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
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. 1. Introduction Antipsychotic drugs are currently used to treat psychotic symptoms in a wide array of psychopathological conditions. Despite the fact that international guidelines recommend prescribing antipsychotic polypharmacy only as the ultimate step [1, 2], antipsychotic polypharmacy is very common in clinical practice. A recent longitudinal perspective survey in Japanese health institutions has found that up to 20% patients suffering from schizophrenia had been exposed to antipsychotic polypharmacy during the 2-year time-window of the study [3]. In a large Italian population from acute inpatient facilities, antipsychotic polypharmacy was recorded in one third of the patients [4], irrespective of the diagnosis. Overall, variable but yet substantial rates of antipsychotic polypharmacy have been described, depending on the sample composition and setting [5–10]. However, factors predisposing to antipsychotic polypharmacy in general psychiatric population and its actual efficacy have been poorly studied to date. Moreover, little is known on the psychopathological determinants that induce
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