title: Adding or switching antipsychotic medications in treatment-refractory schizophrenia.
abstract: OBJECTIVE
  This study compared patients with schizophrenia whose antipsychotic medications were switched to manage treatment-resistant positive psychotic symptoms with those for whom another antipsychotic was added. Psychiatrists' characteristics and perceptions of effectiveness of the medication change on clinical outcomes were also reported.
  
  
  METHODS
  Psychiatrists participating in a nationally representative mailed survey (N=209) reported on the clinical features, management, and response to the change in antipsychotic medication (added versus switched) of one adult patient with treatment-refractory schizophrenia under their care for at least one year.
  
  
  RESULTS
  Thirty-three percent of patients were treated with an added antipsychotic medication. Compared with patients whose antipsychotic medications were switched, those with an added antipsychotic medication were more likely to be female, to have received care from the same psychiatrist for more than two years, and to have been recently prescribed an antidepressant. Compared with psychiatrists who switched antipsychotic prescriptions, those who added an antipsychotic reported that the change was less likely to reduce positive symptoms, improve functioning, and prevent hospitalization. Psychiatrists who added rather than switched antipsychotics reported more frequent attendance at educational programs sponsored by a pharmaceutical company.
  
  
  CONCLUSIONS
  Consistent with other lines of research and practice guideline recommendations, psychiatrists perceive antipsychotic polypharmacy to be a generally ineffective strategy for treatment-resistant positive psychotic symptoms. In light of these findings, efforts to identify and implement more effective evidence-based pharmacologic approaches should be undertaken.
authors.affiliation: Department of Psychiatry, Division of Services Research, University of Maryland School of Medicine, Baltimore, MD 21201, USA. jkreyenb@psych.umaryland.edu
authors.forename: Julie
authors.initials: J
authors.lastname: Kreyenbuhl
authors.forename: Steven C
authors.initials: SC
authors.lastname: Marcus
authors.forename: Joyce C
authors.initials: JC
authors.lastname: West
authors.forename: Joshua
authors.initials: J
authors.lastname: Wilk
authors.forename: Mark
authors.initials: M
authors.lastname: Olfson
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D004358:Drug Therapy / Q000379:methods*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D011570:Psychiatry; D012559:Schizophrenia / Q000188:drug therapy*; D014481:United States
chemical_list: D014150:Antipsychotic Agents