title: How psychotropic polypharmacy in schizophrenia begins: a longitudinal perspective.
abstract: BACKGROUND
  While patients with schizophrenia are often treated with psychotropic polypharmacy, how and when polypharmacy begins is not well documented.
  
  
  METHODS
  A systematic chart review of 300 patients, 100 of whom were psychotropic-free prior to their first visit, was conducted to examine 2-year longitudinal prescription patterns of concomitant psychotropics, in addition to a primary antipsychotic.
  
  
  RESULTS
  Overall polypharmacy occurred in 79% patients, with 2-year rates of the use of hypnotics, benzodiazepine derivative anxiolytics, anticholinergic drugs, antidepressants, and mood stabilizers were 56.7, 49.7, 38.3, 21.3, and 14.0%, respectively. Once polypharmacy had started, it was continued until their final visit in >70% of the patients. In a subgroup of 100 psychotropic-free patients, mood stabilizers, antidepressants, anticholinergic antiparkinsonian drugs, anxiolytics, and hypnotics were initiated after 2.3, 2.3, 2.1, 1.6, and 1.5 antipsychotics had been prescribed, respectively (mean duration before the introduction of a concomitant drug in days: 17.7, 121.6, 86.4, 32.1, and, 57.7, respectively).
  
  
  CONCLUSIONS
  Routine practice deviates significantly from algorithms--with polypharmacy often being initiated early, often a without trial of other options, and once started commonly stays.
authors.affiliation: Department of Neuropsychiatry, Keio University School of Medicine, and Department of Psychiatry, Komagino Hospital, Tokyo, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Shinfuku
authors.forename: H
authors.initials: H
authors.lastname: Uchida
authors.forename: C
authors.initials: C
authors.lastname: Tsutsumi
authors.forename: T
authors.initials: T
authors.lastname: Suzuki
authors.forename: K
authors.initials: K
authors.lastname: Watanabe
authors.forename: Y
authors.initials: Y
authors.lastname: Kimura
authors.forename: Y
authors.initials: Y
authors.lastname: Tsutsumi
authors.forename: K
authors.initials: K
authors.lastname: Ishii
authors.forename: Y
authors.initials: Y
authors.lastname: Imasaka
authors.forename: M
authors.initials: M
authors.lastname: Mimura
authors.forename: S
authors.initials: S
authors.lastname: Kapur
mesh_terms: D000328:Adult; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019338:Polypharmacy; D012189:Retrospective Studies; D012559:Schizophrenia / Q000188:drug therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D006993:Hypnotics and Sedatives