title: Prevalence and nature of antipsychotic polypharmacy among inpatients with schizophrenia spectrum disorders at an Australian mental health service.
abstract: OBJECTIVE
  Though antipsychotic polypharmacy (APP) is widely utilised in many clinical settings for the treatment of people with schizophrenia, the extent of this practice varies considerably between different regions, countries and clinical settings. Studies from Australasia exploring the prevalence and factors associated with APP are sparse and have yielded inconsistent results.
  
  
  METHODS
  We conducted a systematic retrospective audit of the medical records of all admissions in 2010 in the adult wards of a metropolitan public mental health service in Western Australia, having a diagnosis of schizophrenia or schizoaffective disorder. We analysed the rates of APP use, and its association with selected demographic and clinical variables.
  
  
  RESULTS
  The prevalence of APP among our sample of 229 patients was high, at 43.2%. APP was associated with a longer hospital stay (p=0.033) and voluntary admission (p=0.027); but APP was not significantly related to: age, gender, diagnosis and treatment by different psychiatrists.
  
  
  CONCLUSIONS
  Substantial difference exists between everyday clinical practice and recommendations of practice guidelines of schizophrenia, regarding the use of APP. Prospective studies from different settings exploring the relevant clinical, patient, prescriber and system-related issues are warranted, to comprehend the rationale behind high utilisation of APP in clinical practice.
authors.affiliation: Professor, School of Psychiatry and Clinical Neurosciences, University of Western Australia, Crawley, WA, and; Consultant Psychiatrist, John Milne Centre, Bentley Health Service, Bentley, WA, Australia alexander.john@uwa.edu.au.
authors.forename: Alexander P
authors.initials: AP
authors.lastname: John
authors.affiliation: Clinical Nurse Specialist, John Milne Centre, Bentley Health Service, Bentley, WA, Australia.
authors.forename: Trevor
authors.initials: T
authors.lastname: Gee
authors.affiliation: Resident Medical Officer, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.
authors.forename: Sweeka
authors.initials: S
authors.lastname: Alexander
authors.affiliation: Senior Information Analyst, Clinical Research Centre, Mental Health, North Metropolitan Health Service, Mount Claremont, WA, Australia.
authors.forename: Padmaja
authors.initials: P
authors.lastname: Ramankutty
authors.affiliation: Acting Director, Clinical Research Centre, Mental Health, North Metropolitan Health Service, Mount Claremont, WA and; School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, WA, Australia.
authors.forename: Milan
authors.initials: M
authors.lastname: Dragovic
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data; D010343:Patient Admission; D019338:Polypharmacy; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011618:Psychotic Disorders / Q000188:drug therapy*; D012189:Retrospective Studies; D012559:Schizophrenia / Q000188:drug therapy*; D014904:Western Australia / Q000453:epidemiology; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents
keywords: antipsychotic medication; combination therapy; polypharmacy; schizoaffective disorder; schizophrenia