Effects of polypharmacy on outcome in patients with schizophrenia in routine psychiatric treatment.
OBJECTIVE
Evaluating the effects of different types of psychotropic polypharmacy on clinical outcomes and quality of life (QOL) in 374 patients with schizophrenia and schizoaffective disorder in routine care.


METHODS
Psychotropic regimen, clinical outcomes, and QOL were assessed before discharge and after 6, 12, 18, and 24 months. Data were analyzed by mixed-effects regression models for longitudinal data controlling for selection bias by means of propensity scores.


RESULTS
At baseline 22% of participants received antipsychotic monotherapy (APM) (quetiapine, olanzapine, or risperidone), 20% more than one antipsychotic drug, 16% received antipsychotics combined with antidepressants, 16% antipsychotics plus benzodiazepines, 11.5% had antipsychotics and mood stabilizers, and 16% psychotropic drugs from three or more subclasses. Patients receiving APM had better clinical characteristics and QOL at baseline. Patients receiving i) antipsychotics plus benzodiazepines or ii) antipsychotics plus drugs from at least two additional psychotropic drug categories improved less than patients with APM.


CONCLUSIONS
Combinations of antipsychotics with other psychotropic drugs seem to be effective in special indications. Nevertheless, combinations with benzodiazepines and with compounds from multiple drug classes should be critically reviewed. It is unclear whether poorer outcomes in patients with such treatment are its result or its cause.
Department of Psychiatry and Psychotherapy, Zentrum für Psychiatrie Südwürttemberg, Bad Schussenried, Germany. gerhard.laengle@zfp-zentrum.de
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Längle
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Steinert
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Weiser
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Schepp
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Jaeger
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Pfiffner
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Frasch
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Eschweiler
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Messer
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Croissant
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Becker
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Kilian
D000328:Adult; D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019338:Polypharmacy; D011618:Psychotic Disorders / Q000188:drug therapy*; D011788:Quality of Life; D012559:Schizophrenia / Q000188:drug therapy*; D016896:Treatment Outcome
D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D001569:Benzodiazepines