Eastern Journal of Psychiatry

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VOLUME 13 , ISSUE 1-2 ( February-August, 2010 ) > List of Articles

REVIEW ARTICLE

Polypharmacy in Clinical Psychiatry - A Brief Review

Gurvinder Pal Singh

Keywords : Polypharmacy, psychiatry, clinical practice

Citation Information : Singh GP. Polypharmacy in Clinical Psychiatry - A Brief Review. 2010; 13 (1-2):72-76.

DOI: 10.5005/EJP-13-1--2-72

License: CC BY-NC 4.0

Published Online: 13-10-2021

Copyright Statement:  Copyright © 2010; The Author(s).


Abstract

Psychiatrists in clinical practice choose polypharmacy as a therapeutic strategy to control the symptoms. Polypharmacy is much more common than would be expected in contrast to the available treatment guidelines. Higher rates of relapse in patients receiving monotherapy have been documented. Polypharmacy in general clinical practice may be employed with some justification. Unwanted use of these practices may be avoided for better patient care. Limited knowledge and the wide spread marketing has led to widespread acceptance of polypharmacy practices. Some remedial measures are needed in reducing this practice of polypharmacy in our country. In this article an attempt has been made to highlight this important clinical problem for awareness of mental health professionals.


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  1. Ghaemi N, editor. Polypharmacy in psychiatry. New York: Marcel Dekker Inc., 2002.
  2. Berube MS, Neely DJ, DeVinne, PB. American Heritage Dictionary. 2. Boston: Houghton Mifflin Co; 1982.
  3. Sheppard C, Collins L, Fiorentino D, Fracchia J, Merlis S. Polypharmacy in psychiatric treatment. I. Incidence at a state hospital. Curr Ther Res Clin Exp. 1969;12:765–7.
  4. Harris, CM, Heywood, PL, Clayden, AD. The Analysis of Prescribing in General Practice: A Guide to Audit and Research. HSMO: London; 1990.
  5. Stahl SM. Antipsychotic polypharmacy: evidence based or eminence based? Acta Psychiatr Scand. 2002;106:321–322.
  6. Ito H, Koyama A and Higuchi T. Polypharmacy and excessive dosing: psychiatrists’ perceptions of antipsychotic drug prescription British Journal of Psychiatry 2005 187: 243-47.
  7. Adli M, Whybrow PC, Grof P, Rasgon N, Gyulai L, Baethge C, Glenn T, Bauer M. Use of polypharmacy and self reported mood in outpatients with bipolar disorder. Int Journal Of Psychiatry in clinical practice 2005, 9: 251-256.
  8. Sachs GS, Thase ME. Bipolar disorder therapeutics: maintenance treatment. Biol Psychiatry 2000, 48:573-81.
  9. Cuevas C, Sanz EJ, de la Fuente JA, Cueto M. Polypharmacy in psychiatric patients as an alternative to limited mental health resources. Actas Esp Psiquiatr 2005, 33:81-6.
  10. Sernyak MJ, Rosenheck R: Clinicians’ reasons for antipsychotic coprescribing. Journal of Clinical Psychiatry 2004, 65:1597–1600.
  11. Lerma-Carrilo I, Leonor del Pozo M, Pascual-Pinazo F, et al. Polypharmacy and prescribing pattern s in patients with schizophrenia in an acute unit in Spain. Schizophr Bull 2007; 33:475.
  12. Ungvari GS, Pang AH, Chiu HF, et al. Psychotropic drug prescription in rehabilitation. A survey in Hong Kong. Soc Psychiatry Psychiatr Epidemiol 1996, 31:288-291.
  13. Procyshyn RM, Kennedy NB, Tse G. et al. Antipsychotic polypharmacy: a survey of discharge prescription from a tertiary care psychiatry institution. Canadian Journal of Psychiatry 2001, 46:334-339
  14. Johnson DAW, Wright NF. Drug prescribing for schizophrenic outpatient on depot injections. British Journal of Psychiatry 1990, 156:827-834.
  15. Kane JM. The current status of neuroleptic therapy. J Clin Psychiatry. 1989; 50:322-328.
  16. Anil Yagcioglu AE, Kivircik Akdede BB, Turgut TI, et al. A double-blind controlled study of adjunctive treatment with risperidone in schizophrenic patients partially responsive to clozapine: efficacy and safety. Journal of Clinical Psychiatry 2005, 66:63–72.
  17. Small J, Klapper M, Milstein V, Kellams J, Miller M, Marhenke J, Small I. Carbamazepine compared with lithium in the treatment of mania. Arch Gen Psychiatry 1991; 48:915–921.
  18. Emrich HM, Zerssen DV, Kissling W, Moller HJ, Windorfer A: Effect of sodium valproate on mania: the GABA hypothesis of affective disorders. Arch Psychiatr Nervenkr 1980; 229:1–16.
  19. Pope H, McElroy S, Keck P, Hudson J. Valproate in the treatment of acute mania. Arch Gen Psychiatry 1991, 48:62–68.
  20. Freeman TW, Clothier JL, Pazzaglia P, Lesem MD, Swann AC. A double-blind comparison of valproate and lithium in the treatment of acute mania. Am J Psychiatry 1992; 149:108–111.
  21. Burgess S, Geddes J, Hawton K, Townsend E, Jamison K, Goodwin G: Lithium for maintenance treatment of mood disorders. Cochrane Database Syst Rev 2001; 3:CD003013.
  22. Price LH, Charney DS, Heninger GR. Variability of response to lithium augmentation in refractory depression. Am Journal of Psychiatry 1986, 143:1387-1392.
  23. Prange AJ, Loosen PT, Wilson IC, Lipton MA. The therapeutic use of hormones of the thyroid axis in depression, in the Neurobiology of mood disorders. Edited by Post R, Ballenger J. Baltimore, William and Wilkins 1984: 311-312.
  24. Goldberg JF, Garno JL, Leon AC, et al. A history of substance abuse complicates remission from acute mania in bipolar disorder. J Clin Psychiatry, 1999, 60:733-740.
  25. Freeman MP, Freeman SA, McElroy SL. The comorbidity of bipolar and anxiety disorders: prevalence, psychobiology, and treatment issues. J Affect Disord 2002, 68:1-23.
  26. Waddington JL, Youssef HA and Kinsella A. Mortality in schizophrenia. Antipsychotic polypharmacy and absence of adjunctive anticholinergics over the course of a 10-year prospective study. British Journal of Psychiatry 1998, 173:325–329.
  27. Reilly JG, Avis SA, Ferrier IN et al. QTc-interval abnormalities and psychotropic drug therapy in psychiatric patients. Lancet 2000, 355:1048-1052.
  28. Lelliott P, Paton C, Harrington M. Influence of patient variables on polypharmacy and high dose of antipsychotic drugs prescribed in patients. Psychiatric Bulletin 2002, 26:411–414.
  29. Patrick V, Schleifer JS, Nurenberg JR, Gill KJ, Best Practices: An Initiative to Curtail the Use of Antipsychotic Polypharmacy in a State Psychiatric Hospital. Psychiatr Serv 2006, 57:21–23.
  30. Taylor D, Mir S, Mace S, et al. Coprescribing of atypical and typical antipsychotics-prescribing sequence and documented outcome. Psychiatric Bulletin 2002, 26:170-172.
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