Use of combinations of antipsychotics: McLean Hospital inpatients, 2002.
BACKGROUND
The empirical use of combinations of antipsychotic agents appears to be increasing with little research support for the relative efficacy, safety or cost-effectiveness of this practice. Such treatment was evaluated in hospitalized psychiatric patients.


METHODS
Samples of consecutive inpatients treated with > or = 2 ('polytherapy') vs 1 antipsychotic ('monotherapy') were matched on age, sex, diagnosis and admission clinical ratings, and these groups were compared on total daily chlorpromazine-equivalent doses, days in hospital, and changes in clinical ratings between admission and discharge.


RESULTS
The study sample included 69 polytherapy and 115 well-matched monotherapy subjects. Despite matching for initial CGI and GAF ratings, polytherapy was associated with high PANSS subscale scores of positive symptoms among affective psychosis, and relatively greater PANSS subscale ratings of excitement-agitation among patients diagnosed with schizophrenia. Estimated clinical improvement during hospitalization was similar among poly- and monotherapy patients, but total daily CPZ-eq doses at discharge averaged twice-greater with polytherapy, and hospitalization lasted 1.5 times longer.


CONCLUSIONS
Antipsychotic polytherapy as well as the types of agents combined may reflect clinician responses to particular symptom patterns. The value of specific combinations of antipsychotic agents and their comparison with monotherapies requires specific, prospective, randomized and well-controlled trials that consider matching on clinical characteristics and truly comparable doses across regimens.
Centorrino
Franca
F
Department of Psychiatry and Neuroscience Program, Harvard Medical School, Boston, MA 02478-9106, USA.
Fogarty
Kate V
KV
Sani
Gabriele
G
Salvatore
Paola
P
Cincotta
Stephanie L
SL
Hennen
John
J
Guzzetta
Francesca
F
Talamo
Alessandra
A
Saadeh
Mark G
MG
Baldessarini
Ross J
RJ
D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D003627:Data Interpretation, Statistical; D016208:Databases, Factual; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D005260:Female; D006778:Hospitals, Psychiatric; D006801:Humans; D007297:Inpatients; D007902:Length of Stay; D008297:Male; D010351:Patient Discharge; D010607:Pharmacy Service, Hospital; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000191:economics; D016896:Treatment Outcome
D014150:Antipsychotic Agents; D004338:Drug Combinations