Polypharmacy in patients with schizophrenia.
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 2000.


METHODS
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).


CONCLUSIONS
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 patient outcome.
McCue
Robert E
RE
Department of Psychiatry, Woodhull Medical & Mental Health Center, 760 Broadway, Brooklyn, NY 11206, USA. mccuer@nychhc.org
Waheed
Rubina
R
Urcuyo
Leonel
L
D000328:Adult; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D004363:Drug Utilization / Q000639:trends; D005260:Female; D006769:Hospitals, General / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D009519:New York City; D010351:Patient Discharge / Q000639:trends; D011567:Psychiatric Department, Hospital / Q000706:statistics & numerical data; D011619:Psychotropic Drugs / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D012559:Schizophrenia / Q000175:diagnosis / Q000188:drug therapy*; D012565:Schizophrenic Psychology
D011619:Psychotropic Drugs