title: Reducing polypharmacy through the introduction of a treatment algorithm: use of a treatment algorithm on the impact on polypharmacy.
abstract: BACKGROUND
  Polypharmacy is very common in the psychiatric setting despite the lack of evidence to justify its use. The objective of this study was to review the prescription patterns in a tertiary mental health institute in Asia and evaluate the impact of a treatment algorithm for patients with first-episode psychosis (FEP) on the use of polypharmacy.
  
  
  METHODS
  A treatment algorithm was implemented for patients accepted into an Early Psychosis Intervention Programme (EPIP) and the prescription patterns of these patients were compared with a comparator group (pre-EPIP) before the use of the algorithm. The prescribing pattern was established at 2 points: at baseline after the diagnosis was made, and 3 months later.
  
  
  RESULTS
  There were 68 subjects in the comparator group and 483 EPIP patients; the latter were on the average younger. None in the comparator group was diagnosed to have an affective psychosis. There was a significant reduction in the rate of antipsychotic polypharmacy, prolonged use of benzodiazepines and anticholinergic medication in EPIP patients. This group also had an increase in the use of second-generation antipsychotics and received lower doses of antipsychotics.
  
  
  CONCLUSIONS
  The implementation of a treatment algorithm coupled with audit has changed the trend towards polypharmacy among patients with FEP.
authors.affiliation: Department of Early Psychosis Intervention, Institute of Mental Health, Singapore. Siow_Ann_CHONG@imh.com.sg
authors.forename: Siow-Ann
authors.initials: SA
authors.lastname: Chong
authors.forename: Nigila
authors.initials: N
authors.lastname: Ravichandran
authors.forename: Lye-Yin
authors.initials: LY
authors.lastname: Poon
authors.forename: Kai-Ling
authors.initials: KL
authors.lastname: Soo
authors.forename: Swadna
authors.initials: S
authors.lastname: Verma
mesh_terms: D000328:Adult; D000465:Algorithms; D014150:Antipsychotic Agents / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D019338:Polypharmacy; D011618:Psychotic Disorders / Q000188:drug therapy*
chemical_list: D014150:Antipsychotic Agents