more clinical experience and fewer concerns about the risks of polypharmacy Correll et al. Instead, a more differentiated understanding and approach is necessary. Comedication, and especially polypharmacy, should always be considered critically in terms of benefits and risks Barnes and Paton, , and strategies to reduce polypharmacy should be implemented Janssen et al.
In addition, health care costs should be taken into account. On the other hand, polypharmacy is one of the tools we have to offer to treatment-resistant and severely ill patients. From an educational perspective the condensed thoughts suggested by Preskorn and Lacey , seem meaningful:. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Sign In. Advanced Search. Article Navigation.
Close mobile search navigation Article Navigation. Volume Article Contents. History, background, concepts and current use of comedication and polypharmacy in psychiatry H. Address for correspondence: Professor H. Oxford Academic. Google Scholar. Article history.
Cite Citation. Permissions Icon Permissions. Abstract Based on a careful literature search a review is presented of the history, background, concepts and current use of comedication and polypharmacy in psychiatry. Comedictaion , concepts , frequency , pharmacopsychiatry , polypharmacy. Table 1. View Large. Table 2. Table 3. Table 4. Table 5.
View large Download slide. Table 6. Aripiprazole in combination with other antipsychotic drugs may worsen psychosis. Search ADS. Is monotherapy as good as polypharmacy in long-term treatment of bipolar disorder? Polypharmacy trends in office visits by the elderly in the United States, and Pharmacogenetics and pharmacogenomics of schizophrenia: a review of last decade of research.
The influence of concomitant antidepressant medication on safety, tolerability and clinical effectiveness of electroconvulsive therapy. General and comparative efficacy and effectiveness of antidepressants in the acute treatment of depressive disorders: a report by the WPA Section on Pharmacopsychiatry. Persistence with polypharmacy and excessive dosing in patients with schizophrenia treated in four European countries. World federation of societies of biological psychiatry WFSBP guidelines for biological treatment of unipolar depressive disorders in primary care.
Determinants of antipsychotic polypharmacy in psychiatric inpatients: a prospective study.
Combination of antidepressant medications from treatment initiation for major depressive disorder: a double-blind randomized study. Recent trends in antipsychotic combination therapy of schizophrenia and schizoaffective disorder: implications for state mental health policy. Antipsychotic polypharmacy: a survey study of prescriber attitudes, knowledge and behavior. Acceleration and augmentation of antidepressants with lithium for depressive disorders: two meta-analyses of randomized, placebo-controlled trials.
Coadministration of fluvoxamine increases serum concentrations of haloperidol.
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De Hert. Efficacy of antidepressants: a re-analysis and re-interpretation of the Kirsch data. Antipsychotic combination therapy in schizophrenia: a review of efficacy and risks of current combinations. The increasing use of polypharmacotherapy for refractory mood disorders: 22 years of study. Antipsychotic polypharmacy trends among Medicaid beneficiaries with schizophrenia in San Diego County, — Polypharmacy prevalence rates in the treatment of unipolar depression in an outpatient clinic.
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Clozapine alone vs. Polypharmacy and excessive dosing: psychiatrists' perceptions of antipsychotic drug prescription. Validation of polypharmacy process measures in inpatient schizophrenia care.
Half a century of antipsychotics and still a central role for dopamine D2 receptors. Longitudinal analysis of the suicidal behavior risk in placebo-controlled studies of mirtazapine in major depressive disorder. Agomelatine in the treatment of major depressive disorder: potential for clinical effectiveness. Building a better antipsychotic: receptor targets for the treatment of multiple symptom dimensions of schizophrenia. Initial severity and antidepressant benefits: a meta-analysis of data submitted to the food and drug administration.
Prevalence and patterns of concomitant use of selective serotonin reuptake inhibitors and other antidepressants in a high-cost polypharmacy cohort. Food and drug administration perspective on negative symptoms in schizophrenia as a target for a drug treatment claim.