Key Concepts About Polypharmacy in Psychotic Disorders

August 3, 2020

Clinicians should keep in mind the risk-to-benefit ratio considerations before initiating polypharmacy, especially if they have patients with prescriptions inherited from several sources. Here: A summary of recommendations about the use of polypharmacy in psychotic disorders.

A summary of recommendations about the use of polypharmacy in psychotic disorders, by Jose M. Rubio, MD

Overall, evidence is lacking to support the use of antipsychotic polypharmacy for patients with insufficient treatment response in psychosis

-Clinicians should avoid starting a second antipsychotic-If treatment is initiated on a patient who is already on polypharmacy, they should discuss switching to monotherapy

-Confirm that previous antipsychotic monotherapy trials have been of sufficient dose and duration

-Use a clinician-friendly rating scale to monitor treatment response

These diagnostic criteria have yet to become official and codified. Formal diagnostic criteria for DRP is needed. Not only will this support clinicians in providing appropriate care, but such would assist in coding and documentation.

-Consider a diagnosis of treatment-resistant schizophrenia if 2 trials of sufficient time and duration have failed and discuss clozapine treatment

Take home points:

-Clinicians and patients should keep in mind the risk-to-benefit ratio considerations before initiating polypharmacy, especially if they have patients with polypharmacy prescriptions inherited from other providers.

-Special consideration should be given to the use of long-acting injectables and clozapine for patients with poor response to antipsychotics.

For more on this topic, see: Understanding the Risks and Benefits of Antipsychotic Polypharmacy, on which this slideshow is based.