Objective: To perform a retrospective survey of discharge medications at a tertiary care psychiatric
facility in an attempt to gain insight into, and perhaps an understanding of, the
most recent pattern of antipsychotic utilization in patients with a diagnosis not
restricted to schizophrenia.
Methods: This is a retrospective survey that used the Department of Pharmacy’s computer database
to obtain relevant discharge information on all non-geriatric patients discharged
from Riverview Hospital between 1 January and 31 December 2000. The records of 372
patients met the inclusion criteria and formed the database for the survey.
Results: The results of this survey revealed a relatively high prevalence of antipsychotic
polypharmacy (the use of two antipsychotics). Perhaps surprisingly, the highest rate
of antipsychotic polypharmacy was found in individuals diagnosed with schizoaffective
disorder (49.3 %), followed by schizophrenia (44.7 %), bipolar disorder (29.9 %),
and psychosis not otherwise specified (22.5 %).
Conclusion: Although antipsychotic polypharmacy is not a new phenomenon in schizophrenia, this
study is the first to document its employment among other diagnoses.
References
- 1
Bennett J L, Hamilton D L.
Sequential use of antidepressant drugs with chlorpromazine in chronic schizophrenia.
Psychiatr Quart.
1963;
37
53-65
- 2
Casey J F, Hollister L E, Klett J, Lasky J J, Caffey EM E M Jr.
Combined drug therapy of chronic schizophrenics.
Am J Psychiat.
1961;
117
997-1003
- 3
Clark A F, Holden N L.
The persistence of prescribing habits: a survey and follow-up of prescribing to chronic
hospital in-patients.
Br J Psychiat.
1987;
150
8-91
- 4
Cooper J E.
Schizophrenia and allied condition.
Med Int.
1991;
94
3917-3922
- 5
Davies L O, Drummond M.
The economic burden of schizophrenia.
Psychiatr Bull.
1990;
14
522-525
- 6
Diamond H, Tislow R, Snyder T Jr, Rickles K.
Peer review of prescribing patterns in a CHMC.
Am J Psychiat.
1976;
133
697-699
- 7
Edwards S, Kumar V.
A survey of prescribing of psychotropic drugs in a Birmingham psychiatric hospital.
Br J Psychiat.
1984;
145
502-507
- 8
Friedman J, Ault K, Powchik P.
Pimozide augmentation for the treatment of schizophrenic patients who are partial
responders to clozapine.
Biol Psychiat.
1997;
42
522-523
- 9
Hemminki E.
Polypharmacy among psychiatric patients.
Acta Psychiatric Scand.
1977;
56
347-356
- 10
Henderson D C, Goff D C.
Risperidone as an adjunct to clozapine therapy in chronic schizophrenics.
J Clin Psychiat.
1996;
57
395-397
- 11
Kennedy N B, Procyshyn R M.
Rational antipsychotic polypharmacy.
Can J Clin Pharmacol.
2000;
7
155-159
- 12
Ketter T A, Winsberg M E, DeGolia S G. et al .
Rapid efficacy of olanzapine augmentation in nonpsychotic bipolar mixed states.
J Clin Psychiat.
1998;
59
83-85
- 13 Leff J. Schizophrenia: etiology, prognosis and course. In: Jenkins R, Field V,
Young R, editor
The primary care of schizophrenia. London; HMSO Department of Health 1992
- 14
McElroy S L, Frye M, Denicoff K. et al .
Olanzapine in treatment-resistant bipolar disorder.
J Affect Disord.
1998;
49
119-122
- 15
Michel K, Kolakowska T.
A survey of prescribing psychotropic drugs in two psychiatric hospitals.
Br J Psychiat.
1981;
138
217-221
- 16
Muijen M, Siverstone T.
A. Comparative hospital survey of psychotropic drug prescribing.
Br J Psychiat.
1987;
50
510-514
- 17
Procyshyn R M, Kennedy N.
Theoretical basis for loxapine augmentation in risperidone partial responders.
Clin Drugs Invest.
2000;
9
257-266
- 18
Procyshyn R M, Kennedy N B, Tse G, Thompson B.
Antipsychotic polypharmacy: A survey of discharge prescriptions from a tertiary care
psychiatric institution.
Can J Psychiat.
2001;
46
334-339
- 19
Ravindran A V, Jones B W, Al-Zaid K, Lapierre Y D.
Effective treatment of mania with olanzapine: 2 case reports.
J Psychiat Neurosci.
1997;
22
345-346
- 20
Schmidt L G, Lammers V, Stockel M, Muller-Oerlinghausen B.
Recent trends in prescribing psychotropic drugs at a psychiatric university hospital
(1981 - 84).
Pharmacopsychiatry.
1988;
21
126-130
- 21
Schmidt L G, Niemeyer R, Muller-Oerlinghausen B.
Drug prescribing pattern of a psychiatric university hospital in germany.
Pharmacopsychiatry.
1983;
16
35-42
- 22
Sharma V, Pistor L.
Treatment of bipolar mixed sate with olanzapine.
J Psychiat Neurosci.
1999;
24
40-44
- 23
Sheppard C, Collins L, Fiorentino D, Fracchia J, Merlis S.
Polypharmacy in psychiatric treatment: incidence at a state hospital.
Curr Therapeut Res.
1969;
11
765-774
- 24
Shiloh R, Zemishlany D, Radwan A M. et al .
Sulpriride augmentation in people with schizophrenia partially responsive to clozapine.
Br J Psychiat.
1997;
171
569-573
- 25
Soutullo C A, Sorte M T, Foster K D, McElroy S L, Keck P E.
Olanzapine in the treatment of adolescent acute mania: A report of seven cases.
J Affect Disord.
1999;
53
279-283
- 26
Stahl S M.
Antipsychotic polypharmacy, Part I: therapeutic option or dirty little secret?.
J Clin Psychiat.
1999;
60
425-426
- 27
Talbot D R.
Are tranquilizer combinations more effective than a single tranquilizer?.
Am J Psychiat.
1967;
117
997-1000
- 28
Tohen M, Jacobs T G, Grundy S L. et al .
Efficacy of olanzapine in acute bipolar mani.
Arch Gen Psychiat.
2000;
577
841-849
- 29
Tohen M, Sanger T M, McElroy S L. et al .
Olanzapine versus placebo in the treatment of acute mania.
Am J Psychiat.
1999;
156
702-709
- 30
Viorol P, Rober P -A.
Meister P, Oros L, Baumann P. Psychotropic drug prescription in a psychiatric university
hospital.
Pharmacopsychiatry.
1999;
32
29-37
- 31
Weisler R H, Ahearn E P, Davidson J R, Wallace C D.
Adjunctive use of olanzapine in mood disorders: Five case reports.
Ann Clin Psychiat.
1997;
9
259-262
- 32
Working Group for the Canadian Psychiatric Association and the Canadian Alliance for
Research on S chizophrenia.
Canadian clinical practice guidelines for the treatment of schizophrenia.
Can J Psychiat.
1998;
43[Suppl 2 revised]
1S-39S
- 33
Yosselson-Superstine S, Sternik D, Liebenzon D.
Prescribing patterns in psychiatric hospitals in Israel.
Acta Psychiatric Scand.
1979;
60
477-482
- 34
Zullino D, Baumann P.
Olanzapine for mixed episodes of bipolar disorder.
J Psychopharmacol.
1999;
13
198
Dr. Ric M. Procyshyn
422 Henry Esson Young Building
500 Lougheed Highway
Riverview Hospital
Port Coquitlam, British Columbia
Canada
V3C 4J2
Phone: (604) 524-7384
Fax: (604) 524-7693
Email: rprocyshyn@bcmhs.bc.ca
